Improving HIV/AIDS care through treatment advocacy: going beyond client education to empowerment by facilitating client-provider relationships.
Improving HIV/AIDS care through treatment advocacy: going beyond client education to empowerment by facilitating client-provider relationships.
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DOI：
10.1080/09540121.2010.496847
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发表时间：
2011-01
期刊：
影响因子：
1.7
通讯作者：
Bogart LM
中科院分区：
文献类型：
--
作者：
Mutchler MG;Wagner G;Cowgill BO;McKay T;Risley B;Bogart LM
美国各地的艾滋病服务组织（ASO）和初级保健诊所实施了治疗宣传（TA）计划，以帮助艾滋病毒感染者接受护理，并支持他们坚持抗逆转录病毒治疗（ART）。TA旨在通过教育和以客户为中心的艾滋病毒，抗逆转录病毒治疗和其他健康问题的咨询，赋予艾滋病毒感染者权力;代表患者与提供者进行倡导;并将其转介到医疗服务和临床试验。然而，关于TA对客户医疗保健体验的影响，人们知之甚少。本研究的目标包括探索TA服务如何帮助客户参与艾滋病毒护理，启动ART，并坚持使用艾滋病毒药物。我们进行了25个半结构化的定性开放式访谈与艾滋病项目洛杉矶（APLA）招募的艾滋病毒/艾滋病患者，四个艾滋病医疗服务提供者和两个TA工作人员在APLA。在接受访谈的25名客户中，92%为男性，8%为女性。平均年龄为43岁（SD = 9）。大约60%是非洲裔美国人，20%是白色，12%是其他或多种族，4%是拉丁美洲人，4%是亚洲/太平洋岛民。五个相互关联的主题始终出现在客户端，TA和提供商。助教帮助客户了解治疗方法，并在整体背景下支持依从性。此外，助教还充当了与提供者的桥梁，帮助客户培养自我宣传技能。我们的数据表明，TA服务超越了传统的教育和治疗依从性领域。阿索内的技术援助服务也提供了一个安全的场所，以更全面的方式讨论艾滋病毒的初步诊断和其他健康问题。技术援助服务补充了医疗和其他社会服务，使艾滋病毒感染者成为更好的保健服务消费者。未来的定量研究检查TA在改善客户参与护理和依从性方面的有效性是下一步的关键。
Treatment advocacy (TA) programs have been implemented by AIDS service organizations (ASOs) and primary care clinics across the USA to help engage clients with HIV into care and support their adherence to antiretroviral therapy (ART). TA aims to empower people with HIV through education and client-centered counseling regarding HIV, ART, and other health issues; advocate on behalf of patients with providers; and make referrals to healthcare services and clinical trials. However, relatively little is known about the impact TA has on clients’ healthcare experiences. The present study’s objectives included exploring how TA services help clients engage in HIV care, initiate ART, and adhere to HIV medications. We conducted 25 semi-structured qualitative open-ended interviews with clients living with HIV/AIDS recruited from AIDS Project Los Angeles (APLA); four HIV medical providers; and two TA staff at APLA. Of the 25 clients interviewed, 92% were male and 8% were female. The average age was 43 years (SD = 9). About 60% were African-American, 20% were White, 12% were other or multiracial, 4% were Latino, and 4% were Asian/Pacific Islander. Five interconnected themes consistently emerged across clients, TAs, and providers. TAs helped clients understand treatments and supported adherence within a holistic context. Further, TAs acted as a bridge to providers and helped clients build self-advocacy skills. Our data show that TA services go beyond traditional areas of education and treatment adherence. TA services within an ASO also provide a safe place to discuss initial HIV diagnoses and other health issues in a more comprehensive manner. TA services complemented medical and other social services by preparing clients with HIV to be better consumers of healthcare services. Future quantitative research examining the effectiveness of TA on improving clients’ engagement in care and adherence is a critical next step.