Thurman Tonya Renee, Haas Laura J, Dushimimana Abel, Lavin Bridget, Mock Nancy
Department of International Health, Tulane University, New Orleans, LA, USA.
AIDS Care. 2010 Jun;22(6):759-65. doi: 10.1080/09540120903443376.
Case management is a standard practice in the United States for the effective care of people living with HIV and AIDS (PLHA); however, application of this approach in developing countries has not been demonstrated. Although great advances have been made in Africa to increase PLHA's access to HIV services, care and support systems often remain fragmented. In September 2004, CARE International initiated a case management program in health facilities in Rwanda designed to enhance linkages between clinical and non-clinical services for PLHA. This paper presents findings from an evaluation of the program conducted in 2006 focusing on its implementation, specifically the responsibilities of case managers, community linkages, and integration within the health facility. Program outcomes of antiretroviral treatment adherence and quality of life among PLHA also were explored. Qualitative data were collected from case managers, clients, health care providers, and CARE staff. A survey was conducted among 75% of the 149 case managers. Results indicate the case management program strengthened linkages between health facility and community service providers for PLHA. However, most case managers (79%) reported inadequate resources to carry out their duties and high client loads, averaging 55 clients each. They also had limited referral networks. Nonetheless, case managers were highly regarded and appreciated by health professionals, who reported that the program helped to enhance patient-doctor relationships and ensure follow-up of patients' needs. Respondents further highlighted benefits of improved psychosocial well-being and better adherence to antiretroviral medications among clients. Issues remain in terms of case management efficacy in developing country environments, notably the availability and accessibility of needed ancillary services. Despite some limitations, data suggest case management is a viable strategy for providing comprehensive support to PLHA in Rwanda and its implementation elsewhere in Africa should be explored. Considerations in replicating this approach are discussed.
病例管理在美国是对艾滋病毒感染者和艾滋病患者进行有效护理的一种标准做法；然而，这种方法在发展中国家的应用尚未得到证实。尽管非洲在增加艾滋病毒感染者获得艾滋病毒服务方面取得了巨大进展，但护理和支持系统往往仍然分散。2004年9月，国际关怀组织在卢旺达的医疗机构启动了一项病例管理计划，旨在加强为艾滋病毒感染者提供的临床和非临床服务之间的联系。本文介绍了2006年对该计划进行评估的结果，重点是其实施情况，特别是病例管理人员的职责、社区联系以及在医疗机构内的整合情况。还探讨了艾滋病毒感染者抗逆转录病毒治疗依从性和生活质量的计划成果。从病例管理人员、客户、医疗保健提供者和国际关怀组织工作人员那里收集了定性数据。对149名病例管理人员中的75%进行了调查。结果表明，病例管理计划加强了医疗机构与为艾滋病毒感染者提供社区服务的提供者之间的联系。然而，大多数病例管理人员（79%）报告称，开展工作的资源不足，客户负荷很高，平均每人有55名客户。他们的转诊网络也很有限。尽管如此，病例管理人员受到了卫生专业人员的高度评价和赞赏，卫生专业人员报告说，该计划有助于改善医患关系，并确保对患者需求的跟踪。受访者还强调了客户心理社会福祉改善和抗逆转录病毒药物依从性提高的好处。在发展中国家环境中，病例管理的有效性方面仍然存在问题，特别是所需辅助服务的可用性和可及性。尽管存在一些局限性，但数据表明，病例管理是为卢旺达的艾滋病毒感染者提供全面支持的可行战略，应探索在非洲其他地区实施该战略。讨论了复制这种方法时需要考虑的因素。
