Improving linkage to HIV care at low-threshold STI/HIV testing sites: An evaluation of the Immediate Staging Pilot Project in Vancouver, British Columbia
Improving linkage to HIV care at low-threshold STI/HIV testing sites: An evaluation of the Immediate Staging Pilot Project in Vancouver, British Columbia
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DOI：
10.17269/cjph.108.5753
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发表时间：
2017-01-01
影响因子：
4.3
通讯作者：
Ogilvie, Gina
中科院分区：
文献类型：
--
作者：
Brownrigg, Bobbi;Taylor, Darlene;Ogilvie, Gina
目的：即时分期试点项目（ISPP）的目的是通过增加转介到艾滋病毒护理的数量来改善与人类免疫缺陷病毒（HIV）护理的联系，并减少新诊断的HIV患者诊断和联系护理之间的时间。这一试点有可能通过让客户更早地接受治疗来减少艾滋病毒在人群层面的传播。环境：不列颠哥伦比亚省温哥华戴维的布特街诊所和男性健康倡议诊所是低门槛的公共卫生机构，主要向男男性行为者（MSM）提供艾滋病毒/性传播感染检测。干预措施：为了提高男男性行为者在艾滋病毒护理中的参与度，卑诗省疾病控制中心于2012年对新诊断为艾滋病毒的客户实施了为期12个月的ISPP。该试点在诊断时提供CD4和病毒载量检测，实施改进的转诊程序，并加强对客户的护理支持。结果：比较接受标准护理（SOC）组和接受即时分期的干预组与护理结果的关联，与护理时间的中位数关联分别从21.5天减少到14.0天（p = 0.053）。SOC组转介率为56.1%，干预组为94.1% （p < 0.001）。结论：创建最佳实践，包括在诊断时提供CD4和病毒载量检测，加强护理支持和标准化转诊流程，有助于提高向到低门槛诊所就诊的男男性接触者提供的艾滋病毒服务质量。
OBJECTIVES: The objective of the Immediate Staging Pilot Project (ISPP) was to improve linkage to human immunodeficiency virus (HIV) care by increasing the number of referrals made to HIV care, and to decrease the time between diagnosis and linkage to care for newly diagnosed HIV clients. This pilot had the potential to decrease HIV transmission at a population level by engaging clients in treatment earlier.SETTING: The Bute Street Clinic and Health Initiative for Men Clinic on Davie in Vancouver, British Columbia are low-threshold public health facilities providing HIV/STI testing primarily to men who have sex with men (MSM).INTERVENTION: To improve engagement of MSM in the cascade of HIV care, the BC Centre for Disease Control implemented a 12-month ISPP in 2012 for clients newly diagnosed with HIV. The pilot offered CD4 and viral load testing at the time of diagnosis, implemented improved referral procedures and enhanced nursing support for clients.OUTCOMES: Comparing linkage to care outcomes between a group that received the standard of care (SOC) and an intervention group that received immediate staging, the median linkage to care time decreased from 21.5 to 14.0 days respectively (p = 0.053). The referral rates to HIV care were 56.1% in the SOC group and 94.1% in the intervention group (p < 0.001).CONCLUSION: Creating best practices that include offering CD4 and viral load testing at the time of diagnosis, enhanced nursing support and standardized referral processes has facilitated an improvement in the quality of HIV services provided to MSM clients attending low-threshold clinics.