A youth-focused case management intervention to engage and retain young gay men of color in HIV care
A youth-focused case management intervention to engage and retain young gay men of color in HIV care
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DOI：
10.1080/09540121.2010.542125
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发表时间：
2011-01-01
影响因子：
1.7
通讯作者：
Jordan, Wilbert
中科院分区：
文献类型：
--
作者：
Wohl, Amy Rock;Garland, Wendy H.;Jordan, Wilbert
艾滋病毒阳性的拉丁裔和非裔美国男男性行为青年（YMSM）参与和保留艾滋病毒护理的比例较低。一项以青年为重点的案例管理干预（YCM）的评估，旨在提高艾滋病毒护理的保留率。HIV阳性的拉丁裔和非裔美籍男青年，年龄在18-24岁，新诊断为HIV或正在接受间歇性HIV治疗，被纳入由加州洛杉矶县两家HIV诊所的本科水平的同伴病例管理人员管理的心理社会病例管理干预。参与者在前两个月每周与一位病例管理人员会面，在接下来的22个月里每月会面一次。在3个月和6个月的随访中，对艾滋病毒初级保健的保留率进行了评估，并评估了与保留率相关的因素。从2006年4月到2009年4月，61名hiv阳性参与者被纳入干预（54%是非裔美国人，46%拉丁裔，平均年龄21岁）。在参加干预时，78%的青年男性对稳定的住房、营养支持、药物滥用治疗或心理健康服务有迫切或迫切的需求。在干预参与者（n = 61）中，90%的人在三个月时继续接受初级艾滋病毒治疗，70%的人在六个月时继续接受初级艾滋病毒治疗。在先前接受过间歇性护理的患者中（n = 33），参与干预后，在过去六个月内参加所有艾滋病毒初级保健就诊的比例从7%增加到73% （p < 0.0001）。6个月后继续接受艾滋病毒护理与干预就诊次数增加（p = 0.05）、干预时间延长（p = 0.02）和HAART处方有关。这些数据突出了艾滋病毒阳性的非裔美国人和拉丁裔YCM的关键需求，并证明了以诊所为基础的YCM可以有效地稳定难以接触的客户，并使他们保持一致的艾滋病毒护理。
HIV-positive Latino and African-American young men who have sex with men (YMSM) have low rates of engagement and retention in HIV care. An evaluation of a youth-focused case management intervention (YCM) designed to improve retention in HIV care is presented. HIV-positive Latino and African-American YMSM, ages 18-24, who were newly diagnosed with HIV or in intermittent HIV care, were enrolled into a psychosocial case management intervention administered by Bachelor-level peer case managers at two HIV clinics in Los Angeles County, California. Participants met weekly with a case manager for the first two months and monthly for the next 22 months. Retention in HIV primary care at three and six months of follow-up was evaluated as were factors associated with retention in care. From April 2006 to April 2009, 61 HIV-positive participants were enrolled into the intervention (54% African-American, 46% Latino; mean age 21 years). At the time of enrollment into the intervention, 78% of the YMSM had a critical or immediate need for stable housing, nutrition support, substance abuse treatment, or mental health services. Among intervention participants (n = 61), 90% were retained in primary HIV care at three months and 70% at six months. Among those who had previously been in intermittent care (n = 33), the proportion attending all HIV primary care visits in the previous six months increased from 7% to 73% following participation in the intervention (p < 0.0001). Retention in HIV care at six months was associated with increased number of intervention visits (p = 0.05), more hours in the intervention (p = 0.02), and prescription of HAART. These data highlight the critical needs of HIV-positive African-American and Latino YMSM and demonstrate that a clinic-based YCM can be effective in stabilizing hard-to-reach clients and retaining them in consistent HIV care.