Barriers and facilitators of linkage to HIV primary care in New York City.
Barriers and facilitators of linkage to HIV primary care in New York City.
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DOI：
10.1097/qai.0b013e3182a99c19
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发表时间：
2013-11-01
期刊：
影响因子：
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通讯作者：
Watnick D
中科院分区：
文献类型：
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作者：
Bauman LJ;Braunstein S;Calderon Y;Chhabra R;Cutler B;Leider J;Rivera A;Sclafane J;Tsoi B;Watnick D
每五名艾滋病毒携带者中就有一人不知道自己的状况；据估计，他们占新感染者的51%。艾滋病毒的传播可以通过“检测和治疗”策略来减少，这既可以减少病毒载量，也可以减少危险行为。然而，事实证明，将新诊断的艾滋病毒阳性者与护理联系起来具有挑战性。我们报告了与纽约市卫生和精神卫生部门(DOHMH)合作实施的艾滋病毒检测点与护理之间联系的定量和定性数据，该倡议在3年内对607570名居民进行了测试。在TBK期间，伙伴机构报告了进行的艾滋病毒检测总数、确诊阳性数(总体和新的)以及与医疗有关的确诊阳性数。我们对24/30 TBK HIV检测机构的负责人进行了定性访谈，以确定连锁障碍，并选择了9家进行案例研究。联系的障碍分为3个领域：(1)卫生保健系统因素(对提供者预约的长时间等待；预约前要求进行阳性确证测试；系统导航；不尊重患者)；(2)社会因素(艾滋病毒污名)；以及(3)危险人群的特征(例如，精神病、无家可归、使用药物、移民)。联系的最佳做法包括社区组织之间的联网、个性化护理计划、团队方法、全面和协调的护理服务以及患者同行导航。对研究和公共卫生的影响进行了讨论。
One in five people living with HIV are unaware of their status; they account for an estimated 51% of new infections. HIV transmission can be reduced through a “Test and Treat” strategy, which can decrease both viral load and risk behaviors. However, linkage of newly diagnosed HIV positive persons to care has proved challenging. We report quantitative and qualitative data on linkage to care from HIV testing sites that partnered with the New York City Department of Health and Mental Hygiene (DOHMH) to implement “The Bronx Knows”, (TBK) an initiative that tested 607,570 residents over 3 years. During TBK, partner agencies reported the aggregate number of HIV tests conducted, the number of confirmed positives (overall and new), and the number of confirmed positives linked to medical care. We conducted qualitative interviews with directors of 24/30 TBK HIV testing agencies to identify linkage barriers and selected 9 for case studies. Barriers to linkage fell into 3 domains: (1) health care system factors (long wait for provider appointments; requirement of a positive confirmatory test before scheduling an appointment; system navigation; disrespectful to patients); (2) social factors (HIV stigma); and (3) characteristics of risk populations (e.g., mental illness, homelessness, substance use, immigrant). Best practices for linkage included networking among community organizations, individualized care plans, team approach, comprehensive and coordinated care services, and patient peer navigation. Research and public health implications are discussed.