Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005-2016.
Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005-2016.
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DOI：
10.1080/09540121.2018.1426827
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发表时间：
2018-04
期刊：
影响因子：
1.7
通讯作者：
Hubbard McCree D
中科院分区：
文献类型：
--
作者：
Geter A;Sutton MY;Hubbard McCree D
截至2014年底，黑人/非裔美国人（黑人）妇女占感染艾滋病毒妇女的59%，占2015年诊断出艾滋病毒的妇女的61%。与其他种族/族裔的妇女相比，感染艾滋病毒的黑人妇女的健康状况较差；社会和结构决定因素经常被认为是护理的障碍和促进因素。这一定性回顾的目的是确定社会和结构障碍和促进艾滋病毒治疗和护理的BWLH。系统评价分六个阶段进行，使用PubMed、PsycINFO、谷歌Scholar等数据库：1)检索2005年1月至2016年12月期间发表的纳入BWLH的研究，2)排除未发表的报告和评论，3)将搜索限制在我们的主要关键词内，4)将搜索限制在包括HIV感染参与者的研究中，其中60%为黑人，100%为女性，5)提取并总结数据，6)进行上下文综述以确定共同主题。在检索到的534项研究中，有16项纳入了最终综述。研究的重点是：抗逆转录病毒药物依从性（n = 5），参与/保留护理（n = 4），艾滋病毒护理和治疗服务（n = 3），病毒抑制（n = 1），以及解决多种艾滋病毒护理结果（n = 3）。主要障碍主题包括缺乏家庭和/或社会支持，艾滋病毒服务质量差，以及与艾滋病毒相关的耻辱，特别是来自医疗保健提供者的耻辱；主持人的主题包括复原力、案例管理与支持服务之间的积极关系、高度的种族意识以及解决心理健康问题。减少这些障碍和加强促进因素的干预措施可能有助于改善BWLH的护理结果。此外，可能有必要为医疗保健提供者提供更多减少艾滋病毒耻辱的培训。
Black/African American (black) women comprised 59% of women living with HIV at the end of 2014 and 61% of HIV diagnoses among women in 2015. Black women living with HIV infection (BWLH) have poorer health outcomes compared with women of other races/ethnicities; social and structural determinants are often cited as barriers and facilitators of care. The objective of this qualitative review was to identify social and structural barriers and facilitators of HIV treatment and care among BWLH. The systematic review was conducted in six-stages using databases such as PubMed, PsycINFO, and Google Scholar: 1) searched for studies that enrolled BWLH published between January 2005 and December 2016, 2) excluded unpublished reports and commentaries, 3) limited the search to our primary keywords, 4) limited our search to studies that included participants living with HIV infection that were >60% black and 100% female, 5) extracted and summarized the data, and 6) conducted a contextual review to identify common themes. Of 534 studies retrieved, 16 were included in the final review. Studies focused on: ART medication adherence (n = 5), engagement/retention in care (n = 4), HIV care and treatment services (n = 3), viral suppression (n = 1), and addressing multiple HIV care outcomes (n = 3). Main barrier themes included lack of family and/or social support, poor quality HIV services, and HIV-related stigma, particularly from healthcare providers; facilitator themes included resilience, positive relationships between case management and support services, high racial consciousness, and addressing mental health. Interventions that decrease these noted barriers and strengthen facilitators may help improve care outcomes for BWLH. Also, more HIV stigma-reduction training for healthcare providers may be warranted.
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