HIV 临床项目中 HIV 感染者青少年和青年成年人的病毒抑制提供者预测的准确性。
Accuracy of Provider Predictions of Viral Suppression Among Adolescents and Young Adults With HIV in an HIV Clinical Program.
机构信息
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
出版信息
J Int Assoc Provid AIDS Care. 2024 Jan-Dec;23:23259582241252587. doi: 10.1177/23259582241252587.
BACKGROUND
Providers caring for adolescents and young adults with HIV (AYA-HIV) mostly base their adherence counseling during clinical encounters on clinical judgment and expectations of patients' medication adherence. There is currently no data on provider predictions of viral suppression for AYA-HIV. We aimed to assess the accuracy of provider predictions of patients' viral suppression status compared to viral load results.
METHODS
Providers caring for AYA-HIV were asked to predict the likelihood of viral suppression of patients before a clinical encounter and give reasons for their predictions. Provider predictions were compared to actual viral load measurements of patients. Patient data were abstracted from electronic health records. The final analysis included 9 providers, 28 patients, and 34 observations of paired provider predictions and viral load results.
RESULTS
Provider prediction accuracy of viral suppression was low (59%, Cohen's Kappa = 0.16). Provider predictions of lack of viral suppression were based on nonadherence to medications, new patient status, or structural vulnerabilities (e.g., unstable housing). Anticipated viral suppression was based on medication adherence, history of viral suppression, and the presence of family or other social forms of support.
CONCLUSIONS
Providers have difficulty accurately predicting viral suppression among AYA-HIV and may base their counseling on incorrect assumptions. Rapid point-of-care viral load testing may provide opportunities to improve counseling provided during the clinical encounter.
背景
为青少年和青年艾滋病病毒感染者（AYA-HIV）提供护理的医务人员在临床接触期间主要根据临床判断和患者对药物依从性的预期，为患者提供依从性咨询。目前尚无关于医务人员预测 AYA-HIV 病毒抑制情况的相关数据。我们旨在评估医务人员预测患者病毒抑制状态的准确性与病毒载量结果相比。
方法
在临床接触之前，我们要求为 AYA-HIV 提供护理的医务人员预测患者病毒抑制的可能性，并说明其预测依据。医务人员的预测与患者实际的病毒载量测量值进行比较。患者数据从电子健康记录中提取。最终分析共纳入 9 名医务人员、28 名患者和 34 次医务人员预测与病毒载量结果的配对观察。
结果
医务人员预测病毒抑制的准确性较低（59%，Cohen's Kappa=0.16）。医务人员预测无病毒抑制的依据是非药物依从性、新患者状态或结构性脆弱性（例如，不稳定的住房）。预计病毒抑制的依据是药物依从性、既往病毒抑制史以及家庭或其他社会形式的支持。
结论
医务人员难以准确预测 AYA-HIV 的病毒抑制情况，他们的咨询可能基于错误的假设。即时护理点病毒载量检测可能为改善临床接触期间提供的咨询提供机会。
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