Chin John J, Botsko Michael, Behar Elana, Finkelstein Ruth
Department of Urban Affairs and Planning, Hunter College of the City University of New York, New York, NY, USA.
AIDS Care. 2009 Oct;21(10):1289-97. doi: 10.1080/09540120902732019.
In HIV care, the use of social or "ancillary" services to stabilize life situations and remove barriers to care is often seen as a means to the end of ensuring more consistent participation in medical care. By examining the impact of HIV social services on the achievement of intermediate outcomes (i.e., ceasing substance use, initiating anti-retroviral therapy (ART), and entering stable housing) and the relationship between intermediate outcome status and quality of life (QOL), our analysis aims to demonstrate the importance of achieving intermediate outcomes in and of themselves and thereby the importance of the ancillary services that assist clients in attaining desired intermediate outcomes. Our analysis relies on baseline and follow-up data from 1646 HIV-positive participants collected during a longitudinal outcome evaluation of 23 HIV social service programs in the New York metropolitan area. Multivariate linear regression modeling was used to assess the impact of achieving intermediate outcomes on QOL at follow-up, controlling for baseline QOL, and demographic factors. The greatest improvements in QOL were found in individuals who changed their intermediate outcome status from using drugs to not using, from not using ART to using ART, and from being unstably housed to being stably housed. Our analysis strongly suggests the importance of achieving intermediate outcomes in improving QOL, and thereby the importance of social services that facilitate the achievement of these intermediate outcomes. The analysis also provides further validation of a QOL measure, by showing that it varies in systematic and expected ways with the achievement of intermediate outcomes. Our study suggests that social services are not merely ancillary in HIV care but rather crucial for achieving both intermediate outcomes as well as the final outcome of improved QOL.
在艾滋病护理中，利用社会或“辅助”服务来稳定生活状况并消除护理障碍，通常被视为实现更持续参与医疗护理这一目标的手段。通过考察艾滋病社会服务对实现中间结果（即停止药物使用、开始抗逆转录病毒治疗（ART）以及进入稳定住房）的影响，以及中间结果状态与生活质量（QOL）之间的关系，我们的分析旨在证明实现中间结果本身的重要性，从而证明辅助服务对于帮助客户实现期望的中间结果的重要性。我们的分析依赖于在对纽约大都市地区23个艾滋病社会服务项目进行纵向结果评估期间收集的1646名艾滋病病毒阳性参与者的基线和随访数据。多元线性回归模型被用于评估在随访时实现中间结果对生活质量的影响，同时控制基线生活质量和人口统计学因素。生活质量改善最大的是那些中间结果状态从使用药物变为不使用、从不使用抗逆转录病毒治疗变为使用抗逆转录病毒治疗、从不稳定住房变为稳定住房的个体。我们的分析有力地表明了实现中间结果对改善生活质量的重要性，从而表明了有助于实现这些中间结果的社会服务的重要性。该分析还通过表明生活质量测量值随中间结果的实现而以系统且预期的方式变化，进一步验证了一种生活质量测量方法。我们的研究表明，社会服务在艾滋病护理中不仅仅是辅助性的，而是对于实现中间结果以及改善生活质量这一最终结果都至关重要。
