Differences in integrated assessment and management of non-communicable diseases (NCDs) for people with HIV across the WHO European region

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2024-02-15 DOI:10.1111/hiv.13619

Christian Kraef, Sabine Singh, Olga Fursa, Akaki Abutidze, Nino Rukhadze, Velida Mulabdic, Nina Yancheva, Murat Mehmeti, Tatevik Balayan, Arjan Harxhi, Jasmina Trajanovska, Claire Mackintosh, Claudine Duvivier, Marek Beniowski, David Jilich, Dag Henrik Reikvam, Luba Tau, Daria Podlekareva, Lene Ryom, Lars Peters, Justyna Kowalska, Ole Kirk, for the EuroSIDA Study Group

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Abstract

Objectives

We aimed to assess the extent of integration of non-communicable disease (NCD) assessment and management in HIV clinics across Europe.

Methods

A structured electronic questionnaire with 41 multiple-choice and rating-scale questions assessing NCD assessment and management was sent to 88 HIV clinics across the WHO European Region during March–May 2023. One response per clinic was collected.

Results

In all, 51 clinics from 34 countries with >100 000 people with HIV under regular follow-up responded. Thirty-seven clinics (72.6%) reported shared NCD care responsibility with the general practitioner. Systematic assessment for NCDs and integration of NCD management were common overall [median agreement 80%, interquartile range (IQR): 55–95%; and 70%, IQR: 50–88%, respectively] but were lowest in central eastern and eastern Europe. Chronic kidney disease (median agreement 96%, IQR: 85–100%) and metabolic disorders (90%, IQR: 75–100%) were regularly assessed, while mental health (72%, IQR: 63–85%) and pulmonary diseases (52%, IQR: 40–75%) were less systematically assessed. Some essential diagnostic tests such as glycated haemoglobin (HbA1c) for diabetes (n = 38/51, 74.5%), proteinuria for kidney disease (n = 30/51, 58.8%) and spirometry for lung disease (n = 11/51, 21.6%) were only employed by a proportion of clinics. The most frequent barriers for integrating NCD care were the lack of healthcare workers (n = 17/51, 33.3%) and lack of time during outpatient visits (n = 12/51, 23.5%).

Conclusion

Most HIV clinics in Europe systematically assess and manage NCDs. People with HIV appear to be screened more frequently than the general population at the same age. There are, however, larger gaps among eastern European clinics in general and for clinics in all regions related to mental health, pulmonary diseases and the employment of some essential diagnostic tests.

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世卫组织欧洲地区艾滋病毒感染者非传染性疾病 (NCDs) 综合评估和管理的差异。

目的我们旨在评估欧洲各地艾滋病诊所整合非传染性疾病（NCD）评估和管理的程度：2023 年 3 月至 5 月期间，我们向世卫组织欧洲地区的 88 家艾滋病诊所发送了一份结构化电子问卷，其中包含 41 个评估非传染性疾病评估和管理的多选题和评分表问题。每个诊所收集一份答复：共有来自 34 个国家的 51 家诊所做出了回复，这些诊所定期随访的艾滋病毒感染者超过 100,000 人。37家诊所（72.6%）报告与全科医生共同承担了非传染性疾病护理责任。对非传染性疾病进行系统评估和整合非传染性疾病管理在总体上很常见[中位同意率分别为 80%，四分位数间距（IQR）：55-95%；和 70%，四分位数间距（IQR）：50-88%]，但在中东欧最低。慢性肾病（中位数一致率 96%，四分位距：85-100%）和代谢紊乱（90%，四分位距：75-100%）得到定期评估，而心理健康（72%，四分位距：63-85%）和肺部疾病（52%，四分位距：40-75%）则较少得到系统评估。一些基本诊断测试，如糖尿病的糖化血红蛋白（HbA1c）（n = 38/51，74.5%）、肾病的蛋白尿（n = 30/51，58.8%）和肺病的肺活量测定（n = 11/51，21.6%），只有一部分诊所采用。整合非传染性疾病护理最常见的障碍是缺乏医护人员（n = 17/51，33.3%）和门诊时间不足（n = 12/51，23.5%）：结论：欧洲大多数艾滋病诊所都系统地评估和管理非传染性疾病。与同龄的普通人群相比，艾滋病病毒感染者接受筛查的频率似乎更高。然而，东欧诊所在心理健康、肺部疾病和一些基本诊断检测的使用方面与所有地区的诊所相比存在较大差距。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.