Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic
Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic
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DOI：
10.1097/00126334-200304010-00009
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发表时间：
2003-04-01
影响因子：
3.6
通讯作者：
Visnegarwala, F
中科院分区：
文献类型：
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作者：
Giordano, TP;White, AC;Visnegarwala, F
少数民族、女性和吸毒患者可能不太可能接受高效抗逆转录病毒治疗（HAART），尽管它已被证明是有益的。我们回顾了1998年在托马斯街诊所（Thomas Street Clinic）连续就诊的354名患者的医疗记录，托马斯街诊所是休斯顿一家学术附属的公共艾滋病毒专科诊所，以确定药房记录中未接受HAART治疗的相关因素。92名患者（26.0%）在至少6个月的随访期间未接受HAART治疗。未接受HAART治疗的患者更有可能是女性，错过了两次以上的医生预约，CD4细胞计数< 200细胞/毫升或病毒载量大于或等于10(5)拷贝/毫升的可能性更小。在多因素logistic分析中，错过预约（OR = 5.85, p < .0001）、女性（OR = 2.53, p = .001）和CD4计数大于或等于200细胞/ μ l （OR = 2.50, p = .001）是未接受HAART治疗的独立预测因素。超过一半从未接受过HAART治疗的患者在第一次预约后再也没有回到诊所。在新接受治疗的患者中，妇女和依从性差的患者接受HAART治疗的可能性较小。需要努力提高临床保留率，并进一步研究妇女使用HAART的障碍。
Ethnic minority, female, and drug-using patients may be less likely to receive highly active antiretroviral therapy (HAART), despite its proven benefits. We reviewed the medical records of a consecutive population of 354 patients entering care in 1998 at the Thomas Street Clinic, an academically affiliated, public, HIV-specialty clinic in Houston, to determine the factors associated with not receiving HAART as recorded in pharmacy records. Ninety-two patients (26.0%) did not receive HAART during at least 6 months of follow-up. Patients who did not receive HAART were more likely to be women and to have missed more than two physician appointments and were less likely to have a CD4 count < 200 cells/muL or a viral load greater than or equal to 10(5) copies/mL. In multivariate logistic analysis, missed appointments (OR = 5.85, p < .0001), female sex (OR = 2.53, p = .001), and CD4 count greater than or equal to 200 cells/muL (OR = 2.50, p = .001) were independent predictors of not receiving HAART. More than half the patients who never received HAART never returned to the clinic after their first appointment. Among patients new to care, women and those with poor appointment adherence were less likely to receive HAART. Efforts to improve clinic retention and further study of the barriers to HAART use in women are needed.