Adherence to guidelines for the prevention of HIV-related respiratory diseases

Abstract

A Ad dh he er re en nc ce e t to o g gu ui id de el li in ne es s f fo or r t th he e p pr re ev ve en nt ti io on n o of f H HI IV V--r re el la at te ed d r re es sp pi ir ra a--t to or ry y d di is se ea as se es s ABSTRACT: In this study we characterized the pattern of use of preventive therapies for specific respiratory diseases within a cohort of homosexual men and assessed the impact of targeted feedback on the level of compliance with guidelines for these diseases. All human immunodeficiency virus seronegative (HIV-) (n=169) and acquired immune deficiency syndrome (AIDS)-free human immunodeficiency virus seropositive (HIV+) (n=154) participants in our cohort, who completed four annual visits between October 1989 and December 1993, were identified. Information about the use of purified protein derivative (PPD) (tuberculin) testing, history of pneumococcal vaccinations, influenza vaccinations, use of Pneumocystis carinii pneumonia (PCP) prophylaxis, symptoms and CD4 counts was obtained yearly for each subject. In 1992, participating physicians were provided with feedback regarding the overall levels of compliance with contemporary guidelines for the prevention of respiratory disease. As part of this exercise, the guidelines were distributed and discussed.The percentage of HIV+ patients who underwent PPD testing increased from 43 to 65% during the study (p=0.001). Significantly more HIV+ than HIV-patients underwent PPD testing (p<0.001). A total of 144 (94%) HIV+ men received at least one influenza vaccination compared to 60 (35%) HIV-men (p<0.001). Utilization of influenza vaccination in the HIV+ group significantly increased from 78% in 1992 to 92% in 1993 (p<0.001). A total of 104 (68%) HIV+ men received pneumococcal vaccination compared to 2 (1%) HIV-men (p<0.001). Among HIV+ individuals whose absolute CD4+ count was less than 200 cells·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.

Predictors of Influenza Vaccination in HIV‐Infected Patients in the United States, 1990–2002

“…Our overall influenza vaccination coverage of 31% was similar to coverage rates of 28% and 33% reported in earlier studies of HIV-infected patients in the United States [14,15]. Countries with more universal access to health care have reported influenza vaccine coverage rates as high as 92% among their HIV-infected populations [19].…”

Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil

“…Thus, physicians have continued to prescribe this preventive medication according to guidelines. Using targeted physician feedback, Montaner et al 13 showed an increase in adherence to guidelines for PCP prevention from 29% to 61% and an increase in TST provision from 43% to 65% in Vancouver, Canada between 1990 and 1993. However, baseline data collected for the THRio study 14 revealed a low proportion of patients receiving TST and IPT, despite guidelines recommending these measures since 1994.…”

Hepatitis A and B Vaccination Practices for Ambulatory Patients Infected with HIV

“…How do these HBV and HAV screening and vaccination rates compare with comparable vaccination interventions in HIVinfected persons for pneumococcus and influenza? The administration rates for those vaccines are low as well, even among experienced HIV caregivers [7,8,18,19]. The national experience with screening and vaccinating high-risk adolescents and adults has been equally dismal, but when vaccination services are integrated into medical or other drug treatment services, rates of screening and vaccination have increased [18][19][20][21][22][23][24].…”