Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States
Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States
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DOI：
10.1001/jamainternmed.2013.6841
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发表时间：
2013-07-22
影响因子：
39
通讯作者：
Skarbinski, Jacek
中科院分区：
文献类型：
--
作者：
Hall, H. Irene;Frazier, Emma L.;Skarbinski, Jacek
重要性 人类免疫缺陷病毒 (HIV) 感染的早期诊断、及时联系和持续护理以及抗逆转录病毒治疗与降低个体发病率、死亡率和病毒传播有关。然而，这些指标的水平在艾滋病毒感染者群体之间可能有所不同。护理和治疗方面的差异可能会导致艾滋病毒感染率较高的群体中发病率较高。 目的 研究连续护理过程中关键步骤中按性别、年龄、种族/族裔和传播类别划分的艾滋病毒感染者群体之间的差异。 设计和设置 我们从疾病控制和预防中心的国家艾滋病毒监测系统获得数据，以确定了解和不知道自己的艾滋病毒感染者人数 使用反算模型进行感染。我们根据 CD4 水平和病毒载量测试结果计算了诊断后 3 个月内接受护理的人数百分比。我们使用医疗监测项目的数据估算了接受护理、接受抗逆转录病毒治疗和病毒抑制的人员的百分比，该项目是一个在选定地区接受艾滋病毒护理人员的监测系统，代表了美国所有此类人员。 参与者 美国所有艾滋病毒感染者。 主要结果和措施 结果 2009 年，美国估计有 1 148 200 名艾滋病毒感染者，其中 81.9% 已确诊，65.8% 需要接受护理，36.7% 需继续护理，32.7% 接受抗逆转录病毒治疗，25.3% 的病毒载量受到抑制（
IMPORTANCE Early diagnosis of human immunodeficiency virus (HIV) infection, prompt linkage to and sustained care, and antiretroviral therapy are associated with reduced individual morbidity, mortality, and transmission of the virus. However, levels of these indicators may differ among population groups with HIV. Disparities in care and treatment may contribute to the higher incidence rates among groups with higher prevalence of HIV.OBJECTIVE To examine differences between groups of persons living with HIV by sex, age, race/ethnicity, and transmission category at essential steps in the continuum of care.DESIGN AND SETTING We obtained data from the National HIV Surveillance System of the Centers for Disease Control and Prevention to determine the number of persons living with HIV who are aware and unaware of their infection using back-calculation models. We calculated the percentage of persons linked to care within 3 months of diagnosis on the basis of CD4 level and viral load test results. We estimated the percentages of persons retained in care, prescribed antiretroviral therapy, and with viral suppression using data from the Medical Monitoring Project, a surveillance system of persons receiving HIV care in select areas representative of all such persons in the United States.PARTICIPANTS All HIV-infected persons in the United States.MAIN OUTCOMES AND MEASURES Percentage of persons living with HIV who are aware of their infection, linked to care, retained in care, receiving antiretroviral therapy, and achieving viral suppression.RESULTS Of the estimated 1 148 200 persons living with HIV in 2009 in the United States, 81.9% had been diagnosed, 65.8% were linked to care, 36.7% were retained in care, 32.7% were prescribed antiretroviral therapy, and 25.3% had a suppressed viral load (