Espinel Marco, Belza María José, Cabeza-de-Vaca Cristina, Arranz Beatriz, Guerras Juan Miguel, Garcia-Soltero Jennifer, Hoyos Juan
Hospital Universitario La Paz, Madrid, España.
Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
Enferm Infecc Microbiol Clin (Engl Ed). 2018 Oct;36(8):465-471. doi: 10.1016/j.eimc.2017.07.010. Epub 2017 Oct 7.
Contact with the healthcare system by a sample of seropositive men who have sex with men (MSM) prior to their HIV diagnosis are analysed, and missed opportunities (MO) for an earlier HIV diagnosis are identified.
Between 2012-2013, an online survey was conducted among HIV-positive MSM, mainly recruited from gay websites. Those who were diagnosed with HIV between 2010-2013 were analysed. MO were defined as episodes prior to the HIV diagnosis in which the healthcare system was contacted due to an indicator condition of HIV infection and the test was not suggested. The proportion of missed opportunities were compared according to the type of indicator condition, the department consulted and the healthcare professional's knowledge that the patient was MSM.
Overall, 639 participants (66% of 966) reported 1,145 episodes with some indicator condition, the majority of these being identified in primary care (n=527; 46%). The highest percentage of MOs is also observed in primary care (63%). Although the indicator condition with the highest number of MOs was STIs (n=124), the highest percentage of MOs was observed in consultations due to diarrhoea with no known cause (69.8%). The percentage of MOs when the doctor knew that the patient was MSM was 40 vs. 70% when the doctor did not know.
The majority of HIV-positive MSM analysed in this study went to healthcare services for HIV-infection indicator conditions prior to their HIV diagnosis. Primary care was the most-frequently-visited department and is also where the most opportunities were missed to perform an HIV test, even when it was known that the patient was a MSM.
对一组血清学阳性的男男性行为者（MSM）在其HIV诊断之前与医疗保健系统的接触情况进行分析，并确定早期HIV诊断中错失的机会（MO）。
在2012年至2013年期间，对主要从同性恋网站招募的HIV阳性MSM进行了在线调查。对2010年至2013年期间被诊断出感染HIV的人群进行分析。MO被定义为在HIV诊断之前因HIV感染的指示性病症而接触医疗保健系统但未建议进行检测的情况。根据指示性病症的类型、咨询的科室以及医疗保健专业人员是否知晓患者为MSM，对错失机会的比例进行比较。
总体而言，639名参与者（占966名的66%）报告了1145次存在某些指示性病症的情况，其中大部分在初级保健中被发现（n = 527；46%）。在初级保健中也观察到最高比例的MO（63%）。尽管MO数量最多的指示性病症是性传播感染（n = 124），但在因不明原因腹泻进行咨询时观察到的MO比例最高（69.8%）。当医生知晓患者为MSM时，MO的比例为40%，而当医生不知晓时为70%。
本研究中分析的大多数HIV阳性MSM在其HIV诊断之前因HIV感染指示性病症前往医疗保健机构就诊。初级保健是就诊最频繁的科室，也是即使已知患者为MSM但进行HIV检测错失机会最多的地方。
