Schember Cassandra Oliver, Scott Sarah E, Jenkins Cathy A, Rebeiro Peter F, Turner Megan, Furukawa Sally S, Bofill Carmen, Yan Zhou, Jackson Gretchen P, Pettit April C
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States.
JMIR Med Inform. 2022 Jul 25;10(7):e34712. doi: 10.2196/34712.
Approximately 1.1 million people living with HIV live in the United States, and the incidence is highest in Southeastern United States. Electronic patient portal prevalence is increasing and can improve engagement in primary medical care. Retention in care and viral suppression-measures of engagement in HIV care-are associated with decreased HIV transmission, morbidity, and mortality.
We aimed to determine if patient portal access among people living with HIV was associated with retention and viral suppression.
We conducted an observational cohort study among people living with HIV in care at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from 2011-2016. Individual access was defined as patient portal account registration at any point in the year prior. Retention was defined as ≥2 kept appointments or HIV lab measurements ≥3 months apart within a 12-month period. Viral suppression was defined as the last viral load in the calendar year <200 copies/mL. We calculated adjusted prevalence ratios (aPRs) and 95% CIs using modified Poisson regression with generalized estimating equations to estimate the association of portal access with retention and viral suppression.
We included 4237 people living with HIV contributing 16,951 person-years of follow-up (median 5, IQR 3-5 person-years). The median age was 43 (IQR 33-50) years. Of the 4237 people living with HIV, 78.1% (n=4237) were male, 40.8% (n=1727) were Black non-Hispanic, and 56.5% (n=2395) had access. Access was independently associated with retention (aPR 1.13, 95% CI 1.10-1.17) and viral suppression (aPR 1.18, 95% CI 1.14-1.22).
In this population, patient portal access was associated with retention and viral suppression. Future prospective studies should assess the impact of increasing portal access among people living with HIV on these HIV outcomes.
美国约有110万艾滋病毒感染者，东南部的发病率最高。电子患者门户网站的普及率正在上升，并且可以提高对初级医疗保健的参与度。坚持治疗和病毒抑制（艾滋病毒治疗参与度的衡量指标）与艾滋病毒传播、发病率和死亡率的降低相关。
我们旨在确定艾滋病毒感染者使用患者门户网站是否与坚持治疗和病毒抑制相关。
我们在2011年至2016年期间对范德比尔特综合护理诊所（田纳西州纳什维尔）接受治疗的艾滋病毒感染者进行了一项观察性队列研究。个人访问被定义为在前一年的任何时间点注册患者门户网站账户。坚持治疗被定义为在12个月内有≥2次预约就诊或艾滋病毒实验室检测间隔≥3个月。病毒抑制被定义为日历年中最后一次病毒载量<200拷贝/毫升。我们使用修正的泊松回归和广义估计方程计算调整后的患病率比（aPRs）和95%置信区间（CIs），以估计门户网站访问与坚持治疗和病毒抑制之间的关联。
我们纳入了4237名艾滋病毒感染者，随访时间共计16951人年（中位数5，四分位间距3 - 5人年）。中位年龄为43岁（四分位间距33 - 50岁）。在4237名艾滋病毒感染者中，78.1%（n = 4237）为男性，40.8%（n = 1727）为非西班牙裔黑人，56.5%（n = 2395）可以访问门户网站。访问门户网站与坚持治疗（aPR 1.13，95% CI 1.10 - 1.17）和病毒抑制（aPR 1.18，95% CI 1.14 - 1.22）独立相关。
在这一人群中，使用患者门户网站与坚持治疗和病毒抑制相关。未来的前瞻性研究应评估增加艾滋病毒感染者使用门户网站对这些艾滋病毒相关结果的影响。
