Temporal Trends in Presentation for Outpatient HIV Medical Care 2000-010: Implications for Short-term Mortality

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• 作者：Paula S. Seal MD ; MPH (1)
  David A. Jackson MD (1)
  Eric Chamot PhD (2)
  James H. Willig MD (1)
  Christa R. Nevin MSPH (1)
  Jeroan J. Allison MD ; MSc (3)
  James L. Raper DSN ; CRNP ; JD (1)
  Mirjam C. Kempf PhD ; MPH (2)
  Joseph E. Schumacher PhD (4)
  Michael S. Saag MD (1)
  Michael J. Mugavero MD ; MHSc (1)
  
• 关键词：HIV ; HIV testing ; mortality ; disparity ; health policy
• 刊名：Journal of General Internal Medicine
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：26
• 期：7
• 页码：745-750
• 全文大小：205KB
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• 作者单位：Paula S. Seal MD, MPH (1)
  David A. Jackson MD (1)
  Eric Chamot PhD (2)
  James H. Willig MD (1)
  Christa R. Nevin MSPH (1)
  Jeroan J. Allison MD, MSc (3)
  James L. Raper DSN, CRNP, JD (1)
  Mirjam C. Kempf PhD, MPH (2)
  Joseph E. Schumacher PhD (4)
  Michael S. Saag MD (1)
  Michael J. Mugavero MD, MHSc (1)
  
  1. Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, CCB 142, 908 20th Street So, Birmingham, AL, 35294-050, USA
  2. School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
  3. Center for Clinical and Translational Science, Department of Quantitative Health Science, University of Massachusetts, Worcester, MA, USA
  4. Department of Internal Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
  

文摘

Background Many newly diagnosed patients present to outpatient care with advanced HIV infection. More timely HIV diagnosis and initiation of care has the potential to improve individual health outcomes and has public health implications. Objective To assess temporal trends in late presentation for outpatient HIV medial care as measured by CD4 count <200 cells/mm3 and the implications on short-term (1-year) mortality. Design We conducted a cohort study nested in a prospective HIV clinical cohort including patients establishing initial outpatient HIV treatment between 2000-010. Time series regression analysis evaluated temporal trends in late presentation for care measured by the proportion of patients with a CD4 count <200 cells/mm3 or an opportunistic infection at enrollment, and also evaluated trends in short-term mortality. Participants Patients establishing initial outpatient HIV treatment between 2000-010 at an academic HIV clinic. Main Measures The proportion of patients with a CD4 count <200 cells/mm3 or an opportunistic infection at initial presentation and short-term (1-year) mortality following clinic enrollment. Key Results Among 1121 patients, 41% had an initial CD4 count <200 cells/mm3, 25% had an opportunistic infection and 2.4% died within 1-year of their initial visit. Time series regression analysis demonstrated significant reductions in late presentation for HIV care and decreases in short-term mortality with temporal improvement preceding updated CDC HIV testing recommendations. Conclusion We observed a significant decline in the number of patients presenting for outpatient HIV care with advanced disease, particularly in 2006-010. A significant trend in improved short-term survival among patients establishing HIV care was also observed, likely related to more timely presentation for outpatient care in more recent years.