Interventions and approaches to integrating HIV and mental health services: a systematic review.
Interventions and approaches to integrating HIV and mental health services: a systematic review.
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DOI：
10.1093/heapol/czw169
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发表时间：
2017-11-01
影响因子：
3.2
通讯作者：
Legido-Quigley H
中科院分区：
文献类型：
--
作者：
Chuah FLH;Haldane VE;Cervero-Liceras F;Ong SE;Sigfrid LA;Murphy G;Watt N;Balabanova D;Hogarth S;Maimaris W;Otero L;Buse K;McKee M;Piot P;Perel P;Legido-Quigley H
艾滋病毒和艾滋病与精神健康问题并存的频率，以及它们之间复杂的双向关系，突出表明需要将艾滋病毒和精神健康服务相结合的有效护理模式。在这里，我们提出了一个系统的审查，综合了有关干预和方法的文献整合这些服务。这项审查是关于艾滋病毒和非传染性疾病服务整合的更大规模系统审查的一部分。符合条件的研究包括描述或评估旨在将艾滋病毒和精神卫生保健结合起来的干预措施或方法的研究。我们搜索了从最初到2015年10月的多个数据库，独立筛选确定纳入的文章，进行数据提取，并评估评估论文的偏见风险。有45篇文章符合本综述的条件。我们在中观和微观层面确定了三种整合模式：单设施整合、多设施整合和由非医生病例经理协调的整合护理。单站点集成增强了多学科协调，并减少了患者的准入障碍。然而，为有复杂需求的患者提供全套现场专门护理的实用性和成本效益是值得商榷的。以专门机构协作网络为基础的一体化可能会为患有多种疾病的人提供服务，但零散和协调不力的护理可能会构成障碍。由单一病例管理人员协调的综合护理可以实现对病人的持续护理，但需要对病例管理人员进行适当的培训和支持。让患者作为关键参与者参与促进他们自己的治疗计划的整合是一种有希望的方法。这项审查确定了艾滋病毒和精神卫生服务相结合的整合模式的多样性，表明如果在适当的背景下实施，这些模式在产生积极的患者和服务交付结果方面具有潜力。我们的综述揭示了在低收入和中等收入国家缺乏研究，而且仅限于大多数描述性研究。总体而言，需要进行研究，从长期成果和成本效益方面对一体化模式进行评价和比较，特别是在卫生系统一级和艾滋病毒/艾滋病负担较重的区域。
The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in low- and middle- income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden.
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影响因子：
3.2
作者：
Atun, Rifat;de Jongh, Thyra;Adeyi, Olusoji
通讯作者：
Adeyi, Olusoji
影响因子：
1.5
作者：
Bouis, Stephanie;Reif, Susan;Swartz, Marvin
通讯作者：
Swartz, Marvin
影响因子：
2
作者：
Adams, Julie L.;Almond, Maria L. G.;Sikkema, Kathleen J.
通讯作者：
Sikkema, Kathleen J.
影响因子：
--
作者：
Buckingham E;Schrage E;Cournos F
通讯作者：
Cournos F
影响因子：
4.2
作者：
Crepaz, Nicole;Passin, Warren F.;Wolitski, Richard J.
通讯作者：
Wolitski, Richard J.