Early intervention for human immunodeficiency virus in Baltimore sexually transmitted diseases clinics - Impact on gonorrhea incidence in patients infected with HIV

被引:18
作者
Golden, MR
Rompalo, AM
Fantry, L
Bein, M
Perkins, T
Hoover, DR
Zenilman, JM
机构
[1] JOHNS HOPKINS UNIV,SCH MED,DIV INFECT DIS,BALTIMORE,MD 21205
[2] BALTIMORE CITY DEPT HLTH,BALTIMORE,MD
[3] JOHNS HOPKINS UNIV,SCH HYG & PUBL HLTH,DEPT EPIDEMIOL,BALTIMORE,MD
关键词
D O I
10.1097/00007435-199609000-00005
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: High incidences of sexually transmitted diseases (STD) after posttest counseling have been documented in patients diagnosed with human immunodeficiency virus (HIV) in Baltimore STD clinics. In July 1991, the authors instituted an HIV early intervention program providing long-term medical care and social work services. This study compares the incidence of gonorrhea after post-HIV+ test counseling in patients diagnosed with HIV before and after the institution of the early intervention program. Methods: Medical records of a cohort composed of all patients newly diagnosed with HIV and those who underwent posttest counseling for HIV in 1991 to 1993 in two Baltimore STD clinics were reviewed. Patients were offered early intervention medical and social work services. Gonorrhea incidence in this cohort was compared to a historical cohort diagnosed and counseled for post-HIV+ testing in 1988 to 1989 who were not offered early intervention services. Results: The mean follow-up time was 418 days (range, 26 to 703 days). After post-HIV+ test counseling, gonorrhea developed in 39 of 468 (8.3%) men in the 1989 cohort and 13 of 400 (3.3%) men in the 1991 to 1993 cohort. Controlling for variable length of follow-up, the 1991 to 1993 cohort had a relative risk of 0.442 for the development of gonorrhea during the study period (95% confidence interval, 0.225 to 0.790; P = 0.006). Incident gonorrhea after post-HIV+ test counseling also was associated with a prevalent gonorrhea condition at the time of HIV diagnosis (RR = 3.02; 95% CI, 1.75 to 5.23; P = 0.0001) and failure to return for post-HIV+ test counseling as scheduled (RR = 2.27; 95% CI, 1.17-4.43; P = 0.013). After adjustment for gonorrhea at the time of HIV diagnosis and failure to return for scheduled posttest counseling, the difference in gonorrhea incidence between men in the two cohorts remained statistically significant (RR = 0.494; 95% CI, 0.260 to 0.941; P = 0.032). In comparison, overall gonorrhea rates in Baltimore changed little between 1988 and 1993. No significant difference was found in gonorrhea incidence in women, which may have been the result of active gonorrhea screening during the 1991 to 1993 period, which was not performed in 1988 to 1989. Conclusions: Providing clinical care to persons with HIV may facilitate the reduction of high-risk behaviors that lead to incident STDs and further HIV transmission.
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页码:370 / 377
页数:8
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共 29 条
  • [1] [Anonymous], AIDS 2 DECADE
  • [2] ECONOMIC AND POLICY IMPLICATIONS OF EARLY INTERVENTION IN HIV DISEASE
    ARNO, PS
    SHENSON, D
    SIEGEL, NF
    FRANKS, P
    LEE, PR
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 262 (11): : 1493 - 1498
  • [3] BENNETT CL, 1992, J ACQ IMMUN DEF SYND, V5, P1
  • [4] ROUTINE VOLUNTARY HIV SCREENING IN STD CLINIC CLIENTS - CHARACTERIZATION OF INFECTED CLIENTS
    ERICKSON, B
    WASSERHEIT, JN
    ROMPALO, AM
    BRATHWAITE, W
    GLASSER, D
    HOOK, EW
    [J]. SEXUALLY TRANSMITTED DISEASES, 1990, 17 (04) : 194 - 199
  • [5] TARGETING AIDS PREVENTION AND TREATMENT TOWARD HIV-1-INFECTED PERSONS - THE CONCEPT OF EARLY INTERVENTION
    FRANCIS, DP
    ANDERSON, RE
    GORMAN, ME
    FENSTERSHEIB, M
    PADIAN, NS
    KIZER, KW
    CONANT, MA
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 262 (18): : 2572 - 2576
  • [6] THE LIFETIME COST OF TREATING A PERSON WITH HIV
    HELLINGER, FJ
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 270 (04): : 474 - 478
  • [7] EVIDENCE FOR THE EFFECTS OF HIV ANTIBODY COUNSELING AND TESTING ON RISK BEHAVIORS
    HIGGINS, DL
    GALAVOTTI, C
    OREILLY, KR
    SCHNELL, DJ
    MOORE, M
    RUGG, DL
    JOHNSON, R
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 266 (17): : 2419 - 2429
  • [8] THE INCREASING FREQUENCY OF HETEROSEXUALLY ACQUIRED AIDS IN THE UNITED-STATES, 1983-88
    HOLMES, KK
    KARON, JM
    KREISS, J
    [J]. AMERICAN JOURNAL OF PUBLIC HEALTH, 1990, 80 (07) : 858 - 862
  • [9] GONOCOCCAL INFECTIONS
    HOOK, EW
    HOLMES, KK
    [J]. ANNALS OF INTERNAL MEDICINE, 1985, 102 (02) : 229 - 243
  • [10] LYMPHOCYTE-CD4 CONCENTRATIONS IN PATIENTS WITH NEWLY IDENTIFIED HIV-INFECTION ATTENDING STD CLINICS - POTENTIAL IMPACT ON PUBLICLY FUNDED HEALTH-CARE RESOURCES
    HUTCHINSON, CM
    WILSON, C
    REICHART, CA
    MARSIGLIA, VC
    ZENILMAN, JM
    HOOK, EW
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 266 (02): : 253 - 256