ADHERENCE TO GUIDELINES FOR THE PREVENTION OF HIV-RELATED RESPIRATORY-DISEASES

In this study we characterized the pattern of use of preventive therap ies for specific respiratory diseases within a cohort of homosexual me n and assessed the impact of targeted feedback on the level of complia nce with guidelines for these diseases. All human immunodeficiency vir us 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 O ctober 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 Pneumocy stis carinii pneumonia (PCP) prophylaxis, symptoms and CD4 counts was obtained yearly for each subject, In 1992, participating physicians we re provided with feedback regarding the overall levels of compliance w ith contemporary guidelines for the prevention of respiratory disease, As part of this exercise, the guidelines were distributed and discuss ed. The percentage of HIV+ patients who underwent PPD testing increase d from 43 to 65% during the study (p=0.001). Significantly more HIV+ t han 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 vaccinatio n 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 o f men who received primary PCP prophylaxis was 0, 86, 72 and 88 for th e years 1990-1993, respectively. Among HIV+ patients whose only eligib ility criterion for PCP prophylaxis was a CD4+ percentage <20%, compli ance was 55, 30, 37 and 50% for the years 1990-1993, respectively. Amo ng 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 e xceeded a 90% compliance in 1993. These data demonstrate that a subopt imal level of compliance with current guidelines for the prevention of respiratory disease among human immunodeficiency virus-infected indiv iduals can be significantly improved using targeted feedback, Although it is likely that similar effects could be achieved in other populati ons or the community at large, this remains to be demonstrated.