Barriers and facilitators to engagement of vulnerable populations in HIV primary care in New York City.
Barriers and facilitators to engagement of vulnerable populations in HIV primary care in New York City.
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纽约市艾滋病毒初级保健中脆弱人群参与的障碍和促进者。
DOI：
10.1097/qai.0000000000000577
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发表时间：
2015-05-01
期刊：
影响因子：
--
通讯作者：
Warne P
中科院分区：
文献类型：
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作者：
Remien RH;Bauman LJ;Mantell JE;Tsoi B;Lopez-Rios J;Chhabra R;DiCarlo A;Watnick D;Rivera A;Teitelman N;Cutler B;Warne P
参与艾滋病毒护理有助于最大限度地抑制病毒，从而降低发病率和死亡率，防止艾滋病毒的进一步传播。纽约市的艾滋病病例比美国其他任何城市都多，2012年报告称，估计所有艾滋病病毒感染者（PLWH）中只有41%的病毒载量受到抑制，而近四分之三的临床护理人员实现了病毒抑制。因此，在艾滋病毒护理中保留艾滋病毒感染者符合美国国家艾滋病毒/艾滋病战略和州长Cuomo在纽约州结束艾滋病流行的计划的核心目标。我们对四个纽约市人群中的PLWH进行了80次深入的定性访谈，这些人群被确定为不一致地参与艾滋病毒医疗护理：非洲移民，以前被监禁的成年人，变性妇女和与男性发生性关系的年轻男子。艾滋病毒护理参与的障碍和促进因素分为三个领域：（1）系统因素（例如，患者-提供者关系、社会服务机构、刑罚系统和社区之间的过渡）;（2）社会因素（例如，家庭和其他社会支持;与艾滋病毒、药物使用、性取向、性别认同和监禁有关的耻辱）;以及（3）个人因素（例如，精神疾病、物质使用、恢复力）。确定了四个人群中这些主题的相似性和差异以及研究和公共卫生影响。当弱势群体所面临的社会挑战得到解决时，护理工作的参与程度就会最大化;病人与提供者之间的沟通会很强;提供协调一致的服务，包括住房、心理健康和药物使用治疗以及同伴导航。
Engagement in HIV care helps to maximize viral suppression, which, in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, while nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. We conducted 80 in-depth qualitative interviews with PLWH in four NYC populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Barriers to and facilitators of HIV care engagement fell into three domains: (1) system factors (e.g., patient-provider relationship, social service agencies, transitions between penal system and community); (2) social factors (e.g., family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration); and (3) individual factors (e.g., mental illness, substance use, resilience). Similarities and differences in these themes across the four populations as well as research and public health implications were identified. Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed; patient-provider communication is strong; and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation.