Mutchler Matt G, Wagner Glenn, Cowgill Burt O, McKay Tara, Risley Brian, Bogart Laura M
Department of Sociology, California State University, Carson, CA, USA.
AIDS Care. 2011 Jan;23(1):79-90. doi: 10.1080/09540121.2010.496847.
Treatment advocacy (TA) programs have been implemented by AIDS service organizations (ASOs) and primary care clinics across the USA to help engage clients with HIV into care and support their adherence to antiretroviral therapy (ART). TA aims to empower people with HIV through education and client-centered counseling regarding HIV, ART, and other health issues; advocate on behalf of patients with providers; and make referrals to healthcare services and clinical trials. However, relatively little is known about the impact TA has on clients' healthcare experiences. The present study's objectives included exploring how TA services help clients engage in HIV care, initiate ART, and adhere to HIV medications. We conducted 25 semi-structured qualitative open-ended interviews with clients living with HIV/AIDS recruited from AIDS Project Los Angeles (APLA); four HIV medical providers; and two TA staff at APLA. Of the 25 clients interviewed, 92% were male and 8% were female. The average age was 43 years (SD=9). About 60% were African-American, 20% were White, 12% were other or multiracial, 4% were Latino, and 4% were Asian/Pacific Islander. Five interconnected themes consistently emerged across clients, TAs, and providers. TAs helped clients understand treatments and supported adherence within a holistic context. Further, TAs acted as a bridge to providers and helped clients build self-advocacy skills. Our data show that TA services go beyond traditional areas of education and treatment adherence. TA services within an ASO also provide a safe place to discuss initial HIV diagnoses and other health issues in a more comprehensive manner. TA services complemented medical and other social services by preparing clients with HIV to be better consumers of healthcare services. Future quantitative research examining the effectiveness of TA on improving clients' engagement in care and adherence is a critical next step.
美国各地的艾滋病服务组织（ASO）和初级保健诊所都实施了治疗倡导（TA）项目，以帮助感染艾滋病毒的客户接受治疗，并支持他们坚持抗逆转录病毒疗法（ART）。TA旨在通过关于艾滋病毒、ART和其他健康问题的教育以及以客户为中心的咨询，增强艾滋病毒感染者的权能；代表患者向医疗服务提供者进行倡导；并转介至医疗服务和临床试验。然而，关于TA对客户医疗体验的影响，人们了解得相对较少。本研究的目标包括探讨TA服务如何帮助客户接受艾滋病毒治疗、开始ART并坚持服用艾滋病毒药物。我们对从洛杉矶艾滋病项目（APLA）招募的25名艾滋病毒/艾滋病感染者、4名艾滋病毒医疗服务提供者以及APLA的2名TA工作人员进行了25次半结构化定性开放式访谈。在接受访谈的25名客户中，92%为男性，8%为女性。平均年龄为43岁（标准差=9）。约60%为非裔美国人，20%为白人，12%为其他或多种族，4%为拉丁裔，4%为亚裔/太平洋岛民。在客户、TA工作人员和医疗服务提供者中，始终出现了五个相互关联的主题。TA帮助客户在整体背景下理解治疗并支持坚持治疗。此外，TA充当了与医疗服务提供者沟通的桥梁，并帮助客户培养自我倡导技能。我们的数据表明，TA服务超越了传统的教育和治疗依从性领域。ASO内的TA服务还提供了一个安全的场所，以便更全面地讨论初次艾滋病毒诊断和其他健康问题。TA服务通过使艾滋病毒感染者做好成为更好的医疗服务消费者的准备，对医疗和其他社会服务起到了补充作用。未来开展定量研究以检验TA在改善客户接受治疗的参与度和依从性方面的有效性是关键的下一步。
