Sharoda Dasgupta, PhD, MPH, is an Epidemiologist, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Yunfeng Tie, PhD, is a Biostatistician, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Linda Beer, PhD, is an Epidemiologist, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Jennifer Fagan, MA, is an Epidemiologist, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA. John Weiser, MD, is a Medical Epidemiologist, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Assoc Nurses AIDS Care. 2021;32(5):561-568. doi: 10.1097/JNC.0000000000000249.
Failure to maintain viral suppression may be attributed to suboptimal care engagement. Using data collected during 2015-2018, we describe nationally representative estimates of engagement in care among US adults with diagnosed HIV, overall and by viral suppression. Of those who felt they did not receive enough care, we described detailed information on barriers to care by viral suppression. We reported weighted percentages and evaluated differences between groups using Rao-Scott chi-square tests (p < .05). Persons who were not virally suppressed were less likely to be retained in care (57.3 vs. 90.8%). Common barriers to care included life circumstances that impeded receipt of care (50.0%), financial barriers (34.5%), and not feeling sick enough to take medicine (32.0%). Barriers to care varied by viral suppression status, and people who were not virally suppressed were more likely to report more than one barrier to care. These findings demonstrate that barriers can be multifaceted; addressing barriers to care by expanding comprehensive care models in HIV care settings could improve clinical outcomes among people with HIV.
未能维持病毒抑制可能归因于护理参与度不足。利用 2015-2018 年收集的数据，我们描述了美国成年人中按病毒抑制情况划分的、具有代表性的总体和参与护理的估计情况。对于那些认为自己没有得到足够护理的人，我们按病毒抑制情况详细描述了护理障碍的信息。我们报告了加权百分比，并使用 Rao-Scott 卡方检验（p<0.05）评估了组间差异。未达到病毒抑制的人更不可能继续接受护理（57.3%对 90.8%）。常见的护理障碍包括妨碍接受护理的生活情况（50.0%）、经济障碍（34.5%）和感觉病得不够重而无需服药（32.0%）。护理障碍因病毒抑制状态而异，未达到病毒抑制的人更有可能报告多种护理障碍。这些发现表明障碍可能是多方面的；通过扩大艾滋病毒护理环境中的综合护理模式来解决护理障碍，可能会改善艾滋病毒感染者的临床结果。
