Factors associated with engaging socially marginalized HIV-positive persons in primary care
Factors associated with engaging socially marginalized HIV-positive persons in primary care
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DOI：
10.1089/apc.2007.9989
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发表时间：
2007-06-01
影响因子：
4.9
通讯作者：
Cunningham, William E.
中科院分区：
文献类型：
--
作者：
Rumptz, Maureen H.;Tobias, Carol;Cunningham, William E.
本文使用访谈和图表回顾数据，对参与一个多地点示范项目的10个机构的984名客户提供服务的984名客户的数据，分析了与社会边缘化艾滋病毒阳性者参与初级保健相关的因素。样本主要是少数族裔，许多人报告了毒品和精神健康问题，以及住房不稳定。在基线时，大约一半的参与者从事艾滋病毒初级保健；其他参与者要么根本不从事艾滋病毒初级保健，要么在某种程度上从事保健。那些在一定程度上从事护理的人与根本不从事护理的人非常相似，在一些人口统计、健康状况/利用情况以及护理项目的障碍方面，他们与完全从事护理的人有显著不同，在12个月的随访中，他们在参与护理方面的表现同样糟糕。在12个月的纵向分析中，58%的未达到基线水平的患者(n=517)变得更充分地参与到护理中。在控制了疾病阶段的最终多变量模型中，药物使用的减少、结构性障碍和未满足的需求与护理投入有关。注重减少结构性障碍和未得到满足的支助服务需求、消除消极的健康信念和关注药物使用的干预措施是使边缘化的艾滋病毒阳性者参与艾滋病毒初级保健的有希望的公共卫生战略。
This paper examines factors associated with engaging socially marginalized HIV- positive persons in primary care using interview and chart review data from 984 clients presenting for services at 10 agencies participating in a multisite demonstration project. The sample was predominantly minority, and many reported drug and mental health problems as well as housing instability. At baseline, roughly half of the participants were engaged in HIV primary care; the other participants were either not at all engaged in HIV primary care or somewhat engaged in care. Those who were somewhat engaged in care were very similar to those who were not at all engaged in care, and significantly different than those who were fully engaged in care across a number of demographic, health status/ utilization, and barriers to care items and fared equally poorly with regard to engagement in care at 12- month follow- up. In 12-month longitudinal analyses, 58% of those not engaged at baseline ( n = 517) became more fully engaged in care. In the final multivariate model that controlled for disease stage, decreases in drug use, structural barriers, and unmet needs were associated with engagement in care. Interventions that focus on decreasing structural barriers and unmet support services needs, addressing negative health beliefs and attending to drug use are promising public health strategies to engage marginalized HIV- positive persons in HIV primary care.