Strategies to improve HIV care outcomes for people with HIV who are out of care: the need for well designed health systems.
Strategies to improve HIV care outcomes for people with HIV who are out of care: the need for well designed health systems.
复制标题
改善失去护理的艾滋病毒感染者的艾滋病毒护理结果的策略：需要精心设计的卫生系统。
DOI：
10.1097/qad.0000000000003189
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Rotheram-Borus,MaryJane
中科院分区：
文献类型：
--
作者：
Rotheram-Borus,MaryJane
最近对美国艾滋病病毒携带者(PLH)的结果进行的荟萃分析[1]表明了在设计和广泛实施PLH干预措施方面取得的进展和仍然存在的挑战。与早先关于这一主题的两篇综述文章[2，3]相比，这项荟萃分析发现了五种不同的艾滋病毒相关干预措施的显著好处：患者导航、预约提醒、交通和预约协调、社会支持和数据到护理(即使用监视系统通知提供者PLH已退出护理)。当PLH接受干预时，重新参与和保留在护理中，有时是病毒抑制，通常是加倍的。然而，这项审查的必要性令人失望：在确定作为预防的第一个治疗益处25年后，大约61%的PLH没有得到护理[2]，70%没有受到病毒抑制[2]，43%的新感染是由已经退出护理的PLH传播的[1]。这些都是令人沮丧的结果--特别是当对继续接受护理的PLH有明显的好处时--更长、更高质量、更健康的生命，以及对他们的性伴侣没有感染艾滋病毒的好处[4，5]。此外，美国疾病控制与预防中心团队的荟萃分析并未表明干预对终止艾滋病毒流行所需的干预效果有多大的益处。
The most recent meta-analyses of outcomes for persons with HIV (PLH) in the United States who are out-of-care [1] indicate both the progress made and the challenges that remain in designing and broadly implementing interventions for PLH. In contrast to two earlier review articles on this topic [2, 3], this meta-analysis found significant benefits of five different HIV-related interventions: patient navigation, appointment alerts; transportation and appointment coordination; social support, and data-to-care (ie using a surveillance system to inform providers when a PLH has dropped out-of-care). Reengagement and retention in care and, sometimes, viral suppression, typically doubled when PLH received an intervention.Yet, the very need for this review is disappointing: 25 years after the first benefits of treatment as prevention were identified [4–6], about 61% of PLH are out-of-care [2], 70% are not virally suppressed [2], and 43% of new infections are transmitted by PLH who have dropped out-of-care [1]. These are dismal outcomes–especially when there are clear benefits to PLH who remain in care–a longer, high-quality, healthier life, as well as benefits to their sexual partners who do not become infected with HIV [4, 5]. In addition, the CDC team's meta-analyses do not suggest intervention benefits on the magnitude of those needed to end the HIV epidemic.