Cabral Howard J, Tobias Carol, Rajabiun Serena, Sohler Nancy, Cunningham Chinazo, Wong Mitchell, Cunningham William
Boston University School of Public Health, Boston, Massachusetts 02118, USA.
AIDS Patient Care STDS. 2007;21 Suppl 1:S59-67. doi: 10.1089/apc.2007.9986.
Engagement in HIV primary care and the receipt of antiretroviral therapy when clinically indicated offers patients the opportunity to experience HIV disease as a chronic illness. Yet many people, particularly those with comorbid mental health or substance abuse conditions and those who face multiple barriers to care, cycle in and out of care and thus can not reap the life-prolonging benefits of antiretroviral therapy. Although there is evidence about the impact of different interventions on adherence to HIV medications, there is little information about the impact of interventions on engagement or retention in HIV primary care among the hard-to-reach. In this multisite, national study, we contribute new information by exploring the relationship between outreach program contacts and retention in care over a 12-month period among participants in a demonstration project to promote engagement and retention in HIV primary care. We found that when participants received nine or more contacts during the first 3 months of their programs, they were about half as likely to have a substantial gap (defined as 4 months or more) in primary care during the first 12 months of follow-up. This finding remained after controlling for baseline CD4 count. These findings can be used to improve the effectiveness of programs to increase engagement and retention in HIV primary care among the hard-to-reach.
参与HIV初级保健并在临床指征明确时接受抗逆转录病毒治疗，能让患者有机会将HIV疾病当作慢性病来应对。然而，许多人，尤其是那些患有合并心理健康或药物滥用疾病的人以及面临多种就医障碍的人，在接受治疗的过程中反复进出医疗机构，因此无法从抗逆转录病毒治疗中获得延长生命的益处。尽管有证据表明不同干预措施对HIV药物依从性的影响，但关于这些干预措施对难以接触到的人群在HIV初级保健中的参与度或留治率的影响却知之甚少。在这项多地点的全国性研究中，我们通过探讨在一个促进HIV初级保健参与度和留治率的示范项目中，外展项目接触与参与者12个月期间的留治率之间的关系，提供了新的信息。我们发现，当参与者在项目的前3个月接受9次或更多次接触时，在随访的前12个月里，他们在初级保健中出现大幅中断（定义为4个月或更长时间）的可能性大约减半。在对基线CD4计数进行控制后，这一发现依然成立。这些发现可用于提高项目的有效性，以增加难以接触到的人群在HIV初级保健中的参与度和留治率。
