美国南部女性的社区卫生保健可及性与性传播感染：一项跨区域多层次分析。
Neighborhood Health Care Access and Sexually Transmitted Infections Among Women in the Southern United States: A Cross-Sectional Multilevel Analysis.
出版信息
Sex Transm Dis. 2018 Jan;45(1):19-24. doi: 10.1097/OLQ.0000000000000685.
INTRODUCTION
The United States has experienced an increase in reportable sexually transmitted infections (STIs) while simultaneously experiencing a decline in safety net services for STI testing and treatment. This multilevel study assessed relationships between neighborhood-level access to health care and STIs among a predominantly Human Immunodeficiency Virus (HIV)-seropositive cohort of women living in the south.
METHODS
This cross-sectional multilevel analysis included baseline data from HIV-seropositive and HIV-seronegative women enrolled in the Women's Interagency HIV Study sites in Alabama, Florida, Georgia, Mississippi, and North Carolina between 2013 and 2015 (N = 666). Administrative data (eg, United States Census) described health care access (eg, percentage of residents with a primary care provider, percentage of residents with health insurance) in the census tracts where women lived. Sexually transmitted infections (chlamydia, gonorrhea, trichomoniasis, or early syphilis) were diagnosed using laboratory testing. Generalized estimating equations were used to determine relationships between tract-level characteristics and STIs. Analyses were conducted using SAS 9.4.
RESULTS
Seventy percent of participants were HIV-seropositive. Eleven percent of participants had an STI. A 4-unit increase in the percentage of residents with a primary care provider was associated with 39% lower STI risk (risk ratio, 0.61, 95% confidence interval, 0.38-0.99). The percentage of tract residents with health insurance was not associated with STIs (risk ratio, 0.98, 95% confidence interval, 0.91-1.05). Relationships did not vary by HIV status.
CONCLUSIONS
Greater neighborhood health care access was associated with fewer STIs. Research should establish the causality of this relationship and pathways through which neighborhood health care access influences STIs. Structural interventions and programs increasing linkage to care may reduce STIs.
简介
美国报告的性传播感染（STIs）有所增加，同时用于 STI 检测和治疗的安全网服务却有所减少。这项多层次研究评估了美国南部一个以人类免疫缺陷病毒（HIV）阳性为主的女性队列中，社区卫生保健服务的可及性与 STIs 之间的关系。
方法
这项横断面多层次分析纳入了 2013 年至 2015 年间参加阿拉巴马州、佛罗里达州、佐治亚州、密西西比州和北卡罗来纳州的妇女间署 HIV 研究（Women's Interagency HIV Study）站点的 HIV 阳性和 HIV 阴性女性的基线数据（N=666）。行政数据（例如，美国人口普查）描述了女性居住的普查区的卫生保健可及性（例如，有初级保健提供者的居民比例、有医疗保险的居民比例）。使用实验室检测诊断性传播感染（衣原体、淋病、滴虫病或早期梅毒）。使用广义估计方程确定人群水平特征与 STIs 之间的关系。使用 SAS 9.4 进行分析。
结果
70%的参与者 HIV 阳性。11%的参与者患有 STI。居民中有初级保健提供者的比例每增加 4 个单位，STI 风险就会降低 39%（风险比，0.61，95%置信区间，0.38-0.99）。有医疗保险的居民比例与 STIs 无关（风险比，0.98，95%置信区间，0.91-1.05）。该关系不因 HIV 状态而异。
结论
社区卫生保健服务的可及性增加与 STIs 减少有关。研究应确定这种关系的因果关系以及社区卫生保健服务可及性影响 STIs 的途径。增加与护理的联系的结构性干预和项目可能会减少 STIs。
Zotero 插件