by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
October 22, 2019
Short, W. et al. Use of Recommended Preventive Health Care Services and Variations in HIV Care among Women with HIV in the United States, 2013–2014. Opportunities for Expanded Partnerships in Support of Ending the HIV Epidemic
JAIDS Nov 1, 2019;82(3):234–244. doi: 10.1097/QAI.0000000000002141
Along with maintaining patients on effective ART, preventive care and health screening interventions are indicated for the majority of persons living with HIV. Recommendations for preventive health services are issued regularly by various national organizations including the USPSTF, CDC, and other professional societies. There is limited data in regards to how often women who are receiving HIV care are also getting comprehensive medical care. This study used data from the CDC Medical Monitoring Project for the years 2013-2014. The authors used various statistical methods to look at the associations between preventive health screenings, routine HIV care (using CD4 count and viral load measure as proxies), and sociodemographic factors. The study included 2766 women of whom almost half (48%) were 50 years and older. In terms of other demographics, 62% were non-Hispanic black, 68% were living below the federal poverty level, 67% had public health insurance and 37% had greater than a high school education. Regarding HIV treatment, 94% were prescribed ART of whom only 66% had sustained viral suppression at 12 months. Among women in this cohort who were at least 18 years of age or older, 44% were screened for cervical cancer, 28% had breast cancer screening, and 35% were screened for STIs. Twenty-six percent did not meet 6-month, and 37% did not meet 12-month intervals for obtaining CD4 counts and viral load testing. In multivariable analyses, women with no viral load testing in the past 6 months were less likely to have viral suppression. The authors note that the delivery of preventive health care in these women was suboptimal and cite the need for interventions to improve uptake and implementation.
Overall, these data are rather discouraging but also are 5 to 6 years old so I am optimistic that most HIV clinical programs, in particular those that are Ryan White funded are doing better than this cohort of women from the MMP. Newer guidelines have lessened the frequency for mammography and PAP smears which may also improve these data regarding the percent of women screened. However, less frequent visits for CD4 and viral load monitoring – usually every 6 months, make it more challenging to perform all preventive services (including immunizations) at one office visit. Having CQI programs in place that include chart auditing and call-back systems as part of standard office practice are interventions that should help improve these numbers.
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