Schranz Asher J, Brady Kathleen A, Momplaisir Florence, Metlay Joshua P, Stephens Alisa, Yehia Baligh R
1 Department of Medicine, New York University School of Medicine , New York, New York.
AIDS Patient Care STDS. 2015 Mar;29(3):117-25. doi: 10.1089/apc.2014.0199. Epub 2015 Feb 9.
Outpatient care for people living with HIV is delivered in diverse settings. Differences in setting may impact HIV outcomes. We evaluated HIV-infected adults in care at Ryan White-funded clinics in Philadelphia, PA, between 2008 and 2011 to determine how setting of care (hospital versus community-based) influenced HIV outcomes. Clinics were categorized as hospital-based if they were located onsite at a hospital. The composite outcome was completion of the final three steps of the HIV care continuum: (1) retention in care; (2) use of antiretroviral therapy (ART); and (3) viral suppression. Mixed-effects logistic regression, accounting for patient and clinic factors, examined the relationship between care setting and the outcome. In total, 12,637 patients, contributing 32,515 patient-years, received care at 25 clinics (12 hospital-based). Women, non-Hispanic blacks, those with private insurance, and individuals with higher household incomes more commonly attended hospital-based clinics (p<0.05). Of the 12,962 patient-years (40%) during which patients attended community-based clinics, 59% met the outcome. Similarly, 59% of the 19,553 patient-years (60%) in which patients attended hospital-based clinics met the outcome. Adjusting for patient and clinic factors, setting was not associated with the outcome (adjusted odds ratio=1.24, 95% CI=0.84-1.84). In summary, demographics differ among patients visiting hospital and community-based clinics. Completion of the final three steps of the HIV care continuum did not vary between hospital and community-based clinics, which may reflect advances in HIV therapy and the wide availability of HIV care resources.
为感染艾滋病毒的人提供的门诊护理在不同环境中进行。环境差异可能会影响艾滋病毒治疗结果。我们评估了2008年至2011年期间在宾夕法尼亚州费城由瑞安·怀特基金资助的诊所接受治疗的成年艾滋病毒感染者，以确定护理环境（医院与社区诊所）如何影响艾滋病毒治疗结果。如果诊所位于医院内，则被归类为医院型诊所。综合结果是完成艾滋病毒护理连续统一体的最后三个步骤：（1）持续接受护理；（2）使用抗逆转录病毒疗法（ART）；（3）病毒抑制。采用混合效应逻辑回归分析，考虑患者和诊所因素，研究护理环境与结果之间的关系。共有12637名患者在25家诊所（12家医院型诊所）接受治疗，贡献了32515个患者年。女性、非西班牙裔黑人、有私人保险的人以及家庭收入较高的人更常去医院型诊所就诊（p<0.05）。在患者前往社区诊所就诊的12962个患者年（40%）中，59%达到了该结果。同样，在患者前往医院型诊所就诊的19553个患者年（60%）中，59%达到了该结果。在调整患者和诊所因素后，护理环境与结果无关（调整后的优势比=1.24，95%置信区间=0.84-1.84）。总之，前往医院型诊所和社区诊所就诊的患者在人口统计学特征上存在差异。艾滋病毒护理连续统一体最后三个步骤的完成情况在医院型诊所和社区诊所之间没有差异，这可能反映了艾滋病毒治疗的进展以及艾滋病毒护理资源的广泛可及性。
