The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa.
The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa.
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DOI：
10.1097/qai.0000000000001445
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发表时间：
2017-08-15
期刊：
影响因子：
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通讯作者：
Gaziano TA
中科院分区：
文献类型：
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作者：
Manne-Goehler J;Montana L;Gómez-Olivé FX;Rohr J;Harling G;Wagner RG;Wade A;Kabudula CW;Geldsetzer P;Kahn K;Tollman S;Berkman LF;Bärnighausen TW;Gaziano TA
在艾滋病毒阳性人群中，糖尿病和高血压的患病率有所上升，但人们对抗逆转录病毒治疗方案在为这些疾病提供服务方面所起的作用了解有限。本研究的目的是评估抗逆转录病毒治疗与糖尿病和高血压患者医疗服务利用之间的关系。非洲的健康与老龄化：对南非INDEPTH社区的纵向研究是一项5,059名成年人的队列研究。基线研究收集了关于艾滋病毒、抗逆转录病毒治疗、糖尿病和高血压的基于生物标志物的数据，以及关于医疗保健利用的自我报告数据。我们计算了HIV和ART状态对糖尿病和高血压护理利用的差异，并使用多变量logistic回归来估计ART使用与这些条件下服务利用之间的关系，控制年龄、性别、体重指数（BMI）、教育和家庭财富五分位数。hiv阳性人群的平均年龄、BMI、高血压和糖尿病患病率较低（均p<0.001）。多变量logistic回归显示，ART的使用与血压（aOR 1.27 95% CI 1.04-1.55）、血糖测量（aOR 1.26, 95% CI 1.05-1.51）、运动咨询（aOR 1.57, 95% CI 1.11-2.22）、高血压诊断意识（aOR 1.52, 95% CI 1.12-2.05）和高血压治疗（aOR 1.63, 95% CI 1.21-2.19）显著相关。使用抗逆转录病毒治疗的艾滋病毒阳性患者更有可能接受过糖尿病和高血压的医疗保健服务。这种明显的抗逆转录病毒治疗优势表明，抗逆转录病毒治疗方案可能是加强慢性病护理卫生系统的一种手段。
The prevalence of diabetes and hypertension has increased in HIV-positive populations but there is limited understanding of the role that ART programs play in the delivery of services for these conditions. The aim of this study is to assess the relationship between ART use and utilization of healthcare services for diabetes and hypertension. Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa is a cohort of 5,059 adults. The baseline study collects biomarker-based data on HIV, ART, diabetes and hypertension and self-reported data on healthcare utilization. We calculated differences in care utilization for diabetes and hypertension by HIV and ART status and used multivariable logistic regressions to estimate the relationship between ART use and utilization of services for these conditions, controlling for age, sex, body mass index (BMI), education and household wealth quintile. Mean age, BMI, hypertension and diabetes prevalence were lower in the HIV-positive population (all p<0.001). Multivariable logistic regression showed that ART use was significantly associated with greater odds of blood pressure (aOR 1.27 95% CI 1.04–1.55) and blood sugar measurement (aOR 1.26, 95% CI 1.05–1.51), counseling regarding exercise (aOR 1.57, 95% CI 1.11–2.22), awareness of hypertension diagnosis (aOR 1.52, 95% CI 1.12–2.05) and treatment for hypertension (aOR 1.63, 95% CI 1.21–2.19). HIV-positive patients who use ART are more likely to have received healthcare services for diabetes and hypertension. This apparent ART advantage suggests that ART programs may be a vehicle for strengthening health systems for chronic care.