MacCarthy Sarah, Hoffmann Michael, Nunn Amy, Silva Luís Augusto Vasconcelos da, Dourado Ines
RAND Corporation, Santa Monica, California, United States of America.
Brown University, Providence, Rhode Island, United States of America.
Rev Panam Salud Publica. 2016 Dec;40(6):418-426.
Early, continued engagement with the HIV treatment continuum can help achieve viral suppression, though few studies have explored how risk factors for delays differ across the continuum. The objective of this study was to identify predictors of delayed diagnosis, delayed linkage to care, and nonadherence to treatment in the city of Salvador, Bahia, Brazil.
Data were collected during 2010 in a cross-sectional study with a sample (n = 1 970) of HIV-infected individuals enrolled in care. Multiple logistic regression analyses identified sociodemographic variables, behaviors, and measures of health service quality that were associated with delayed diagnosis, delayed linkage to care, and treatment nonadherence.
For delayed diagnosis, male gender (adjusted odds ratio (AOR), 3.02; 95% confidence interval (CI), 2.0-4.6); age 45 years and older (AOR, 1.67; 95% CI, 1.1-2.5); and provider-initiated testing (AOR, 3.00; 95% CI, 2.1-4.4) increased odds, while drug use (AOR, 0.29; 95% CI, 0.2-0.5) and receiving results in a private space (AOR, 0.37; 95% CI, 0.2-0.8) decreased odds. For delayed linkage to care, unemployment (AOR, 1.42; 95% CI, 1.07-1.9) and difficulty understanding or speaking with a health care worker (AOR, 1.61; 95% CI, 1.2-2.1) increased odds, while posttest counseling (AOR, 0.49; 95% CI, 0.3-0.7) decreased odds. For nonadherence, experiencing verbal or physical discrimination related to HIV (AOR, 1.94; 95% CI, 1.3-3.0) and feeling mistreated or not properly attended to at HIV care (AOR, 1.60; 95% CI, 1.0-2.5) increased odds, while posttest counseling (AOR, 0.34; 95% CI, 0.2-0.6) decreased odds.
More attention is needed on how policies, programs, and research can provide tailored support across the treatment continuum.
尽早持续参与艾滋病病毒治疗过程有助于实现病毒抑制，不过很少有研究探讨在整个治疗过程中延误的风险因素有何不同。本研究的目的是确定巴西巴伊亚州萨尔瓦多市艾滋病病毒诊断延误、护理衔接延误及治疗不依从的预测因素。
2010年在一项横断面研究中收集数据，样本为1970名接受护理的艾滋病病毒感染者。多项逻辑回归分析确定了与诊断延误、护理衔接延误及治疗不依从相关的社会人口统计学变量、行为及卫生服务质量指标。
对于诊断延误，男性（调整优势比[AOR]，3.02；95%置信区间[CI]，2.0 - 4.6）、45岁及以上年龄（AOR，1.67；95% CI，1.1 - 2.5）以及由医疗服务提供者发起的检测（AOR，3.00；95% CI，2.1 - 4.4）会增加可能性，而药物使用（AOR，0.29；95% CI，0.2 - 0.5）以及在私密空间得知检测结果（AOR，0.37；95% CI，0.2 - 0.8）会降低可能性。对于护理衔接延误，失业（AOR，1.42；95% CI，1.07 - 1.9）以及与医护人员沟通理解困难或存在语言障碍（AOR，1.61；95% CI，1.2 - 2.1）会增加可能性，而检测后咨询（AOR，0.49；95% CI，0.3 - 0.7）会降低可能性。对于治疗不依从，经历与艾滋病病毒相关的言语或身体歧视（AOR，1.94；95% CI，1.3 - 3.0）以及在艾滋病护理中感觉受到虐待或未得到妥善照料（AOR，1.60；95% CI，1.0 - 2.5）会增加可能性，而检测后咨询（AOR，0.34；95% CI，0.2 - 0.6）会降低可能性。
需要更多关注政策、项目和研究如何能在整个治疗过程中提供量身定制的支持。
