Sexually Transmitted Infection Testing of HIV-Positive Medicare and Medicaid Enrollees Falls Short of Guidelines
Sexually Transmitted Infection Testing of HIV-Positive Medicare and Medicaid Enrollees Falls Short of Guidelines
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DOI：
10.1097/olq.0000000000000695
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发表时间：
2018-01-01
影响因子：
3.1
通讯作者：
Leibowitz, Arleen A.
中科院分区：
文献类型：
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作者：
Landovitz, Raphael J.;Gildner, Jennifer L.;Leibowitz, Arleen A.
背景与HIV携带者发生性行为的男性具有较高的性传播感染(STI)发生率。因此，疾病控制和预防中心(CDC)建议至少每年对HIV感染者进行一次性传播感染筛查。方法我们计算了2010年拥有联邦医疗保险或医疗补助保险的HIV阳性加州人中梅毒、衣原体和淋病的检测率。Logistic回归估计了每种细菌性传播感染的检测与人口统计学和提供者因素的关系。结果2010年，不到三分之二的艾滋病毒阳性医疗保险和不到四分之三的医疗补助参与者接受了梅毒测试。筛查衣原体或淋病的频率较低：2010年，约有30%的医疗保险参与者接受了衣原体或淋病检测，但接受检测的医疗补助参与者比例较高(45%-46%)。在同一天，只有34%接受梅毒测试的艾滋病毒阳性医疗保险参与者也进行了衣原体或淋病筛查。近一半的医疗补助参与者在同一天接受了所有3种性传播感染的测试。结论尽管衣原体和淋病感染在HIV感染者中的感染率有所增加，而且与HIV的传播密切相关，但这些感染的检测率很低。增加STI检测的干预措施包括：在医疗记录中提示定期对抽血进行梅毒检测，以监测病毒载量，选择退出STI检测的同意，以及对提供者进行教育，使其了解STI在艾滋病毒阳性患者中的临床重要性。最后，改变阻碍直肠衣原体和淋病感染的核酸扩增检测的财务激励是至关重要的。
Background Men who have sex with men with HIV have high sexually transmitted infection (STI) incidence. Thus, the Centers for Disease Control and Prevention (CDC) recommends at least yearly STI screening of HIV-infected individuals.Methods We calculated testing rates for syphilis, chlamydia, and gonorrhea among HIV-positive Californians with Medicare or Medicaid insurance in 2010. Logistic regressions estimated how testing for each bacterial STI relates to demographic and provider factors.Results Fewer than two-thirds of HIV-positive Medicare and fewer than three-quarters of Medicaid enrollees received a syphilis test in 2010. Screenings for chlamydia or gonorrhea were less frequent: approximately 30% of Medicare enrollees were tested for chlamydia or gonorrhea in 2010, but higher proportions of Medicaid enrollees were tested (45%-46%). Only 34% of HIV-positive Medicare enrollees who were tested for syphilis were also screened for chlamydia or gonorrhea on the same day. Nearly half of Medicaid enrollees were tested for all 3 STIs on the same day. Patients whose providers had more HIV experience had higher STI testing rates.Conclusions Testing rates for chlamydia and gonorrhea infection are low, despite the increase in these infections among people living with HIV and their close association with HIV transmission. Interventions to increase STI testing include the following: prompts in the medical record to routinely conduct syphilis testing on blood drawn for viral load monitoring, opt-out consent for STI testing, and provider education about the clinical importance of STIs among HIV-positive patients. Last, it is crucial to change financial incentives that discourage nucleic acid amplification testing for rectal chlamydia and gonorrhea infections.