Lakshmi Seetha, Beekmann Susan E, Polgreen Philip M, Rodriguez Allan, Alcaide Maria L
a Division of Infectious Diseases , University of South Florida , Tampa , USA.
c Departments of Internal Medicine , University of Iowa Carver College of Medicine , Iowa City , USA.
AIDS Care. 2018 May;30(5):569-577. doi: 10.1080/09540121.2017.1385720. Epub 2017 Oct 9.
Models of care for people living with HIV (PLWH) have varied over time due to long term survival, development of HIV-associated non-AIDS conditions, and HIV specific primary care guidelines that differ from those of the general population. The objectives of this study are to assess how often infectious disease (ID) physicians provide primary care for PLWH, assess their practice patterns and barriers in the provision of primary care. We used a 6-item survey electronically distributed to ID physician members of Emerging Infections Network (EIN). Of the 1248 active EIN members, 644 (52%) responded to the survey. Among the 644 respondents, 431 (67%) treated PLWH. Of these 431 responders, 326 (75%) acted as their primary care physicians. Responders who reported always/mostly performing a screening assessment as recommended per guidelines were: (1) Screening specific to HIV (tuberculosis 95%, genital chlamydia/gonorrhoea 77%, hepatitis C 67%, extra genital chlamydia/gonorrhoea 47%, baseline anal PAP smear for women 36% and men 34%); (2) Primary care related screening (fasting lipids 95%, colonoscopy 95%, mammogram 90%, cervical PAP smears 88%, depression 57%, osteoporosis in postmenopausal women 55% and men >50 yrs 33%). Respondents who worked in university hospitals, had <5 years of ID experience, and those who cared for more PLWH were most likely to provide primary care to all or most of their patients. Common barriers reported include: refusal by patient (72%), non-adherence to HIV medications (43%), other health priorities (44%), time constraints during clinic visit (43%) and financial/insurance limitations (40%). Most ID physicians act as primary care providers for their HIV infected patients especially if they are recent ID graduates and work in university hospitals. Current screening rates are suboptimal. Interventions to increase screening practices and to decrease barriers are urgently needed to address the needs of the aging HIV population in the United States.
由于长期生存、与HIV相关的非艾滋病疾病的发展以及与普通人群不同的HIV特异性初级保健指南，针对HIV感染者（PLWH）的护理模式随时间而有所不同。本研究的目的是评估传染病（ID）医生为PLWH提供初级保健的频率，评估他们在提供初级保健方面的实践模式和障碍。我们使用了一份包含6个项目的调查问卷，通过电子方式分发给新兴感染网络（EIN）的ID医生成员。在1248名活跃的EIN成员中，644人（52%）回复了调查。在644名受访者中，431人（67%）治疗PLWH。在这431名受访者中，326人（75%）担任他们的初级保健医生。报告始终/大多按照指南建议进行筛查评估的受访者包括：（1）HIV特异性筛查（结核病95%、生殖系统衣原体/淋病77%、丙型肝炎67%、生殖器外衣原体/淋病47%、女性基线肛门巴氏涂片36%、男性34%）；（2）初级保健相关筛查（空腹血脂95%、结肠镜检查95%、乳房X线摄影90%、宫颈巴氏涂片88%、抑郁症57%、绝经后女性骨质疏松症55%、50岁以上男性33%）。在大学医院工作、ID经验少于5年以及照顾更多PLWH患者的受访者最有可能为所有或大多数患者提供初级保健。报告的常见障碍包括：患者拒绝（72%）、不坚持服用HIV药物（43%）、其他健康优先事项（44%）、门诊就诊时的时间限制（43%）以及财务/保险限制（40%）。大多数ID医生担任其HIV感染患者的初级保健提供者，特别是如果他们是ID专业的近期毕业生且在大学医院工作。目前的筛查率不理想。迫切需要采取干预措施来增加筛查实践并减少障碍，以满足美国老龄化HIV人群的需求。
