HIV Care Continuum for HIV-Infected Emergency Department Patients in an Inner-City Academic Emergency Department
HIV Care Continuum for HIV-Infected Emergency Department Patients in an Inner-City Academic Emergency Department
复制标题
DOI：
10.1016/j.annemergmed.2015.01.001
复制
发表时间：
2015-07-01
影响因子：
6.2
通讯作者：
Rothman, Richard E.
中科院分区：
文献类型：
--
作者：
Hsieh, Yu-Hsiang;Kelen, Gabor D.;Rothman, Richard E.
研究目的：最近发布的艾滋病毒护理连续倡议是国家艾滋病战略的基石，也是改善艾滋病毒感染者护理的模式。据我们所知，没有研究探索急诊科（艾德）患者的整个HIV护理连续体。我们确定在艾滋病毒护理连续体的差距，以确定潜在的机会，改善护理艾滋病毒感染的艾德patient.Methods：混合方法的方法被用于在2007年1内城艾德。数据元素来自identityunlinked HIV血清阳性率研究，一个正在进行的非靶向HIV筛查计划，和已知的HIV阳性艾德patients.Results的结构化调查：3,417独特的艾德患者的身份unlinked测试发现，265（7.8%）是HIV阳性。在HIV检测呈阳性的患者中，73%的患者曾接受过既往诊断（基于自我报告、病历审查或血清中存在抗逆转录病毒药物），但只有61%的患者被临床医生确认为HIV感染（基于自我报告或病历审查）。在检测呈阳性的患者中，43%与护理有关，39%继续接受护理，27%正在接受抗逆转录病毒治疗，26%知道自己正在接受抗逆转录病毒治疗，22%病毒抑制，只有9%自我意识到自己的病毒抑制。据我们所知，这项研究是第一个量化的差距，艾滋病毒护理的艾德患者人群，艾滋病毒护理连续作为一个框架。我们的研究结果确定了不同的阶段（即检测，提供者对艾滋病毒诊断的认识，以及与护理的联系），如果分配了适当的资源，这些阶段存在最大的干预机会。这种模式可以作为其他惰性可治疗疾病的模式，经常观察到的ED，其中护理的连续性是至关重要的。
Study objective: The recently released HIV Care Continuum Initiative is a cornerstone of the National AIDS Strategy and a model for improving care for those living with HIV. To our knowledge, there are no studies exploring the entirety of the HIV Care Continuum for patients in the emergency department (ED). We determine gaps in the HIV Care Continuum to identify potential opportunities for improved care for HIV-infected ED patients.Methods: A mixed-methods approach was used in 1 inner-city ED in 2007. Data elements were derived from an identityunlinked HIV seroprevalence study, an ongoing nontargeted HIV screening program, and a structured survey of known HIV-positive ED patients.Results: Identity-unlinked testing of 3,417 unique ED patients found that 265 (7.8%) were HIV positive. Of patients testing HIV positive, 73% had received a previous diagnosis (based on self-report, chart review, or presence of antiretrovirals in serum), but only 61% were recognized by the clinician as being HIV infected (based on self-report or chart review). Of patients testing positive, 43% were linked to care, 39% were retained in care, 27% were receiving antiretrovirals, 26% were aware of their receiving antiretroviral treatment, 22% were virally suppressed, and only 9% were self-aware of their viral suppression.Conclusion: To our knowledge, this study is the first to quantify gaps in HIV care for an ED patient population, with the HIV Care Continuum as a framework. Our findings identified distinct phases (ie, testing, provider awareness of HIV diagnosis, and linkage to care) in which the greatest opportunities for intervention exist, if appropriate resources were allocated. This schema could serve as a model for other indolent treatable diseases frequently observed in EDs, where continuity of care is critical.