Barriers to recommended gynecologic care in an urban United States HIV clinic.
Barriers to recommended gynecologic care in an urban United States HIV clinic.
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在美国城市艾滋病毒诊所推荐妇科护理的障碍。
DOI：
10.1089/jwh.2009.1670
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Chander,Geetanjali
中科院分区：
文献类型：
--
作者：
Tello,MoniqueA;Jenckes,Mollie;Gaver,Jennifer;Anderson,JeanR;Moore,RichardD;Chander,Geetanjali
背景：尽管宫颈细胞学异常的风险增加，但感染艾滋病毒的女性经常错过妇科预约。我们调查了在城市 HIV 诊所接受妇科护理的障碍。方法：我们对在城市 HIV 诊所接受妇科服务的 200 名妇女进行了横断面调查，随后进行了焦点小组调查。主要结局包括 (1) 错过妇科预约和 (2) 去年接受过子宫颈抹片检查。自变量包括社会人口特征、儿童保育责任、物质使用、抑郁症状、社会支持、人际暴力、CD4 计数和 HIV-1 RNA。我们进行了多变量逻辑回归来检查自变量和结果之间的关联。然后，我们举行了两个焦点小组，旨在收集意见并加深我们对调查主要结果的理解。结果：在 200 名女性中，69% 的女性至少错过了一次妇科预约，22% 的女性在过去一年中没有进行子宫颈抹片检查。在逻辑回归中，中度（比值比 [OR] 3.1，95% 置信区间 [CI] 1.4-6.7）和重度（OR 3.1，95% CI 1.3-7.5）抑郁症状和过去一个月的物质使用（OR 2.3，95% CI 1.0-5.3）与上一年错过预约有关。与高中或更高学历相比，教育水平低于高中（OR 0.3，95% CI 0.1-0.6）与上一年未进行子宫颈抹片检查有关。当分析仅限于有子宫颈的女性 (n= 166) 时，中度 (OR 2.5，95% CI 1.1-5.7) 和重度 (OR 2.5，95% CI 1.0-6.3) 抑郁系统仍然与前一年错过妇科预约和年龄 > 50 岁 (OR 0.3，95% CI 0.1-0.9) 显着相关，HIV-1 RNA > 50（OR 0.4，95% CI 0.2-0.9）和教育水平低于高中（OR 0.2，95% CI 0.1-0.5）与过去 12 个月内未进行子宫颈抹片检查有关。对焦点小组数据的定性分析表明，恐惧、恶劣天气和忘记预约可能会导致错过妇科预约。结论：艾滋病毒感染女性中妇科医疗保健未得到充分利用。我们发现抑郁症状、药物滥用、害怕妇科检查以及忘记预约可能是妇科护理的障碍。针对这些障碍的干预措施可能会改善该人群对妇科护理的使用。
Background:Despite an increased risk for cervical cytologic abnormalities, HIV-infected women frequently miss their gynecology appointments. We examined barriers to adherence with gynecologic care in an urban HIV clinic.Methods:We conducted a cross-sectional survey of 200 women receiving gynecologic services in an urban HIV clinic, followed by focus groups. Primary outcomes included (1) missed gynecology appointments and (2) receipt of a Pap smear in the previous year. Independent variables included sociodemographic characteristics, child care responsibilities, substance use, depressive symptoms, social support, interpersonal violence, CD4 count, and HIV-1 RNA. We conducted multivariable logistic regression to examine associations between independent variables and outcomes. We then held two focus groups designed to gather opinions on and increase our understanding of the key findings from the survey.Results:Of 200 women, 69% missed at least one gynecology appointment, and 22% had no Pap smear in the past year. In logistic regression, moderate (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.4-6.7) and severe (OR 3.1, 95% CI 1.3-7.5) depressive symptoms and past-month substance use (OR 2.3, 95% CI 1.0-5.3) were associated with missing an appointment in the prior year. An education level of less than high school (OR 0.3, 95% CI 0.1-0.6) compared with high school diploma or greater was associated with not having a Pap smear in the previous year. When analyses were limited to women with a cervix (n= 166), moderate (OR 2.5, 95% CI 1.1-5.7) and severe (OR 2.5, 95% CI 1.0-6.3) depressive systems remained significantly associated with missing a gynecology appointment in the previous year and age >50 (OR 0.3, 95% CI 0.1-0.9), an HIV-1 RNA > 50 (OR 0.4, 95% CI 0.2-0.9), and education level less than high school (OR 0.2, 95% CI 0.1-0.5) were associated with not having a Pap smear in the past 12 months. Qualitative analysis of the focus group data suggested that fear, inclement weather, and forgetting appointments may contribute to missed gynecology appointments.Conclusion:Gynecologic healthcare is underused among HIV-infected women. We found that depressive symptoms, substance use, fear of the gynecologic examination, and simply forgetting about the appointment may be barriers to gynecologic care. Interventions targeting these barriers may improve use of gynecologic care among this population.
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