The Clinical Implications of High Rates of Intimate Partner Violence Against HIV-Positive Women
The Clinical Implications of High Rates of Intimate Partner Violence Against HIV-Positive Women
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DOI：
10.1097/qai.0b013e31829bb007
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发表时间：
2013-09-01
影响因子：
3.6
通讯作者：
Gill, M. John
中科院分区：
文献类型：
--
作者：
Siemieniuk, Reed A. C.;Krentz, Hartmut B.;Gill, M. John
简介：亲密伴侣暴力（IPV）与妇女感染艾滋病毒的风险增加有关，然而，IPV是否影响艾滋病毒感染后的结果尚不确定。我们评估IPV对HIV阳性women.Methods的影响：所有艾滋病毒阳性的妇女谁接受门诊艾滋病毒护理在南部阿尔伯塔2009年3月至2012年1月进行了IPV筛查。与IPV的社会人口因素，健康相关的生活质量，临床状态，和住院的关联，从区域数据库和多变量回归analysis.Results评估：筛选的339名妇女，137（40.4%）报告经历IPV。暴露IPV者吸烟率较高[校正患病率（APR）= 5.07; 95%可信区间（CI）：2.72 - 9.43];（APR = 7.58; CI：2.45 - 23.26）;有监禁史（APR = 4.84，CI：1.85至12.68）;抑郁症（APR = 2.50，CI：1.15至5.46）;和焦虑症（APR = 5.75，CI：2.10至15.63）。IPV降低了健康相关生活质量（APR = 2.94，CI：1.40 - 6.16），分别为差/一般与非常好/极好。暴露于IPV的女性每1000患者年住院256次，而未暴露于IPV的女性每1000患者年住院166次（P < 0.001）。与HIV无关的住院（APR = 1.42，CI：1.16 - 1.73）和门诊HIV护理开始后与HIV相关的住院（APR = 2.19，CI：1.01 - 4.85）的相对风险增加。可修改的贡献者的不良结果包括减少使用抗逆转录病毒治疗（APR = 0.55，CI：0.34至0.91）和额外的中断护理超过1年（APR = 1.90，CI：1.07至3.39）。结论：IPV与有害的HIV相关和HIV无关的健康结果，其中，次优的参与护理是一个贡献者。为了改善结果，从业人员应致力于增加对这些妇女的照顾。
Introduction: Intimate partner violence (IPV) is associated with increased risk of HIV infection among women, however, whether IPV affects outcomes after HIV infection is uncertain. We assess the impact of IPV on HIV-positive women.Methods: All HIV-positive women who received outpatient HIV care in southern Alberta between March 2009 and January 2012 were screened for IPV. The associations with IPV of sociodemographic factors, health-related quality of life, clinical status, and hospitalizations were obtained from a regional database and evaluated with multivariable regression analysis.Results: Of 339 women screened, 137 (40.4%) reported experiencing IPV. Those disclosing IPV had higher rates of smoking [ adjusted prevalence ratio (APR) = 5.07; 95% confidence interval (CI): 2.72 to 9.43]; illicit drug use (APR = 7.58; CI: 2.45 to 23.26); a history of incarceration (APR = 4.84, CI: 1.85 to 12.68); depression (APR = 2.50, CI: 1.15 to 5.46); and anxiety disorders (APR = 5.75, CI: 2.10 to 15.63). Health-related quality of life was diminished with IPV (APR = 2.94, CI: 1.40 to 6.16) for poor/fair versus very good/excellent. IPV-exposed women were hospitalized 256 times per 1000 patient-years compared to 166/1000 patient-years among IPV-unexposed (P < 0.001) women. The relative risk was increased for HIV-unrelated hospitalizations (APR = 1.42, CI: 1.16 to 1.73) and for HIV-related hospitalizations after outpatient HIV care was initiated (APR = 2.19, CI: 1.01 to 4.85). Modifiable contributors to the poor outcomes included decreased use of antiretroviral therapy (APR = 0.55, CI: 0.34 to 0.91) and additional interruptions in care longer than 1 year (APR = 1.90, CI: 1.07 to 3.39).Conclusions: IPV is associated with deleterious HIV-related and HIV-unrelated health outcomes, of which, suboptimal engagement in care is a contributor. To improve outcomes, practitioners should aim to increase engagement in care of these women in particular.