Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade County.
Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade County.
复制标题
迈阿密戴德县艾滋病毒/艾滋病患者的最佳医疗服务的个人和系统障碍协会。
DOI：
10.1097/qai.0000000000000572
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发表时间：
2015-05-01
期刊：
影响因子：
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通讯作者：
Metsch LR
中科院分区：
文献类型：
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作者：
Wawrzyniak AJ;Rodríguez AE;Falcon AE;Chakrabarti A;Parra A;Park J;Mercogliano K;Villamizar K;Kolber MA;Feaster DJ;Metsch LR
阻碍患者继续接受艾滋病毒治疗的障碍不利于患者在艾滋病毒连续治疗过程中取得进展。以前的文献集中在个人，客户层面的障碍和干预措施，以解决他们。相比之下，研究系统层面障碍对艾滋病毒护理结果的作用的工作较少。本研究旨在了解在佛罗里达州迈阿密-戴德市最大的HIV诊所就诊的HIV感染患者的个体和系统性障碍如何与诊所预约出勤率和病毒学抑制相关。此外，我们研究了这些障碍作为潜在的综合征因素对这些健康结果的协同效应。通过对从电子病历中确定的444名艾滋病毒感染门诊患者（187名定期就诊，191名不定期就诊，66名非就诊）进行面对面的研究访谈，确定了就诊障碍。与其他出勤组相比，不出勤组的病毒载量更高，病毒学抑制的可能性更小，CD4计数更低，抑郁症状更严重，生活混乱，生活质量更低，食品不安全和近期吸毒的比例更高。此外，与定期就诊的人相比，不就诊的人与医生的关系评分较低，医疗信息的清晰度较低，而且更多地报告说交通是就诊的障碍。当被视为综合征时，与未报告任何屏障的患者相比，具有三个或更多个体水平屏障的患者更有可能检测到病毒载量（or = 3.60, 95%CI[1.71, 7.61]）。我们的研究结果表明，就诊时有多种障碍的患者应优先获得帮助和未来的干预措施，以提高护理的保持性。干预措施应同时解决多个个人和系统层面的障碍，特别注意解决抑郁症状、组织技能、与医生的关系以及与艾滋病毒相关的健康教育。
Barriers to retention in HIV care are detrimental to patients’ progress along the HIV continuum of care. Previous literature has focused on individual, client-level barriers and interventions to address them. In contrast, less work has examined the role of system-level barriers on HIV care outcomes. The present study seeks to understand how individual and systemic barriers individually are associated with clinic appointment attendance and virologic suppression in HIV-infected patients attending the largest HIV clinic in Miami-Dade, Florida. In addition, we examined the synergistic effects of these barriers as potential syndemic factors on these health outcomes. Barriers to clinic attendance were determined in a face-to-face study interview with 444 HIV-infected outpatients (187 regular attenders, 191 irregular attenders, 66 non-attenders) identified from electronic medical records. Compared to the other attendance groups, non-attenders had higher viral loads, were less likely to be virologically suppressed, had lower CD4 counts, had higher depressive symptoms, life chaos, lower quality of life, and higher rates of food insecurity and recent drug use. Additionally, non-attenders compared to regular attenders had lower physician relationship ratings, had lower medical information clarity, and more often reported transportation as a barrier to clinic attendance. When viewed as a syndemic, compared to patients not reporting any barriers, patients with three or more individual-level barriers were more likely to have a detectable viral load (OR = 3.60, 95%CI [1.71, 7.61]). Our findings suggest that patients presenting to the clinic with multiple barriers should be prioritized for assistance and future interventions to improve retention in care. Interventions should address multiple individual and system level barriers simultaneously with particular attention to addressing depressive symptoms, organizational skills, relationship with the physician, and HIV-related health education.