Rajabiun Serena, Mallinson R Kevin, McCoy Kate, Coleman Sharon, Drainoni Mari-Lynn, Rebholz Casey, Holbert Tim
Health and Disability Working Group, Boston University School of Public Health, Boston, Massachusetts 02210, USA.
AIDS Patient Care STDS. 2007;21 Suppl 1:S20-9. doi: 10.1089/apc.2007.9990.
This qualitative study investigated the process of engagement in HIV medical care from the perspective of people living with HIV/AIDS (PLWHA). In-depth interviews were conducted with 76 participants in six cities. All participants were considered underserved because of histories of substance use, mental illness, incarceration, homelessness, or cultural barriers to the traditional health care system. A semistructured interview guide elicited narratives related to health care and the role of program interventions in facilitating access to care. Data analysis revealed that participants cycled in and out of care, a process that was influenced by (1) their level of acceptance of being diagnosed with HIV, (2) their ability to cope with substance use, mental illness, and stigma, (3) their health care provider relationships, (4) the presence of external support systems, and (5) their ability to overcome practical barriers to care. Outreach interventions played a role in connecting participants to care by dispelling myths and improving knowledge about HIV, facilitating access to HIV care and treatment, providing support, and reducing the barriers to care. The findings suggest that outreach programs can interrupt this cyclical process and foster sustained, regular HIV care for underserved PLWHA by conducting client-centered risk assessments to identify and reduce sources of instability and improve the quality of provider relationships; implementing strategies that promote healthy practices; creating a network of support services in the community; and supporting adherence through frequent follow-ups for medication and appointment keeping.
这项定性研究从艾滋病毒/艾滋病感染者（PLWHA）的角度调查了参与艾滋病毒医疗护理的过程。对六个城市的76名参与者进行了深入访谈。由于有药物使用史、精神疾病、监禁、无家可归或存在传统医疗保健系统的文化障碍，所有参与者都被视为医疗服务不足。一份半结构化访谈指南引出了与医疗保健以及项目干预措施在促进获得护理方面的作用相关的叙述。数据分析表明，参与者在接受护理的过程中进进出出，这一过程受到以下因素影响：（1）他们对被诊断感染艾滋病毒的接受程度；（2）他们应对药物使用、精神疾病和耻辱感的能力；（3）他们与医疗保健提供者的关系；（4）外部支持系统的存在；（5）他们克服护理实际障碍的能力。外展干预措施通过消除误解、提高对艾滋病毒的认识、促进获得艾滋病毒护理和治疗、提供支持以及减少护理障碍，在将参与者与护理联系起来方面发挥了作用。研究结果表明，外展项目可以通过开展以客户为中心的风险评估来识别和减少不稳定因素并改善提供者关系的质量，从而中断这一循环过程，并为医疗服务不足的艾滋病毒/艾滋病感染者提供持续、定期的艾滋病毒护理；实施促进健康行为的策略；在社区建立支持服务网络；以及通过对药物治疗和预约遵守情况进行频繁随访来支持依从性。
