The Association of Unmet Needs With Subsequent Retention in Care and HIV Suppression Among Hospitalized Patients With HIV Who Are Out of Care.
The Association of Unmet Needs With Subsequent Retention in Care and HIV Suppression Among Hospitalized Patients With HIV Who Are Out of Care.
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DOI：
10.1097/qai.0000000000001874
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Giordano TP
中科院分区：
文献类型：
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作者：
Dandachi D;May SB;Davila JA;Cully J;Amico KR;Kallen MA;Giordano TP
艾滋病毒住院患者的需求未得到满足可能会阻碍艾滋病毒护理的参与，从而导致更差的临床结果。我们的目的是检查未满足的生存需求（如住房、交通、食物）和医疗需求（如心理健康、药物滥用治疗）作为保留艾滋病毒护理和病毒载量抑制的障碍的作用。我们使用的数据来自促进患者自我护理干预研究的导师方法，该研究纳入了2010年至2013年期间在一家大型公立医院住院的hiv患者，这些患者不在护理范围内。我们研究了未满足的需求对HIV护理的保留（在0-30天和30-180天内参加HIV预约）和出院后6个月病毒载量抑制的影响。纳入417名参与者，78%报告基线时未满足需求≥1项，最常见的是牙科保健（55%），财务（43%）或住房需求（34%）。基线需求未满足的参与者，与没有需求的参与者相比，更有可能是非裔美国人，已有艾滋病毒诊断和保险。未满足的运输需求与较低的留置率相关（OR: 0.5; 95% CI: 0.34-0.94, p=0.03），即使在调整了其他因素后也是如此。与没有需求的参与者相比，那些报告≥3种未满足生存需求的参与者不太可能表现出病毒载量的改善（OR: 0.51; 95% CI: 0.28-0.92; p=0.03），也不太可能继续护理（OR: 0.52; 95% CI: 0.28-0.95; p=0.03）。更广泛地参与能够帮助满足住院病人生存需要的方案，可能对个人和公共卫生都有重大好处。
Unmet needs among hospitalized patients with HIV may prevent engagement in HIV care leading to worse clinical outcomes. Our aim was to examine the role of unmet subsistence needs (e.g. housing, transportation, food) and medical needs (e.g. mental health, substance abuse treatment) as barriers for retention in HIV care and viral load suppression. We utilized data from the Mentor Approach for Promoting Patients’ Self-Care intervention study, the enrolled hospitalized HIV-patients at a large publicly funded hospital between 2010 and 2013, who were out-of-care. We examined the effect of unmet needs on retention in HIV care (attended HIV appointments within 0–30 days and 30–180 days) and viral load suppression, six months after discharge. 417 participants were enrolled, 78% reported having ≥1 unmet need at baseline, most commonly dental care (55%), financial (43%), or housing needs (34%). Participants with unmet needs at baseline, compared to those with no needs, were more likely to be African American, have an existing HIV diagnosis and insured. An unmet need for transportation was associated with lower odds of retention in care (OR: 0.5; 95% CI:0.34–0.94, p=0.03), even after adjusting for other factors. Compared to participants with no need, those who reported ≥3 unmet subsistence needs were less likely to demonstrate viral load improvement (OR: 0.51; 95% CI:0.28–0.92; p=0.03) and to be retained in care (OR: 0.52; 95% CI:0.28–0.95; p=0.03). Broader access to programs that can assist in meeting subsistence needs among hospitalized patients could have significant individual and public health benefits.
影响因子：
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作者：
Davila JA;Hartman C;Cully J;Stanley M;Amico KR;Soriano E;Minick S;May SB;Giordano TP
通讯作者：
Giordano TP