Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection
Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection
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DOI：
10.1086/505212
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发表时间：
2006-07-15
影响因子：
11.8
通讯作者：
Bangsberg, D. R.
中科院分区：
文献类型：
--
作者：
Kushel, M. B.;Colfax, G.;Bangsberg, D. R.
背景病例管理（CM）协调对具有复杂医疗保健需求的人的护理。尚不清楚CM是否能有效改善无家可归者和边缘居住的人类免疫缺陷病毒（HIV）感染者的生物学结局。我们的目标是确定CM是否与减少急性医疗护理使用和改善无家可归者和边缘居住的HIV感染者的生物学结局有关。我们在加州旧金山弗朗西斯科的一个基于概率的社区样本中进行了一项前瞻性观察性队列研究。主要独立变量为CM，定义为无或罕见（25%但75%的任何CM）。因变量为3个自我报告的卫生服务使用指标（接受初级保健、急诊就诊和住院治疗以及抗逆转录病毒治疗依从性）和2个生物指标（CD 4+细胞计数增加>= 50%和CD 4+细胞计数几何平均HIV载量改善≥ 50%）。当模型中包括抗逆转录病毒治疗依从性时，CM与几何HIV载量< 400拷贝/mL无关。研究的局限性包括缺乏随机化。CM可能是一种成功的方法，以提高艾滋病毒感染的无家可归者和边缘居住的成年人之间的抗逆转录病毒治疗和生物学结果的坚持。
Background. Case management ( CM) coordinates care for persons with complex health care needs. It is not known whether CM is effective at improving biological outcomes among homeless and marginally housed persons with human immunodeficiency virus ( HIV) infection. Our goal was to determine whether CM is associated with reduced acute medical care use and improved biological outcomes in homeless and marginally housed persons with HIV infection.Methods. We conducted a prospective observational cohort study in a probability-based community sample of HIV-infected homeless and marginally housed adults in San Francisco, California. The primary independent variable was CM, defined as none or rare ( any CM in 25% but 75%). The dependent variables were 3 self-reported health service use measures ( receipt of primary care, emergency department visits and hospitalizations, and antiretroviral therapy adherence) and 2 biological measures ( increase in CD4(+) cell count of >= 50% and geometric mean HIV load of = 50% improvements in CD4+ cell count. CM was not associated with geometric HIV load < 400 copies/mL when antiretroviral therapy adherence was included in the model. Study limitations include a lack of randomization.Conclusion. CM may be a successful method to improve adherence to antiretroviral therapy and biological outcomes among HIV-infected homeless and marginally housed adults.