From Access to Engagement: Measuring Retention in Outpatient HIV Clinical Care
From Access to Engagement: Measuring Retention in Outpatient HIV Clinical Care
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DOI：
10.1089/apc.2010.0086
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发表时间：
2010-10-01
影响因子：
4.9
通讯作者：
Giordano, Thomas P.
中科院分区：
文献类型：
--
作者：
Mugavero, Michael J.;Davila, Jessica A.;Giordano, Thomas P.
人们日益认识到，参与艾滋病毒护理是最大限度提高患者个体治疗效果的关键步骤。最近更新的艾滋病毒医学协会艾滋病毒初级保健指南包括一项新的建议，强调将坚持治疗范围从抗逆转录病毒药物扩展到坚持临床护理的重要性。除了个人健康之外，强调对艾滋病毒预防采取“检测和治疗”的做法，突出了参与临床护理在公共卫生方面的重要性，作为普遍艾滋病毒检测（“检测”）和普遍抗逆转录病毒治疗（“治疗”）之间的重要中介。想要系统地评估HIV临床参与的管理者、研究人员和临床医生面临的一个挑战是决定如何衡量护理中的保留。测量保留率是复杂的，因为这个过程包括多次门诊访问（重复测量），随着时间的推移而纵向发生。本文综合了艾滋病毒护理中常用的五种保留措施，强调了它们在方法和概念上的优势和局限性，并提出了某些措施可能优于其他措施的情况。这五项指标分别是失诊率、预约依从性、就诊持续性、护理差距以及人力资源和服务管理局艾滋病毒/艾滋病局（HRSA HAB）艾滋病毒护理保留绩效指标。正如在抗逆转录病毒药物依从性方面所指出的那样，没有金标准来衡量护理中的保留情况，应考虑每种措施的优点和局限性，特别是在期望应用的情况下，指导选择保留措施。
Engagement in HIV care is increasingly recognized as a crucial step in maximizing individual patient outcomes. The recently updated HIV Medicine Association primary HIV care guidelines include a new recommendation highlighting the importance of extending adherence beyond antiretroviral medications to include adherence to clinical care. Beyond individual health, emphasis on a "test and treat'' approach to HIV prevention highlights the public health importance of engagement in clinical care as an essential intermediary between the putative benefits of universal HIV testing ("test'') followed by ubiquitous antiretroviral treatment ("treat''). One challenge to administrators, researchers and clinicians who want to systematically evaluate HIV clinical engagement is deciding on how to measure retention in care. Measuring retention is complex as this process includes multiple clinic visits (repeated measures) occurring longitudinally over time. This article provides a synthesis of five commonly used measures of retention in HIV care, highlighting their methodological and conceptual strengths and limitations, and suggesting situations where certain measures may be preferred over others. The five measures are missed visits, appointment adherence, visit constancy, gaps in care, and the Human Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) performance measure for retention in HIV care. As has been noted for antiretroviral medication adherence, there is no gold standard to measure retention in care, and consideration of the advantages and limitations of each measure, particularly in the context of the desired application, should guide selection of a retention measure.