登记性取向及确认用于充分进行艾滋病毒风险评估的指示性状况的重要性。
The importance of registration of sexual orientation and recognition of indicator conditions for an adequate HIV risk-assessment.
作者信息
Joore Ivo K, Geerlings Suzanne E, Brinkman Kees, van Bergen Jan E A M, Prins Jan M
机构信息
Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, 1100 DE, Amsterdam, The Netherlands.
Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.
出版信息
BMC Infect Dis. 2017 Feb 28;17(1):178. doi: 10.1186/s12879-017-2279-y.
BACKGROUND
HIV testing among risk groups and guided by HIV indicator conditions (IC) is widely recommended by European guidelines. In this study we investigated how these strategies are used by general practitioners (GP) and in other healthcare settings. The objectives of our study were to describe: 1) the proportion of consultations in primary care and other healthcare settings in the five years prior to diagnosis; 2) patient and GP perspectives on the primary healthcare providers' awareness and registration of sexual orientation and ethnicity in the electronic medical record (EMR); and 3) the proportion of HIV-infected patients who had been diagnosed with an IC prior to HIV diagnosis.
METHODS
A survey study (2014-2016) was conducted among newly diagnosed HIV-infected patients presenting at two HIV outpatient clinics in Amsterdam. We collected information on the number of consultations and extent of HIV testing in healthcare settings in the 5 years prior to HIV diagnosis; on patient and GP perspectives on the primary healthcare providers' awareness of sexual orientation and ethnicity; and on preselected ICs and symptoms of acute HIV infection prior to diagnosis. GPs were also approached for further information.
RESULTS
In the 5 years prior to HIV diagnosis, 82.9% of the 111 patients had one or more consultations with their GP, but only 34.8% had one or more HIV tests performed in general practice during this period. In more than 50% of cases the patients took the initiative for the positive HIV test. GPs stated that they were aware of the sexual orientation of 59.6% of their patients who were men who have sex with men (MSM); however, sexual orientation was only documented in the EMR in 34.0% of these cases. GPs also reported that they were aware that a patient was from an HIV endemic country in more than half of the cases. GPs diagnosed 48.3% of all ICs and 39.5% of this group was offered an HIV test at that time.
CONCLUSIONS
Documentation of sexual orientation and ethnicity, and IC-guided testing by GPs could be the starting point for more proactive provider-initiated HIV testing.
背景
欧洲指南广泛推荐在高危人群中并依据HIV指示性疾病（IC）开展HIV检测。在本研究中，我们调查了全科医生（GP）以及其他医疗环境中如何运用这些策略。我们研究的目的是描述：1）诊断前五年内在初级保健和其他医疗环境中的就诊比例；2）患者和全科医生对初级医疗服务提供者在电子病历（EMR）中对性取向和种族的知晓及记录情况的看法；3）在HIV诊断之前已被诊断患有指示性疾病的HIV感染患者的比例。
方法
对阿姆斯特丹两家HIV门诊新诊断的HIV感染患者进行了一项调查研究（2014 - 2016年）。我们收集了HIV诊断前5年内在医疗环境中的就诊次数和HIV检测程度的信息；患者和全科医生对初级医疗服务提供者对性取向和种族的知晓情况的看法；以及诊断前预先选定的指示性疾病和急性HIV感染症状的信息。还向全科医生获取了更多信息。
结果
在HIV诊断前的5年中，111名患者中有82.9%与他们的全科医生进行了一次或多次就诊，但在此期间只有34.8%的患者在全科医疗中进行了一次或多次HIV检测。在超过50%的病例中，患者主动进行了HIV检测呈阳性。全科医生表示，他们知晓其59.6%的男男性行为者（MSM）患者的性取向；然而，在这些病例中，只有34.0%的性取向记录在了电子病历中。全科医生还报告说，在超过一半的病例中他们知晓患者来自HIV流行国家。全科医生诊断出所有指示性疾病的48.3%，并且当时该组中有39.5%的患者接受了HIV检测。
结论
性取向和种族的记录以及全科医生依据指示性疾病进行的检测可能是更积极主动的由医疗服务提供者发起的HIV检测的起点。
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