An Exploratory Study to Assess Individual and Structural Level Barriers Associated With Poor Retention and Re-engagement in Care Among Persons Living With HIV/AIDS.
An Exploratory Study to Assess Individual and Structural Level Barriers Associated With Poor Retention and Re-engagement in Care Among Persons Living With HIV/AIDS.
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DOI：
10.1097/qai.0000000000001242
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发表时间：
2017-02-01
期刊：
影响因子：
--
通讯作者：
Armstrong WS
中科院分区：
文献类型：
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作者：
Colasanti J;Stahl N;Farber EW;Del Rio C;Armstrong WS
保持护理是艾滋病毒护理连续体中最具挑战性的一步。许多参与护理并实现病毒抑制的患者都有护理中断，其特征是进出护理（“流失”）。不良的滞留会产生临床后果，并导致新的艾滋病毒传播，但如何预测或预防这种情况仍然难以捉摸。本研究试图了解个体和结构层面的障碍之间的关系，以及乔治亚州亚特兰大市艾滋病毒/艾滋病感染者的不良保留率。我们通过访谈对连续接受治疗6年的艾滋病毒感染患者（“连续接受治疗”，n = 32）和最近未接受治疗的患者（“未接受治疗”，n = 27）进行了调查。我们评估了成功参与的个人层面的保护因素（自我效能、弹性、感知社会支持和披露），参与不良的风险因素（物质使用、精神疾病和耻辱），以及结构/系统层面的障碍（经济和住房不稳定、交通、食品不安全、沟通障碍、监禁史）。采用卡方检验和Mann-Whitney U检验对两个人群进行比较。连续保留和未保留的人群先前的病毒抑制率都很高，但很少有未保留的患者在返回护理时被病毒学抑制（11%）。年轻、吸食可卡因、食物不安全、金融不稳定、住房不稳定以及过去一年的电话号码变化在未保留人口中更有可能出现。我们的研究结果表明，需要有针对性的风险评估工具来预测保留不良的最高风险患者，从而可以针对这些个体进行公共卫生干预。
Retention in care is the most challenging step along the HIV care continuum. Many patients who engage in care and achieve viral suppression have care interruptions, characterized by moving in and out of care (“churn”). Poor retention has clinical consequences and contributes to new HIV transmissions, but how to predict or prevent it remains elusive. This study sought to understand the relationship between individual- and structural-level barriers, and poor retention for persons living with HIV/AIDS in Atlanta, Georgia. We administered a survey, through interviews, with HIV-infected patients continuously retained in care for 6 years (“continuously retained,” n = 32) and patients with recent gaps in care (“unretained” n = 27). We assessed individual-level protective factors for successful engagement (self-efficacy, resilience, perceived social support, and disclosure), risk factors for poor engagement (substance use, mental illness, and stigma), and structural/systemic-level barriers (financial and housing instability, transportation, food insecurity, communication barriers, incarceration history). Chi-square and Mann-Whitney U tests were used to compare the two populations. Both continuously retained and unretained populations had high rates of prior viral suppression but few unretained patients were virologically suppressed upon return to care (11%). Younger age, crack cocaine use, food insecurity, financial instability, housing instability and phone number changes in the past year were significantly more likely to be present in the unretained population. Our findings suggest the need for targeted risk assessment tools to predict the highest risk patients for poor retention whereby public health interventions can be directed to those individuals.