人類免疫缺乏病毒(愛滋病毒)感染者的預期餘命在反轉錄病毒療法的引進後顯著增加，而這些感染者皆需持續在醫療系統中以接受最理想的照顧。另一方面，一些感染者被診斷時已處於晚期，而晚期就醫將帶來較高的死亡風險。即便過去研究已經留意到持續照護和晚期就醫的各自影響，但持續照護和晚期就醫之間的關係尚未得到充分了解。此外，隨著生存率的提高，愛滋病毒感染者逐漸高齡化，也使得慢性共病的醫療照護更加被重視。糖尿病則是這些常見的重要慢性共病之一。在照護過程中，愛滋病毒感染者可能會接受不同專科醫師的糖尿病照護，而這些不同的照護過程可能帶來不同的影響。在本論文中，我們利用台灣全民健保資料庫，探討持續照護對新進入醫療系統的愛滋病毒感染者的調節作用，並探討不同照護模式對合併糖尿病的感染者的影響為何。第一部分的研究檢視了晚期就醫、持續照護及其相互作用對第二年因伺機性感染的效應。研究樣本中，超過一半 (59.38%，總樣本數: 9112) 在第一年有持續照護，8.63% 為晚期就醫者，110 名 (1.21%) 感染者在第二年因伺機性感染而住院。晚期就醫和未持續照護皆是第二年因伺機性感染住院的獨立預測因子（勝算比分別為2.58 和3.27），並且它們之間的相互作用具有統計學意義(未持續照護 × 晚期就醫，勝算比為3.82）。結果顯示，第一年的持續照護可作為一個調節因子，相對於早期就醫者，對於晚期就醫者提供了更強的保護作用。至於不同糖尿病照護模式的影響，在本研究中，若該感染者由同一位感染科醫師提供糖尿病和愛滋病照護，歸為集中照護組，其他則被歸類為共同照護組。在一組愛滋病毒感染者合併糖尿病的橫截面樣本中 (總樣本數:523) ，集中照護組的比例是54.88% (樣本數:287)，其他人屬於共同照護組。研究顯示，相較於共同照護組，集中照護組較不易遺漏血脂肪檢查（勝算比：0.30）、肌酸酐（勝算比：0.19）和丙胺酸轉胺酶（勝算比：0.23）的檢測，但更易遺漏尿蛋白檢測（勝算比：1.56）與眼底檢查（勝算比：4.97）。然而，兩組在血清空腹血糖和糖化血色素的執行率方面沒有明顯差異。上述的研究結果對於政策制定者提供了資訊，未來也許能為早期與晚期就醫者制定不同的策略，並也指出照護模式對於糖尿病照護過程面指標，有著不同的效應，可藉此資訊後續提升愛滋病毒感染者的糖尿病照護品質。

Even though the life expectancy of people living with human immunodeficiency virus (HIV) increases substantially after the introduction of antiretroviral therapy, all those people need to be retained in the healthcare system to receive optimal medical care. However, some of people living with HIV (PLWH) are late presenters, diagnosed with HIV in an advanced stage, carrying a higher risk for mortality. Though the influence of retention in care and late presenters had been shown in previous studies, the relationship between retention in care and late presentation has not been well-studied. In addition, the aging of PLWH resulting from the improvement of survival also makes it necessary to pay attention to the medical care for chronic comorbidities. Among those comorbidities, diabetes mellitus (DM) is one of the common chronic comorbidities. HIV-infected individuals may receive diabetes care from different specialists, and this variety of care process may have different effects on diabetes care. In this dissertation, Taiwan National Health Insurance Research Database was used to evaluate the moderator effect of retention in care on PLWH who newly enter the healthcare system, and to explore the effects of different care models on the quality of diabetes care for PLWH with DM in Taiwan. Our research results revealed the impact of late presentation, retention in care, and their interaction on the risk of subsequent hospitalizations due to opportunistic infections (OIs-hospitalizations) in the second year. More than half (59.38%) of PLWH (n = 9112) were retained in care in the first year, 8.63% were late presenters, and 110 (1.21%) patients had subsequent hospitalization in the second year. Late presentation and non-retention were independent predictors of OIs-hospitalizations in the second year (OR: 2.58 and OR: 3.27, respectively) and the interaction between them was statistically significant (non-retention in care × late presentation, OR: 3.82). The results demonstrated that retention in care in the first year is a moderator providing a stronger protective effect for late presenters than early presenters. As for the impact of different care models, the consolidated care group included the people who receive diabetes care and HIV care by the same infectious diseases physician, and the others were categorized to the shared care group. Of a cross-sectional sample including PLWH with DM (n=523), 54.88% (n=287) of the samples accounted for the consolidated care group, and the others were allocated in the shared care group. We found that the consolidated care group was less likely to miss the serum tests of lipid profile (OR: 0.30), creatinine (OR: 0.19), and alanine transaminase (OR: 0.23), but more often missed urine protein test (OR: 1.56) and fundoscopic examination (OR: 4.97) than the shared care group. However, the two groups did not differ in the performance rates of serum fasting glucose or HbA1c. Those study findings may call for policymakers to develop different strategies for early or late presenters, and pointed out that the care model has different effects on the quality indicators of diabetes care. The above information can be used to improve the quality of diabetes care for PLWH with DM.

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