Missed Connections: HIV-Infected People Never in Care
Missed Connections: HIV-Infected People Never in Care
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DOI：
10.1177/003335491312800207
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发表时间：
2013-03-01
影响因子：
3.3
通讯作者：
Hart, Clyde
中科院分区：
文献类型：
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作者：
Bertolli, Jeanne;Garland, Pamela Morse;Hart, Clyde
Objective.如果更多的艾滋病毒诊断者得到艾滋病毒护理，延长艾滋病毒感染后的生命并大大减少传播的临床干预措施可能会产生更大的影响。我们测试了一种基于监督的方法来调查延迟进入护理的原因。三个州和两个城市的卫生部门工作人员联系了4至24个月前被诊断为艾滋病毒感染的合格成年人，他们没有报告CD4+淋巴细胞（CD4）或病毒载量（VL）检测。工作人员进行了面谈，进行了CD4和VL检测，并提供了艾滋病毒医疗服务的转诊。报告的CD4和VL测试进行了前瞻性监测，以确定受访者是否已进入护理后的采访。基于监测的后续行动发现了报告CD4和VL检测的问题，从而改善了监测。然而，报告问题导致了寻找已经在护理中的人的努力被浪费。由于监测病例记录中的联系信息往往过时或不正确，后续行动很困难。在这些人中，37%的人接受护理，29%的人拒绝参加。来自132人的信息访谈产生了改进服务的想法，如强调早期启动艾滋病毒护理的好处，在诊断后不久提供覆盖资格信息，并利用其他医疗预约提供与艾滋病毒护理联系的帮助。对与护理无关的艾滋病毒诊断个人进行基于监测的后续行动，提供了改善监测和联系服务的信息，但由于难以识别、定位和招募合格人员，效率低下。由于监测记录缺失、不完整或不准确而造成的不必要影响可能会随着数据质量的提高而减少。
Objective. Clinical interventions that lengthen life after HIV infection and significantly reduce transmission could have greater impact if more HIV-diagnosed people received HIV care. We tested a surveillance-based approach to investigating reasons for delayed entry to care.Methods. Health department staff in three states and two cities contacted eligible adults diagnosed with HIV four to 24 months previously who had no reported CD4+ lymphocyte (CD4) or viral load (VL) tests. The staff conducted interviews, performed CD4 and VL testing, and provided referrals to HIV medical care. Reported CD4 and VL tests were prospectively monitored to determine if respondents had entered care after the interview.Results. Surveillance-based follow-up uncovered problems with reporting CD4 and VL tests, resulting in surveillance improvements. However, reporting problems led to misspent effort locating people who were already in care. Follow-up proved difficult because contact information in surveillance case records was often outdated or incorrect. Of those reached, 37% were in care and 29% refused participation. Information from 132 people interviewed generated ideas for service improvements, such as emphasizing the benefits of early initiation of HIV care, providing coverage eligibility information soon after diagnosis, and leveraging other medical appointments to provide assistance with linkage to HIV care.Conclusions. Surveillance-based follow-up of HIV-diagnosed individuals not linked to care provided information to improve both surveillance and linkage services, but was inefficient because of difficulties identifying, locating, and recruiting eligible people. Inefficiencies attributable to missing, incomplete, or inaccurate surveillance records are likely to diminish as data quality is improved through ongoing use.