Johnson Robert L, Botwinick Geri, Sell Randall L, Martinez Jaime, Siciliano Carl, Friedman Lawrence B, Dodds Sally, Shaw Kimberly, Walker Lynn E, Sotheran Jo L, Bell Douglas
Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UMDNJ-New Jersey Medical School, Newark, New Jersey 07101, USA.
J Adolesc Health. 2003 Aug;33(2 Suppl):31-8. doi: 10.1016/s1054-139x(03)00158-7.
This article describes the essential components for effective and comprehensive HIV care for youth who have tested positive and have been linked to HIV treatment. Descriptive profile data are also presented that detail the demographics, risk behaviors and health care barriers of youth served in the five Special Projects of National Significance (SPNS), which focused on adolescents and young adults.
Data presented are from the core multi-site data set, which was standardized across the five youth-oriented SPNS projects. Substance use and mental health symptoms were gathered using the Personal Problem Questionnaire (PPQ) screener, which was an adaptation of the PRIME-MD. In-depth qualitative interviews with enrolled HIV-positive youth were also conducted by several Projects.
Medical care alone is not enough and cannot be effective without supportive program components such as flexible scheduling, and a multi-disciplinary team approach that includes assertive case management. Case Managers help enrolled youth with concrete service needs such as housing, emergency financial assistance for food/utilities, transportation, child care, coverage for prescriptions, and public entitlements. They also help isolated youth to connect with a personal support system. Addressing those needs helps to facilitate and reinforce treatment adherence and retention. In addition to other identified needs such as stable housing and transportation, a significant number of enrolled youth self-reported having experienced physical, sexual, and/or emotional abuse in their lives and articulated a need for mental health services. Therefore, effective HIV care for youth must be multi-faceted; it must consist of more than a medical component.
本文描述了为检测呈阳性并已接受HIV治疗的青少年提供有效和全面HIV护理的基本组成部分。还提供了描述性概况数据,详细说明了五个具有全国意义的特殊项目(SPNS)所服务青少年的人口统计学特征、风险行为和医疗保健障碍,这些项目主要针对青少年和青年。
所呈现的数据来自核心多站点数据集,该数据集在五个以青少年为导向的SPNS项目中实现了标准化。使用个人问题问卷(PPQ)筛查工具收集物质使用和心理健康症状信息,该工具是对PRIME-MD的改编。几个项目还对已登记的HIV阳性青少年进行了深入的定性访谈。
仅靠医疗护理是不够的,若没有诸如灵活排班等支持性项目组成部分以及包括积极主动的病例管理在内的多学科团队方法,就无法有效。个案管理员帮助已登记的青少年满足具体的服务需求,如住房、食品/水电费紧急经济援助、交通、儿童保育、处方药覆盖范围和公共福利。他们还帮助孤立无援的青少年建立个人支持系统。满足这些需求有助于促进和加强治疗依从性及留存率。除了其他已确定的需求,如稳定住房和交通外,大量已登记的青少年自我报告在生活中曾遭受身体、性和/或情感虐待,并表示需要心理健康服务。因此,为青少年提供有效的HIV护理必须是多方面的;它必须不仅仅包括医疗组成部分。