Shelton Rachel C, Golin Carol E, Smith Scott R, Eng Eugenia, Kaplan Andrew
University of North Carolina at Chapel Hill School of Public Health, Department of Health Behavior and Health Education, Chapel Hill, North Carolina, USA.
AIDS Patient Care STDS. 2006 Mar;20(3):193-204. doi: 10.1089/apc.2006.20.193.
Highly active antiretroviral therapy (HAART) adherence rates of 90%-95% or more are required to be effective at treating the virus and preventing drug resistance. From both a medical and public health perspective, it is essential that HIV-positive clients strictly adhere to antiretroviral treatment regimens. One promising approach to promoting optimal adherence rates among HIV-positive individuals is training and reimbursing case managers to provide adherence coordination services to HIV-positive clients. In this study, a sample of 16 HIV/ AIDS case managers from agencies across North Carolina participated in a Case Management Adherence Training and Coordination Program for a 3-month period. After case manager training, case managers enrolled 1-4 of their existing clients, who met eligibility criteria, to receive the adherence coordination program. Data were analyzed from focus group interviews and individual interviews conducted with case manager participants; their respective client care plans were also analyzed to identify primary barriers and strategies reported by case managers. Although case managers perceived themselves to be well positioned to provide adherence coordination services for their HIV-positive clients, they also identified barriers that they face in providing these services, including lack of reimbursement for their time, inadequate training, and insufficient knowledge of HIV/AIDS and medications. The findings of this study suggest that, with appropriate training and reimbursement, HIV/AIDS case managers can play a pivotal role in promoting and improving client adherence to antiretroviral medications.
高效抗逆转录病毒疗法（HAART）的依从率需达到90%-95%或更高，才能有效治疗病毒并预防耐药性。从医学和公共卫生角度来看，HIV阳性患者严格遵守抗逆转录病毒治疗方案至关重要。一种有望提高HIV阳性个体最佳依从率的方法是培训并补偿个案管理员，以便为HIV阳性患者提供依从性协调服务。在本研究中，来自北卡罗来纳州各机构的16名HIV/艾滋病个案管理员样本参加了为期3个月的个案管理依从性培训与协调项目。在个案管理员培训后，个案管理员招募了1-4名符合资格标准的现有患者接受依从性协调项目。对与个案管理员参与者进行的焦点小组访谈和个人访谈数据进行了分析；还分析了他们各自的客户护理计划，以确定个案管理员报告的主要障碍和策略。尽管个案管理员认为自己有能力为HIV阳性患者提供依从性协调服务，但他们也指出了在提供这些服务时面临的障碍，包括时间没有得到补偿、培训不足以及对HIV/艾滋病和药物的了解不够。本研究结果表明，通过适当的培训和补偿，HIV/艾滋病个案管理员可以在促进和提高患者对抗逆转录病毒药物的依从性方面发挥关键作用。
