Gokhale Runa H, Bradley Heather, Weiser John
a Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA.
b Epidemic Intelligence Service , Centers for Disease Control and Prevention , Atlanta , GA , USA.
AIDS Care. 2017 Jul;29(7):928-935. doi: 10.1080/09540121.2017.1280125. Epub 2017 Jan 23.
Advances in antiretroviral therapy (ART) and reproductive technologies have made transmission of HIV to partners and infants almost completely preventable. Comprehensive reproductive health counseling (CRHC) is an important component of care for women living with HIV, but few women report discussing reproductive health with an HIV care provider. We surveyed a probability sample of U.S. HIV care providers during 2013-2014. Of 2023 eligible providers, 1234 responded (64% adjusted provider response rate). We estimated the percentage delivering CRHC to their female patients. CRHC was defined as delivering each of five components of reproductive health care to most or all female patients. We assessed associations between provider characteristics and delivering CRHC using chi-squared tests and multivariable logistic regression. Of all providers, 49% (95% confidence interval [CI], 42-55) reported delivering all components of CRHC: 71% assessed reproductive intentions of reproductive-aged women, 78% explained perinatal transmission risk, 87% discussed ART for preventing perinatal transmission, 76% provided contraception as appropriate, and 64% provided referrals for preconception care. Among providers who offered primary care (83% of sample), 52% (CI: 44-60) delivered CRHC compared to 33% (CI: 22-44) of providers who did not offer primary care (P = .01). More female providers (46% of sample) compared to male providers delivered CRHC (57% [CI: 48-65] vs. 40% [CI: 31-50], P < .01). Delivery of CRHC by providers did not differ by patient caseload. After adjusting for gender, years of HIV experience, and patient caseload, providing primary care to HIV-infected patients remained associated with delivering CRHC (adjusted prevalence ratio [aPR] 1.48, 95% CI 1.02-2.16). Provider delivery of CRHC is not consistent with current guidelines that recommend discussing reproductive health with all reproductive-aged women who are living with HIV, even among providers offering primary care to their HIV patients.
抗逆转录病毒疗法（ART）和生殖技术的进步已使HIV向性伴侣和婴儿的传播几乎完全可以预防。全面生殖健康咨询（CRHC）是HIV感染女性护理的重要组成部分，但很少有女性报告与HIV护理提供者讨论生殖健康问题。我们在2013 - 2014年对美国HIV护理提供者的一个概率样本进行了调查。在2023名符合条件的提供者中，1234人做出了回应（调整后的提供者回应率为64%）。我们估计了向其女性患者提供CRHC的比例。CRHC被定义为向大多数或所有女性患者提供生殖健康护理的五个组成部分中的每一个。我们使用卡方检验和多变量逻辑回归评估提供者特征与提供CRHC之间的关联。在所有提供者中，49%（95%置信区间[CI]，42 - 55）报告提供了CRHC的所有组成部分：71%评估了育龄女性的生殖意愿，78%解释了围产期传播风险，87%讨论了用于预防围产期传播的ART，76%酌情提供了避孕措施，64%提供了孕前护理转诊。在提供初级护理的提供者中（样本的83%），52%（CI：44 - 60）提供了CRHC，而未提供初级护理的提供者中这一比例为33%（CI：22 - 44）（P = 0.01）。与男性提供者相比，更多女性提供者（样本的46%）提供了CRHC（57%[CI：48 - 65]对40%[CI：31 - 50]，P < 0.01）。提供者提供CRHC的情况在患者工作量方面没有差异。在对性别、HIV从业年限和患者工作量进行调整后，为HIV感染患者提供初级护理仍然与提供CRHC相关（调整后的患病率比[aPR]为1.48，95%CI为1.02 - 2.16）。即使在为HIV患者提供初级护理的提供者中，提供者提供CRHC的情况也与当前建议不一致，即建议与所有感染HIV的育龄女性讨论生殖健康问题。
