title: Evaluating the utility of provider-recorded clinical status in the medical records of HIV-positive adults in a limited-resource setting.
abstract: Provider-reported summaries of clinical status may assist with clinical management of HIV in resource poor settings if they reflect underlying biological processes associated with HIV disease progression. However, their ability to do so is rarely evaluated. Therefore, we aimed to assess the relationship between a provider-recorded summary of clinical status and indicators of HIV progression. Data were abstracted from 201 randomly selected medical records at a large HIV clinic in the Dominican Republic. Multivariable logistic regressions were used to examine the relationship between provider-assigned clinical status and demographic (gender, age, nationality, education) and clinical factors (reported medication adherence, CD4 cell count, viral load). The mean age of patients was 41.2 (SD = ±10.9) years and most were female (n = 115, 57%). None of the examined characteristics were significantly associated with provider-recorded clinical status. Higher CD4 cell counts were more likely for females (OR = 2.2 CI: 1.12-4.31) and less likely for those with higher viral loads (OR = 0.33 CI: 0.15-0.72). Poorer adherence and lower CD4 cell counts were significantly associated with higher viral loads (OR = 4.46 CI: 1.11-20.29 and 6.84 CI: 1.47-37.23, respectively). Clinics using provider-reported summaries of clinical status should evaluate the performance of these assessments to ensure they are associated with biologic indicators of disease progression.
authors: 1 Columbia University School of Nursing, NY, USA.
authors: Samantha
authors: S
authors: Stonbraker
authors: 2 Department of Epidemiology, Mailman School of Public Health, NY, USA.
authors: Montina
authors: M
authors: Befus
authors: 3 Clínica de Familia La Romana, La Romana, Dominican Republic.
authors: Leonel Lerebours
authors: LL
authors: Nadal
authors: 3 Clínica de Familia La Romana, La Romana, Dominican Republic.
authors: Mina
authors: M
authors: Halpern
authors: 1 Columbia University School of Nursing, NY, USA.|2 Department of Epidemiology, Mailman School of Public Health, NY, USA.
authors: Elaine
authors: E
authors: Larson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; clinical status; resource-limited setting; retrospective review