Woods Elizabeth R, Samples Cathryn L, Melchiono Maurice W, Harris Sion Kim
Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Semin Pediatr Infect Dis. 2003 Jan;14(1):43-53. doi: 10.1053/spid.2003.127217.
The Boston HAPPENS Program is a collaborative network of care consisting of multiservice outreach agencies; community health centers; and hospitals for HIV-positive, homeless, and hard-to-reach youth. In four years of data collection, the program served more than 2,000 youth, including 54 HIV-positive youth. The youth were 19.9 +/- 2.9 years old; 64 percent female; 45 percent youth of color; 11 percent gay/lesbian, bisexual, or undecided; and 13 percent homeless or runaway. Homeless youth were much more likely to have been involved with a mental health system (47% vs. 12%, P < 0.001), the criminal justice system (20% vs. 2%, P < 0.001), high-risk sexual behaviors (21% vs. 3%, P < 0.001), and substance abuse (25% vs. 6%, P < 0.001) than were other youth served by the program. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect under-served youth to health care. Outreach and human immunodeficiency virus (HIV) counseling and testing services can offer important portals of entry into health services for at-risk youth. Support services such as outreach, case management, and mental health services are needed to complement medical services by all youth at-risk for contracting HIV. Support services are necessary for the initiation and retention of youth in care so that early case identification and complex treatment regimens can be initiated and tailored to the individual.
波士顿“发生”项目是一个由多服务外展机构、社区健康中心和医院组成的合作式护理网络，服务对象为感染艾滋病毒、无家可归且难以接触到的青少年。在四年的数据收集过程中，该项目为2000多名青少年提供了服务，其中包括54名感染艾滋病毒的青少年。这些青少年的年龄为19.9±2.9岁；64%为女性；45%为有色人种青少年；11%为同性恋、双性恋或性取向未确定者；13%为无家可归者或离家出走者。与该项目服务的其他青少年相比，无家可归的青少年更有可能曾与心理健康系统（47%对12%，P<0.001）、刑事司法系统（20%对2%，P<0.001）、高危性行为（21%对3%，P<0.001）以及药物滥用（25%对6%，P<0.001）有过关联。需要有提供连续服务、多种进入途径和不同类型护理场所的综合护理网络，以便将服务不足的青少年与医疗保健联系起来。外展服务以及人类免疫缺陷病毒（HIV）咨询和检测服务可为高危青少年提供进入健康服务的重要入口。需要诸如外展服务、病例管理和心理健康服务等支持性服务，以补充所有有感染HIV风险的青少年的医疗服务。支持性服务对于促使青少年开始接受并持续接受护理十分必要，这样才能尽早进行病例识别并启动针对个体的复杂治疗方案。
