Diagnosing HIV Infection in Primary Care Settings: Missed Opportunities
Diagnosing HIV Infection in Primary Care Settings: Missed Opportunities
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DOI：
10.1089/apc.2013.0099
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发表时间：
2013-07-01
影响因子：
4.9
通讯作者：
McKellar, Mehri
中科院分区：
文献类型：
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作者：
Chin, Tammy;Hicks, Charles;McKellar, Mehri
在美国，20%的艾滋病毒感染者不知道他们的诊断。在医疗机构中改进艾滋病毒筛查建议的应用可能有助于诊断。从北卡罗来纳州达勒姆县新诊断的HIV感染者的病历中审查了临床患者数据和既往医疗访视，这些人于2008-2011年在杜克大学医学中心开始接受HIV护理。使用Pearson卡方检验和logistic回归对2002-2004年的类似数据进行比较。确定了101例连续新诊断患者：67例男性; 73例黑人，20例白色和8例西班牙裔/拉丁裔。平均年龄为39岁（范围，17-69），73人有健康保险。中位基线CD 4计数为313个细胞/μ L（范围，4-1302），HIV-1病毒载量为45，700拷贝/mL（范围，165- 10，000，000）。三分之一的基线CD 4计数= 1次既往访视，47例≥ 2次访视。在既往就诊的患者中，37/72（51%）在第一次或第二次就诊时在急诊科就诊。男性在首次就诊时被诊断的可能性是女性的三倍（p = 0.03，OR=3.2）。尽管CDC建议在医疗机构中广泛进行艾滋病毒筛查，但艾滋病毒诊断仍然延迟，即使是在那些经常接触医疗保健的人中。教育提供者和消除艾滋病毒筛查的障碍可能会改善这一问题。
In the United States, 20% of HIV-infected persons are unaware of their diagnosis. Improved application of HIV screening recommendations in healthcare settings may facilitate diagnosis. Clinical patient data and previous healthcare visits were reviewed from medical records of newly diagnosed HIV-infected persons in Durham County, North Carolina, who initiated HIV care at Duke University Medical Center in 2008-2011. Comparisons were made to similar data from 2002-2004 using the Pearson's chi-square test and logistic regression. 101 consecutive newly diagnosed patients were identified: 67 males; 73 black, 20 white, and 8 Hispanic/Latino. Mean age was 39 years (range, 17-69), and 73 had health insurance. Median baseline CD4 count was 313 cells/mu L (range, 4-1302), and HIV-1 viral load was 45,700 copies/mL (range, 165-10,000,000). One-third had a baseline CD4 count = 1 prior visits, and 47 had >= 2 visits. Among those with prior visits, 37/72 (51%) were seen in an emergency department on the first or second visit. Men were three times more likely than women to be diagnosed at their first healthcare encounter (p = 0.03, OR=3.2). Despite CDC recommendations for widespread HIV screening in healthcare settings, HIV diagnosis remains delayed, even among those with frequent healthcare encounters. Educating providers and removing barriers to HIV screening may improve this problem.