Improving health outcomes for IPV-exposed women living with HIV.
Improving health outcomes for IPV-exposed women living with HIV.
复制标题
改善暴露于 IPV 且感染 HIV 的女性的健康状况。
DOI：
10.1097/qai.0b013e3182a29f1b
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Seth,Puja
中科院分区：
文献类型：
--
作者：
Wingood,GinaM;DiClemente,RalphJ;Seth,Puja
对感染艾滋病毒的妇女的参与、保留和持续护理可以减少艾滋病毒的传播，加强预防信息，促进高度积极的抗逆转录病毒疗法的坚持，并加强对性传播疾病的监测。1国家估计表明，42%-59%的艾滋病毒感染成年人没有得到护理。2，3鉴于艾滋病医疗护理参与度低的不良后果，了解与参与度低相关的患者特征是临床和公共卫生的优先事项。艾滋病毒感染者可以按照沿着一系列护理活动进行分类：从不接受护理的人、接受不一致护理的人和接受一致医疗护理的人。3-5这篇评论与Siemieniuk等人的手稿一起发表，6《亲密伴侣对艾滋病毒阳性妇女的高暴力率的临床影响》。在这项研究中，339名接受门诊治疗的艾滋病毒阳性妇女接受了亲密伴侣暴力（IPV）筛查。这项研究的结果证实了现有的经验数据，表明暴露于IPV可能会增加艾滋病毒传播的风险，这可能是精神健康状况不佳，非法药物使用，风险较高的性行为或监禁史的结果。然而，本手稿还扩展了文献，以研究IPV与感染艾滋病毒的女性中各种不良行为、临床和健康结果之间的关联。作者观察到，在感染艾滋病毒的女性样本中，IPV的患病率为40%。报告IPV的女性有更高的吸烟率，非法药物使用，抑郁症，焦虑症，监禁史，儿童虐待史，以及与健康相关的生活质量下降。此外，暴露于IPV的女性比未暴露于IPV的女性更容易住院（分别为256次/1000患者-年vs. 166/1000患者-年，P，0.001）。此外，与HIV无关的住院和门诊HIV护理后HIV相关住院的相对风险在暴露于IPV的女性中开始并显著增加。不良的临床健康结果还包括抗逆转录病毒疗法的使用减少和超过1年的额外中断护理。6为了解感染IPV的艾滋病毒感染妇女为何未能最佳地参与护理，开展了有限的研究。一些数据表明，妇女可能有相互冲突的优先事项，干扰寻求艾滋病毒医疗护理。这些挑战可能包括非法药物使用、不稳定的住房、应对能力差、焦虑或抑郁症，或获得医疗保险的机会有限。Siemieniuk等人在研究中观察到的许多因素可能会限制暴露于IPV的HIV感染妇女有效浏览医疗保健系统的能力。此外，研究应探索各种方法，如使用同行或准专业人员，5以促进妇女有效地驾驭往往是冗长的医疗保健系统的能力。其他研究还表明，医疗服务的可及性有限是一个重要因素，可能会促进与护理的联系和潜在参与。5因此，将创伤服务与艾滋病毒抗体阳性妇女通常得到的医疗服务放在一起，有助于她们继续接受护理，并提高她们的生活质量。
Engagement, retention, and continuity of care for women living with HIV may reduce HIV transmission, reinforce prevention messages, promote highly active antiretroviral therapy adherence, and enhance monitoring of sexually transmitted diseases. 1 National estimates suggest that 42%-59% of HIV-infected adults are not in care. 2, 3 Given the adverse consequences of poor engagement in HIV medical care, understanding patient characteristics associated with poor engagement is a clinical and public health priority. HIV-infected individuals may be categorized along a continuum of engagement in care: those never in care, those with inconsistent care, and those with consistent medical care. 3-5 This commentary accompanies the manuscript by Siemieniuk et al, 6 The clinical implications of high rates of intimate partner violence against HIV-positive women. In this study, 339 HIV-positive women receiving outpatient care were screened for intimate partner violence (IPV). Findings from this study corroborate existing empirical data demonstrating that exposure to IPV may increase risk for HIV transmission, perhaps as a consequence of poor mental health, illicit substance use, riskier sexual practices, or history of incarceration. However, this manuscript also extends the literature to examine associations between IPV and a diverse range of adverse behavioral, clinical and health outcomes among women living with HIV.The authors observed a 40% prevalence of IPV among their sample of women living with HIV. Women reporting IPV had higher rates of smoking, illicit substance use, depression, anxiety disorders, incarceration histories, history of childhood abuse, and diminished health-related quality of life. Moreover, IPV-exposed women were significantly more likely to be hospitalized compared with IPV-unexposed women (256 times per 1000 patient-years vs. 166/1000 patient-years, respectively, P, 0.001). Additionally, the relative risk for HIV-unrelated hospitalizations and HIV-related hospitalizations after outpatient HIV care was initiated and markedly increased for IPV-exposed women. Adverse clinical health outcomes also included decreased use of antiretroviral therapy and additional interruptions in care longer than 1 year. 6 Limited research has been undertaken to understand why IPV-exposed women living with HIV have suboptimal engagement in care. Some data suggest that women may have conflicting priorities that interfere with seeking HIV medical care. These challenges may include illicit drug use, unstable housing, poor coping, anxiety or depressive disorders, or limited access to health insurance. These factors, many of which were observed in the study by Siemieniuk et al, may limit the ability of IPV-exposed HIV-infected women to effectively navigate the health care system. Furthermore, research should explore methods, such as use of peers or paraprofessionals, 5 to facilitate the ability of women to effectively navigate the oftentimes labyrinthine health care system. Additional research has also shown that the limited accessibility of medical services is an important factor that may promote linkage and potential engagement with care. 5 Thus, colocating trauma services with medical services that HIV-positive women typically receive facilitates retention in care and improves their quality of life.
登录
查看更多内容
影响因子：
1.8
作者：
Ikard, K;Janney, J;Kahn, JG
通讯作者：
Kahn, JG
DOI：
10.1097/qai.0b013e31829bb007
发表时间：
2013-09-01
影响因子：
3.6
作者：
Siemieniuk, Reed A. C.;Krentz, Hartmut B.;Gill, M. John
通讯作者：
Gill, M. John
利用创伤理论设计服务系统。
DOI：
--
发表时间：
2001
期刊：
影响因子：
--
作者：
M. Harris;R. Fallot
通讯作者：
R. Fallot
影响因子：
4.6
作者：
Edwards, Valerie J.;Black, Michele C.;Perry, Geraldine S.
通讯作者：
Perry, Geraldine S.