Portal de Periódicos da CAPES

Assessing Gaps in Comprehensive HIV Care Across Settings of Care for Women Living with HIV in Canada

2020; Mary Ann Liebert, Inc.; Volume: 29; Issue: 11 Linguagem: Inglês

10.1089/jwh.2019.8121

1931-843X

Nadia O’Brien, Claire Godard‐Sebillotte, Lashanda Skerritt, Janice Dayle, Allison Carter, Susan Law, Joseph Cox, Neil Andersson, Angela Kaida, Mona Loutfy, Alexandra de Pokomandy, Rahma Abdul-Noor, Aranka Anema, Jonathan B. Angel, Dada Mamvula Bakombo, Fatimatou Barry, Greta R. Bauer, Kerrigan Beaver, Marc Boucher, Isabelle Boucoiran, Jason Brophy, Lori A. Brotto, Ann N. Burchell, Claudette Cardinal, Lynne Cioppa, Tracey Conway, José Côté, Jasmine Cotnam, Cori d’Ambrumenil, Erin Ding, Danièle Dubuc, Janice Duddy, Mylène Fernet, Annette Fraleigh, Peggy Frank, Brenda Gagnier, Marilou Gagnon, Jacqueline Gahagan, Claudine Gasingirwa, Nada Gataric, Rebecca Gormley, Saara Greene, Danielle Groleau, Charlotte Guerlotté, Trevor Hart, Catherine Hankins, Roula Kteily-Hawa, Emily Heer, Robert S. Hogg, Terry Lee Howard, Shazia Islam, Joseph Jean-Gilles, Hermione Jefferis, Evin Jones, Charu Kaushic, Mina Kazemi, Mary Kestler, Maxime Kiboyogo, Marina B. Klein, Nadine Kronfli, Gladys Kwaramba, Gary Lacasse, Ashley Lacombe‐Duncan, Melanie Lee, Rebecca Lee, Jenny Li, Viviane D. Lima, Elisa Lloyd‐Smith, Carmen H. Logie, Evelyn J. Maan, Valérie Martel-Lafrenière, Carrie Martin, Renée Masching, Lyne Massie, Melissa Medjuck, Brigitte Ménard, Cari L. Miller, J.R.A. Mitchell, Gerardo Mondragon, Deborah Money, Ken Monteith, Marvelous Muchenje, Florida Mukandamutsa, Mary Ndung’u, Valerie Nicholson, Kelly K. O’Brien, Gina Ogilvie, S Ogunnaike-Cooke, Joanne Otis, Rebeccah Parry, Sophie Patterson, Angela Paul, Doris Peltier, Neora Pick, Alie Pierre, Jeff Powis, Karène Proulx‐Boucher, Corinna Quan, Jesleen Rana, Eric Abella Roth, Danielle Rouleau, Geneviève Rouleau, Sergio Rueda, Kate Salters, Margarite Sánchez, Roger Sandre, Jacquie Sas, Édénia Savoie, Paul Sereda, Stephanie Smith, Marcie Summers, Wangari Tharao, Christina Tom, Cécile Tremblay, Jason Trigg, Sylvie Trottier, Angela Underhill, Anne Catherine Wagner, Sharon Walmsley, Clara Wang, Kath Webster, Wendy Wobeser, Denise Wozniak, Mark H. Yudin, Wei Zhang, Julia Zhu,

Syphilis Diagnosis and Treatment

Background: Women living with HIV in Canada experience barriers to comprehensive HIV care. We sought to describe care gaps across a typology of care. Methods: We analyzed baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). A typology of care was characterized by primary HIV physician and care setting. Quality-of-care indicators included the following: Pap test, Pap test discussions, reproductive goal discussions, breast cancer screening, antiretroviral therapy (ART) use, adherence, HIV viral load, and viral load discussions. We defined comprehensive care with three indicators: Pap test, viral load, and either reproductive goal discussions over last 3 years or breast cancer screening, as indicated. Multivariable logistic regression analyses measured associations between care types and quality-of-care indicators. Results: Among women living with HIV accessing HIV care, 56.4% (657/1,164) experienced at least one gap in comprehensive care, most commonly reproductive goal discussions. Women accessed care from three types of care: (1) physicians (specialist and family physicians) in HIV clinics (71.6%); (2) specialists in non-HIV clinics (17.6%); and (3) family physicians in non-HIV clinics (10.8%), with 55.5%, 63.9%, and 50.8% gaps in comprehensive care, respectively. Type 3 care had double the odds of not being on ART: adjusted odds ratio (AOR 2.09, 95% confidence interval [CI] 1.16–3.75), while Type 2 care had higher odds of not having discussed the importance of Pap tests (AOR 1.48, 95% CI 1.00–2.21). Discussion: Women continue to experience gaps in care, across types of care, indicating the need to evaluate and strengthen women-centered models of care.