Trillion virion delay -: Time from testing positive for HIV to presentation for primary care
Trillion virion delay -: Time from testing positive for HIV to presentation for primary care
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DOI：
10.1001/archinte.158.7.734
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发表时间：
1998-04-13
影响因子：
--
通讯作者：
Hingson, R
中科院分区：
文献类型：
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作者：
Samet, JH;Freedberg, KA;Hingson, R
背景资料：人类免疫缺陷病毒（HIV）感染者的初步介绍，以医疗保健经常发生在先进的immunosuppress.Objectives点：调查艾滋病毒检测和介绍到初级保健之间的时间。还检查因素与延迟presentation.Methods：189个连续的门诊病人没有事先初级保健HIV感染进行了评估，在2个城市医院：波士顿市医院，波士顿，马萨诸塞州，和罗得岛医院，普罗维登斯。在双变量和多变量分析中，对社会人口统计学、酒精和药物使用、社会支持、性信仰和实践以及艾滋病毒检测问题进行了研究，以确定艾滋病毒检测结果呈阳性后延迟到初级保健的相关性。在189例患者中，74例（39%）延迟寻求初级保健超过1年，61例（32%）延迟超过2年，35例（18%）在HIV血清学初筛阳性后5年以上。受试者的中位CD 4（+）细胞计数为0.28 x 10（9）/L（范围：0.001-1.71 x 10（9）/L）。在多元线性回归分析中，发现以下特征与艾滋病毒检测后延迟到初级保健相关：（P <0.001）没有母亲（P = 0.01）没有配偶或伴侣（P = 0.08）;在检测前不知道HIV风险（P <0.001）;通过邮件或电话通知HIV状态（P = 0.002）。性别和酒精滥用筛查之间的交互作用是显着的（P = .03），并建议筛查结果阳性的男性延迟更长时间（CAGE [一种酒精中毒筛查问卷，包含4个结构化问题]，2+）与没有阳性筛查结果的男性或女性进行比较。艾滋病毒检测结果呈阳性的病人往往拖延一年多才开始接受初级医疗服务。在进行艾滋病毒检测时，有关药物滥用、社会支持和个人艾滋病毒风险状况的认识等方面的现成信息有助于确定哪些患者处于与初级保健无关的高风险之中。通过邮件或电话通知艾滋病毒感染状况的病人比亲自通知的病人拖延的时间要长得多。努力确保初级保健的联系，在通知阳性的艾滋病毒血清状态的时间是必要的，以最大限度地提高个人和公共卫生的好处，应该是一个明确的任务，测试后咨询。
Background: Human immunodeficiency virus (HIV)infected individuals' initial presentation to medical care frequently occurs at a point of advanced immunosuppression.Objectives: To investigate the time between HIV testing and presentation to primary care. Also to examine factors associated with delayed presentation.Methods: One hundred eighty-nine consecutive outpatients without prior primary care for HIV infection were assessed at 2 urban hospitals: Boston City Hospital, Boston, Mass, and Rhode Island Hospital, Providence. Sociodemographics, alcohol and drug use, social support, sexual beliefs and practices, and HIV testing issues were examined in bivariate and multivariate analyses for association with delay in presentation to primary care after positive test results for HIV.Results: Of 189 patients, 74 (39%) delayed seeking primary care for more than 1 year, 61 (32%) delayed for more than 2 years, and 35 (18%) for more than 5 years after an initial positive HIV serologic evaluation. The median CD4(+) cell count of subjects was 0.28 x 10(9)/L (range, 0.001-1.71 x 10(9)/L). In multiple linear regression analysis the following characteristics were found to be associated with delayed presentation to primary care after HIV testing: history of injection drug use (P < .001); not having a living mother (P = .01); not having a spouse or partner (P = .08); not being aware of HIV risk before testing (P < .001); and being notified of HIV status by mail or telephone (P = .002). An interaction effect between sex and screening for alcohol abuse was significant (P = .03) and suggested longer delays for men with positive screening test results (CAGE [an alcoholism screening questionnaire containing 4 structured questions], 2+) compared with men without positive screening test results or women.Conclusions: Patients with positive HIV test results often delay for more than a year before establishing primary medical care. Information readily available at the time of HIV testing concerning substance abuse, social support, and awareness of personal HIV risk status is useful in identifying patients who are at high risk of not linking with primary care. Patients who were notified of their HIV status by mail or telephone delayed considerably longer than those notified in person. Efforts to ensure primary care linkage at the time of notification of positive HIV serostatus are necessary to maximize benefits for both individual and public health and should be an explicit task of posttest counseling.