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在美国接受医疗护理的具有全国代表性的HIV感染成年人群体中,延迟进入HIV医疗护理体系的情况。

Delayed entry into HIV medical care in a nationally representative sample of HIV-infected adults receiving medical care in the USA.

作者信息

Robertson McKaylee, Wei Stanley C, Beer Linda, Adedinsewo Demilade, Stockwell Sandra, Dombrowski Julia C, Johnson Christopher, Skarbinski Jacek

机构信息

a Oak Ridge Institute for Science and Education , Oak Ridge , TN , USA.

b Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA.

出版信息

AIDS Care. 2016;28(3):325-33. doi: 10.1080/09540121.2015.1096891. Epub 2015 Oct 23.


DOI:10.1080/09540121.2015.1096891
PMID:26493721
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10929962/
Abstract

Before widespread antiretroviral therapy (ART), an estimated 17% of people delayed HIV care. We report national estimates of the prevalence and factors associated with delayed care entry in the contemporary ART era. We used Medical Monitoring Project data collected from June 2009 through May 2011 for 1425 persons diagnosed with HIV from May 2004 to April 2009 who initiated care within 12 months. We defined delayed care as entry >three months from diagnosis. Adjusted prevalence ratios (aPRs) were calculated to identify risk factors associated with delayed care. In this nationally representative sample of HIV-infected adults receiving medical care, 7.0% (95% confidence interval [CI]: 5.3-8.8) delayed care after diagnosis. Black race was associated with a lower likelihood of delay than white race (aPR 0.38). Men who have sex with women versus women who have sex with men (aPR 1.86) and persons required to take an HIV test versus recommended by a provider (aPR 2.52) were more likely to delay. Among those who delayed 48% reported a personal factor as the primary reason. Among persons initially diagnosed with HIV (non-AIDS), those who delayed care were twice as likely (aPR 2.08) to develop AIDS as of May 2011. Compared to the pre-ART era, there was a nearly 60% reduction in delayed care entry. Although relatively few HIV patients delayed care entry, certain groups may have an increased risk. Focus on linkage to care among persons who are required to take an HIV test may further reduce delayed care entry.

摘要

在广泛采用抗逆转录病毒疗法(ART)之前,估计有17%的人延迟接受艾滋病毒治疗。我们报告了当代ART时代延迟接受治疗的患病率及相关因素的全国估计情况。我们使用了2009年6月至2011年5月收集的医疗监测项目数据,这些数据来自2004年5月至2009年4月被诊断出感染艾滋病毒且在12个月内开始接受治疗的1425人。我们将延迟治疗定义为从诊断之日起超过三个月才开始接受治疗。计算调整后的患病率比(aPRs)以确定与延迟治疗相关的风险因素。在这个具有全国代表性的接受医疗护理的艾滋病毒感染成年人样本中,7.0%(95%置信区间[CI]:5.3 - 8.8)在诊断后延迟接受治疗。黑人种族与白人种族相比,延迟治疗的可能性较低(aPR 0.38)。与男性发生性行为的男性与与女性发生性行为的女性相比(aPR 1.86),以及被要求进行艾滋病毒检测而非由医疗服务提供者建议检测的人(aPR 2.52)更有可能延迟治疗。在延迟治疗的人中,48%报告个人因素是主要原因。在最初被诊断为感染艾滋病毒(非艾滋病)的人中,延迟治疗的人到2011年5月发展为艾滋病的可能性是其他人的两倍(aPR 2.08)。与ART时代之前相比,延迟接受治疗的情况减少了近60%。虽然相对较少的艾滋病毒患者延迟接受治疗,但某些群体可能风险增加。关注被要求进行艾滋病毒检测的人群与治疗的衔接可能会进一步减少延迟接受治疗的情况。

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[5]
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[7]
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本文引用的文献

[1]
Behavioral and clinical characteristics of persons receiving medical care for HIV infection - Medical Monitoring Project, United States, 2009.

MMWR Suppl. 2014-6-20

[2]
Barriers and facilitators of linkage to HIV primary care in New York City.

J Acquir Immune Defic Syndr. 2013-11-1

[3]
Patterns and correlates of linkage to appropriate HIV care after HIV diagnosis in the US Medicaid population.

Sex Transm Dis. 2013-1

[4]
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Am J Public Health. 2012-11-15

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Open AIDS J. 2012

[6]
Delayed entry into HIV medical care after HIV diagnosis: risk factors and research methods.

AIDS Care. 2012

[7]
Time to first annual HIV care visit and associated factors for patients in care for HIV infection in 10 US cities.

AIDS Care. 2011-10

[8]
Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention.

J Acquir Immune Defic Syndr. 2012-1-1

[9]
Clinical and behavioral characteristics of adults receiving medical care for HIV infection --- Medical Monitoring Project, United States, 2007.

MMWR Surveill Summ. 2011-9-2

[10]
Prevention of HIV-1 infection with early antiretroviral therapy.

N Engl J Med. 2011-7-18

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