Barriers to Bacterial Sexually Transmitted Infection Testing of HIV-Infected Men Who Have Sex With Men Engaged in HIV Primary Care.
Barriers to Bacterial Sexually Transmitted Infection Testing of HIV-Infected Men Who Have Sex With Men Engaged in HIV Primary Care.
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DOI：
10.1097/olq.0000000000000320
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发表时间：
2015-10
影响因子：
3.1
通讯作者：
Marrazzo JM
中科院分区：
文献类型：
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作者：
Barbee LA;Dhanireddy S;Tat SA;Marrazzo JM
在过去一年中，大约15%的艾滋病毒感染的男男性行为者在艾滋病毒初级保健中被诊断患有性传播感染，但性传播感染检测频率仍然很低。我们试图量化一家大型城市艾滋病护理诊所的STI检测频率，并确定增加STI检测的患者和提供者相关障碍。我们从电子病历中提取实验室数据，计算STI检测频率（定义为在18个月内至少接受一次检测的艾滋病毒感染MSM人数除以从事护理的MSM人数）。我们对患者和提供者进行了匿名调查，以找出障碍。生殖道外淋病和衣原体检测率较低（29%-32%），但梅毒检测率较高（72%）。患者经常报告高风险行为，包括吸毒（16.4%）和近期细菌性STI（25.5%），以及近期检测率（前6个月>60%）。大多数人（72%）报告在艾滋病毒初级保健中进行了性传播感染检测，但三分之一的人去其他地方进行“更容易”（42%）、匿名（21%）或更频繁（16%）的检测。艾滋病毒初级保健提供者缺乏检测和治疗知识（25-32%），并表示缺乏时间（68%），对性史和生殖器检查感到不适（21%）以及患者不情愿（39%）是增加性传播感染检测的障碍。艾滋病毒护理中的性传播感染检测仍然低得令人无法接受。需要加强对提供者的教育，沿着采取减少提供者时间和增加患者舒适度以及性传播感染检测频率的战略。
Approximately 15% of HIV-infected MSM engaged in HIV primary care have been diagnosed with an STI in the past year, yet STI testing frequency remains low. We sought to quantify STI testing frequencies at a large, urban HIV care clinic, and to identify patient- and provider-related barriers to increased STI testing. We extracted laboratory data in aggregate from the electronic medical record to calculate STI testing frequencies (defined as the number of HIV-infected MSM engaged in care who were tested at least once over an 18-month period divided by the number of MSM engaged in care). We created anonymous surveys of patients and providers to elicit barriers. Extra-genital gonorrhea and chlamydia testing were low (29%–32%), but the frequency of syphilis testing was higher (72%). Patients frequently reported high-risk behaviors, including drug use (16.4%) and recent bacterial STI (25.5%), as well as substantial rates of recent testing (>60% in prior 6 months). Most (72%) reported testing for STI in HIV primary care, but one-third went elsewhere for “easier” (42%), anonymous (21%) or more frequent (16%) testing. HIV primary care providers lacked testing and treatment knowledge (25–32%), and cited lack of time (68%), discomfort with sexual history taking and genital exam (21%), and patient reluctance (39%) as barriers to increased STI testing. STI testing in HIV care remains unacceptably low. Enhanced education of providers, along with strategies to decrease provider time and increase patient ease and frequency of STI testing, are needed.