背景:在摩洛哥,在2011年估计的29,000名艾滋病毒感染者中,只有20%知道自己的艾滋病毒状况。超过一半的诊断处于艾滋病阶段。我们假设那些不知道自己感染的人与医疗保健系统接触过HIV指标,这可能会促使医疗保健提供者提供测试。目的是评估在摩洛哥获得护理的新诊断为艾滋病毒的患者中错过的艾滋病毒检测机会。
方法:2012-2013年在六个摩洛哥艾滋病毒中心进行了一项横断面研究。参与者年龄≥18岁,并在HIV诊断后6个月内寻求治疗。在面对面访谈期间管理的标准化问卷收集了患者在HIV诊断时的特征,HIV检测和病史。在HIV诊断之前的3年内评估了与护理的接触和临床状况的发生。在此期间,我们评估了医疗服务提供者是否向患有HIV相关临床或行为状况的患者提供了HIV检测.
结果:我们招募了650名新诊断为HIV的患者(中位年龄:35岁,女性:55%,异性恋者:81%,诊断为AIDS或CD4<200细胞/mm3:63%)。在HIV诊断之前的3年内,71%(n=463)的参与者与医疗系统有≥1次接触。在323名患有HIV相关临床疾病的人中,22%的人没有为他们寻求护理,9%的人寻求护理并接受了医疗保健提供者的艾滋病毒检测。其余69%的人没有接受检测,被认为错过了艾滋病毒检测的机会。与男人发生性关系的男人,83%的人没有向他们的医疗保健提供者解决他们的性行为,11%的人没有接受艾滋病毒检测,而6%的人在向提供者报告性行为后接受了艾滋病毒检测。
结论:在可能感染期间实际寻求治疗的人群中,许多艾滋病毒检测的机会,基于高危行为或临床体征,错过了。这突出表明需要提高医师对艾滋病毒临床指标的认可度,进一步扩大非专业提供者基于社区的艾滋病毒检测,并实施自我测试,以增加可访问性和隐私性。
BACKGROUND: In Morocco, of the estimated 29,000 people living with HIV in 2011, only 20% were aware of their HIV status. More than half of diagnoses were at the AIDS stage. We assumed that people who were unaware of their infection had contacts with the healthcare system for HIV indicators that might prompt the healthcare provider to offer a test. The aim was to assess missed opportunities for HIV testing in patients newly diagnosed with HIV who accessed care in Morocco.
METHODS: A cross-sectional study was conducted in 2012-2013 in six Moroccan HIV centers. Participants were aged ≥18, and had sought care within 6 months after their HIV diagnosis. A standardized questionnaire administered during a face-to-face interview collected the patient\'s characteristics at HIV diagnosis, HIV testing and medical history. Contacts with care and the occurrence of clinical conditions were assessed during the 3 years prior to HIV diagnosis. Over this period, we assessed whether healthcare providers had offered HIV testing to patients with HIV-related clinical or behavioral conditions.
RESULTS: We enrolled 650 newly HIV-diagnosed patients (median age: 35, women: 55%, heterosexuals: 81%, diagnosed with AIDS or CD4 < 200 cells/mm3: 63%). During the 3 years prior to the HIV diagnosis, 71% (n = 463) of participants had ≥1 contact with the healthcare system. Of 323 people with HIV-related clinical conditions, 22% did not seek care for them and 9% sought care and were offered an HIV test by a healthcare provider. The remaining 69% were not offered a test and were considered as missed opportunities for HIV testing. Of men who have sex with men, 83% did not address their sexual behavior with their healthcare provider, 11% were not offered HIV testing, while 6% were offered HIV testing after reporting their sexual behavior to their provider.
CONCLUSIONS: Among people who actually sought care during the period of probable infection, many opportunities for HIV testing, based on at-risk behaviors or clinical signs, were missed. This highlights the need to improve the recognition of HIV clinical indicators by physicians, further expand community-based HIV testing by lay providers, and implement self-testing to increase accessibility and privacy.