Bradford Judith B, Coleman Sharon, Cunningham William
The Fenway Institute of Fenway Community Health, Boston, Massachusetts., Center of Public Policy, Virginia Commonwealth University, Richmond, Virginia 23284-3065, USA.
AIDS Patient Care STDS. 2007;21 Suppl 1:S49-58. doi: 10.1089/apc.2007.9987.
Little is known about the effectiveness of outreach interventions to engage and retain underserved populations living with HIV in stable, primary medical care. This study provided an opportunity to adapt a patient navigation model first developed for cancer care to assess its effectiveness with HIV-infected disadvantaged populations. Four grantees from the Health Resources and Services Administration (HRSA)-funded Outreach Initiative developed and successfully implemented navigation-like interventions. We examined the effectiveness of these interventions in decreasing barriers to HIV primary medical care and improving health outcomes. The conceptual framework laid out in the 1993 Institute of Medicine report Access to Health Care in America provided a valuable heuristic for guiding the analysis, and we used the model to select measures for the study. A reduction in barriers, improvement in mediators, and improved health outcomes were observed over the 12-month intervention period. Structural barriers to HIV care and provider engagement were significantly associated with health outcomes. Based on study results, we propose that an adapted navigation approach referred to as "HIV System Navigation" has promise for improving access to HIV care and warrants further development.
关于外展干预措施在促使未得到充分服务的艾滋病毒感染者参与并持续接受稳定的初级医疗保健方面的效果，人们了解甚少。本研究提供了一个机会，可对最初为癌症护理而开发的患者导航模式进行调整，以评估其对感染艾滋病毒的弱势群体的有效性。来自卫生资源与服务管理局（HRSA）资助的外展倡议的四家受赠机构开发并成功实施了类似导航的干预措施。我们研究了这些干预措施在减少艾滋病毒初级医疗保健障碍和改善健康结果方面的效果。1993年医学研究所报告《美国的医疗保健可及性》中提出的概念框架为指导分析提供了宝贵的启发，我们使用该模型来选择研究的衡量标准。在为期12个月的干预期内，观察到障碍减少、调节因素改善以及健康结果得到改善。艾滋病毒护理的结构障碍和提供者参与度与健康结果显著相关。基于研究结果，我们建议一种称为“艾滋病毒系统导航”的适应性导航方法有望改善艾滋病毒护理的可及性，值得进一步开发。
