Mosen D M, Wenger N S, Shapiro M F, Andersen R M, Cunningham W E
Department of Medicine, School of Medicine, University of California, Los Angeles 90095, USA.
AIDS Care. 1998 Oct;10(5):617-28. doi: 10.1080/09540129848479.
Lack of timely HIV testing leads to missed prevention opportunities and poor prevention counselling may be related to further disease spread. We examined the association of self-reported access to medical care with receiving HIV testing and preventive counselling services among a sample of patients with HIV disease prior to hospitalization. We conducted a cross-sectional interview of 217 Los Angeles patients hospitalized with HIV-related illness between 1992 and 1993 and abstracted clinical data from the medical record. Eighty-four per cent of patients received HIV testing prior to hospitalization, but only 33% received preventive counselling services. Only 48% of all patients rated outpatient medical care as somewhat or very easy to obtain. Controlling for severity of illness, better access to outpatient medical care (OR = 1.48; 95% CI = 1.02-2.15), having a regular source of care (OR = 3.40; 95% CI = 1.29-8.97) and non-homosexual mode of HIV transmission (OR = 0.31; 0.12-0.83) were associated with receiving HIV testing services prior to hospitalization. Having a regular source of care (OR = 3.55; 95% CI = 1.37-9.22), being VA (Veterans' Administration) insured (OR = 6.16; 1.46-26.05), older age (OR = 0.95; 95% CI = 0.90-0.99) and having a CD4 count between 101-200 (OR = 0.19; 95% CI = 0.06-0.63) were associated with receiving HIV counselling. Limited self-reported access to medical care is associated with fewer patients receiving HIV testing and counselling. Improving timeliness of HIV testing may require removing the barriers to medical care.
缺乏及时的艾滋病毒检测会导致错失预防机会，而欠佳的预防咨询可能与疾病的进一步传播有关。我们在一组住院前的艾滋病毒疾病患者样本中，研究了自我报告的获得医疗服务机会与接受艾滋病毒检测及预防咨询服务之间的关联。我们对1992年至1993年间在洛杉矶因与艾滋病毒相关疾病住院的217名患者进行了横断面访谈，并从病历中提取了临床数据。84%的患者在住院前接受了艾滋病毒检测，但只有33%的患者接受了预防咨询服务。所有患者中只有48%认为门诊医疗服务在一定程度上或非常容易获得。在控制疾病严重程度后，更好地获得门诊医疗服务（比值比=1.48；95%置信区间=1.02-2.15）、有固定的医疗服务来源（比值比=3.40；95%置信区间=1.29-8.97）以及非同性恋的艾滋病毒传播方式（比值比=0.31；0.12-0.83）与住院前接受艾滋病毒检测服务有关。有固定的医疗服务来源（比值比=3.55；95%置信区间=1.37-9.22）、拥有退伍军人管理局保险（比值比=6.16；1.46-26.05）、年龄较大（比值比=0.95；95%置信区间=0.90-0.99）以及CD4细胞计数在101至200之间（比值比=0.19；95%置信区间=0.06-0.63）与接受艾滋病毒咨询有关。自我报告的获得医疗服务机会有限与接受艾滋病毒检测和咨询的患者较少有关。提高艾滋病毒检测的及时性可能需要消除获得医疗服务的障碍。
