O'Brien Nadia, Godard-Sebillotte Claire, Skerritt Lashanda, Dayle Janice, Carter Allison, Law Susan, Cox Joseph, Andersson Neil, Kaida Angela, Loutfy Mona, de Pokomandy Alexandra
Department of Family Medicine, McGill University, Montreal, Canada.
Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada.
J Womens Health (Larchmt). 2020 Nov;29(11):1475-1485. doi: 10.1089/jwh.2019.8121. Epub 2020 Jun 5.
Women living with HIV in Canada experience barriers to comprehensive HIV care. We sought to describe care gaps across a typology of care. We analyzed baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). A typology of care was characterized by primary HIV physician and care setting. Quality-of-care indicators included the following: Pap test, Pap test discussions, reproductive goal discussions, breast cancer screening, antiretroviral therapy (ART) use, adherence, HIV viral load, and viral load discussions. We defined comprehensive care with three indicators: Pap test, viral load, and either reproductive goal discussions over last 3 years or breast cancer screening, as indicated. Multivariable logistic regression analyses measured associations between care types and quality-of-care indicators. Among women living with HIV accessing HIV care, 56.4% (657/1,164) experienced at least one gap in comprehensive care, most commonly reproductive goal discussions. Women accessed care from three types of care: (1) physicians (specialist and family physicians) in HIV clinics (71.6%); (2) specialists in non-HIV clinics (17.6%); and (3) family physicians in non-HIV clinics (10.8%), with 55.5%, 63.9%, and 50.8% gaps in comprehensive care, respectively. Type 3 care had double the odds of not being on ART: adjusted odds ratio (AOR 2.09, 95% confidence interval [CI] 1.16-3.75), while Type 2 care had higher odds of not having discussed the importance of Pap tests (AOR 1.48, 95% CI 1.00-2.21). Women continue to experience gaps in care, across types of care, indicating the need to evaluate and strengthen women-centered models of care.
加拿大感染艾滋病毒的女性在获得全面艾滋病毒护理方面面临障碍。我们试图描述不同护理类型中的护理差距。我们分析了加拿大艾滋病毒女性性与生殖健康队列研究（CHIWOS）的基线数据。护理类型由初级艾滋病毒医生和护理机构来界定。护理质量指标包括：巴氏试验、巴氏试验讨论、生殖目标讨论、乳腺癌筛查、抗逆转录病毒疗法（ART）使用、依从性、艾滋病毒病毒载量以及病毒载量讨论。我们用三项指标定义全面护理：巴氏试验、病毒载量，以及过去3年中进行的生殖目标讨论或视情况而定的乳腺癌筛查。多变量逻辑回归分析衡量了护理类型与护理质量指标之间的关联。在接受艾滋病毒护理的感染艾滋病毒女性中，56.4%（657/1164）在全面护理方面至少存在一处差距，最常见的是生殖目标讨论。女性接受三种类型的护理：（1）艾滋病毒诊所的医生（专科医生和家庭医生）（71.6%）；（2）非艾滋病毒诊所的专科医生（17.6%）；以及（3）非艾滋病毒诊所的家庭医生（10.8%），全面护理方面的差距分别为55.5%、63.9%和50.8%。第3类护理未接受抗逆转录病毒疗法的几率是其他护理的两倍：调整后的优势比（AOR 2.09，95%置信区间[CI] 1.16 - 3.75），而第2类护理未讨论巴氏试验重要性的几率更高（AOR 1.48，95% CI 1.00 - 2.21）。不同护理类型的女性在护理方面仍存在差距，这表明需要评估并加强以女性为中心的护理模式。
