Modernizing Field Services for Human Immunodeficiency Virus and Sexually Transmitted Infections in the United States.
Modernizing Field Services for Human Immunodeficiency Virus and Sexually Transmitted Infections in the United States.
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DOI：
10.1097/olq.0000000000000652
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发表时间：
2017-10
影响因子：
3.1
通讯作者：
Dombrowski JC
中科院分区：
文献类型：
--
作者：
Golden MR;Katz DA;Dombrowski JC
针对性传播感染的公共卫生实地服务尚未充分发展，以应对性传播感染问题的规模不断扩大、其集中于男男性行为者、新的通信技术的出现以及作为艾滋病毒预防基石的抗逆转录病毒疗法的可获得性。外地服务需要现代化。现代化应力求将实地服务目标扩大到性伴侣性传播感染检测和治疗之外，以包括：对细菌性性传播感染者及其伴侣进行艾滋病毒检测，包括努力促进经常进行艾滋病毒/性传播感染检测;增加安全套的使用;与艾滋病毒护理和促进病毒抑制挂钩和重新挂钩;推广PrEP;与长效避孕措施挂钩;以及转诊医疗保险。现场服务项目无法在完成传统工作的同时推进这些新目标。现代化将需要愿意重新考虑外地服务工作的一些长期问题，包括面对面面谈和实地调查的中心地位。寻求现代化的卫生部门将需要仔细评估其正在进行的活动，并进行重组，使现场服务资源的使用与计划优先事项保持一致。在某些情况下，这可能需要进行重组，使工作人员更加专业化，并与监测活动更密切地结合起来。调整方案将需要新的工作人员培训，改进数据管理系统，并加大对监测和评估的投资。虽然现代化可能要经过多年的发展，但现在就应该开始。
Public health field services for sexually transmitted infections (STIs) have not adequately evolved to address the expanding scale of the STI problem, its concentration among men who have sex with men, the emergence of new communication technologies and the availability of antiretroviral therapy as a cornerstone of HIV prevention. Field services need to modernize. Modernization should seek to expand field services objectives beyond sex partner STI testing and treatment to include: HIV testing of persons with bacterial STI and their partners, including efforts to promote frequent HIV/STI testing; increased condom access; linkage and relinkage to HIV care and promotion of viral suppression; PrEP promotion; linkage to long acting contraception; and referral for health insurance. Field services programs cannot advance these new objectives while simultaneously doing all of the work they have traditionally done. Modernization will require a willingness to reconsider some longstanding aspects of field services work, including the centrality of face-to-face interviews and field investigations. Health departments seeking to modernize will need to carefully assess their ongoing activities and reorganize to align the use of field services resources with program priorities. In some instances, this may require reorganization to allow staff greater specialization and closer integration with surveillance activities. Adapting programs will require new staff training, improvements in data management systems, and a greater investment in monitoring and evaluation. While modernization is likely to evolve over many years, the time to start is now.