摘要
在这项研究中,我们对一群同性恋男性中使用预防治疗特定呼吸道疾病的模式进行了描述,并评估了有针对性的反馈对这些疾病指南依从性水平的影响。所有人类免疫缺陷病毒血清阴性(HIV-) (n=169)和获得性免疫缺陷综合征(AIDS)无人类免疫缺陷病毒血清阳性(HIV+) (n=154)的参与者在我们的队列中被确定,他们在1989年10月至1993年12月期间完成了每年4次的访问。每年获取每个受试者关于纯化蛋白衍生物(PPD)(结核菌素)检测使用、肺炎球菌疫苗接种史、流感疫苗接种、卡氏肺孢子虫肺炎(PCP)预防使用、症状和CD4计数的信息。1992年,参与的医生收到了关于遵守当代预防呼吸系统疾病准则的总体水平的反馈。作为这项工作的一部分,分发和讨论了指导方针。在研究期间,接受PPD检测的HIV阳性患者的百分比从43%增加到65% (p=0.001)。接受PPD检测的HIV+患者明显多于HIV-患者(p<0.001)。总共有144名(94%)艾滋病毒阳性男性接受了至少一次流感疫苗接种,相比之下,60名(35%)艾滋病毒阳性男性(p<0.001)。HIV阳性组的流感疫苗使用率从1992年的78%显著增加到1993年的92% (p<0.001)。共有104名(68%)艾滋病毒阳性男性接受了肺炎球菌疫苗接种,而只有2名(1%)艾滋病毒阳性男性接受了疫苗接种(p<0.001)。 Among HIV+ individuals whose absolute CD4+ count was less than 200 cells x mm(-3), the percentage of men who received primary PCP prophylaxis was 0, 86, 72 and 88 for the years 1990-1993, respectively. Among HIV+ patients whose only eligibility criterion for PCP prophylaxis was a CD4+ percentage <20%, compliance was 55, 30, 37 and 50% for the years 1990-1993, respectively. Among HIV+ subjects, increases in the compliance level were noted for all preventive therapies after targeted feedback was provided during the last quarter of 1992. However, only utilization of influenza vaccine exceeded a 90% compliance in 1993. These data demonstrate that a suboptimal level of compliance with current guidelines for the prevention of respiratory disease among human immunodeficiency virus-infected individuals can be significantly improved using targeted feedback. Although it is likely that similar effects could be achieved in other populations or the community at large, this remains to be demonstrated.