Myers Janet J, Kang Dufour Mi-Suk, Koester Kimberly A, Rose Carol Dawson, Shade Starley B, Maiorana Andres, Morin Stephen F
Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.
AIDS Care. 2013;25(5):640-5. doi: 10.1080/09540121.2012.722187. Epub 2012 Sep 13.
The delivery of HIV risk assessment and behavioral counseling by clinicians in HIV clinical settings is one component in a comprehensive "positive prevention" strategy to help patients reduce their transmission risk behavior. Clinicians engage in behavioral prevention inconsistently, however, depending on whether patients are new to a practice or are established in regular care and on their attitudes and characteristics of their practices. We analyzed clinician reports of behavioral prevention delivered before and after participation in a large federal demonstration project of positive prevention interventions. The interventions that were part of this project were successful in increasing behavioral prevention among both new and returning patients. Prior to study interventions, clinicians reported counseling 69% of new patients and 52% of returning patients. In follow-up interviews 12 months after receiving training, clinicians reported delivering prevention messages to 5% more new patients and 9% of returning patients (both p<0.01). After 12 months, clinicians were more likely to engage in behavioral prevention if other providers in their sites were also involved. Clinicians agreeing that behavioral prevention was part of the clinic's mission were more likely to conduct it. The interventions were successful in mitigating the influence of provider attitudes precluding prevention delivery. Intervention strategies can help clinicians more consistently deliver behavioral prevention messages to their HIV-infected patients.
在艾滋病临床诊疗环境中，临床医生开展艾滋病风险评估及行为咨询，是全面“积极预防”策略的一个组成部分，旨在帮助患者降低传播风险行为。然而，临床医生在开展行为预防方面并不一致，这取决于患者是初次就诊还是已接受常规治疗，以及医生的态度和诊疗特点。我们分析了参与一项大型联邦积极预防干预示范项目的临床医生在参与前后所提供的行为预防报告。该项目中的干预措施成功地提高了新患者和复诊患者的行为预防水平。在研究干预之前，临床医生报告称，为69%的新患者和52%的复诊患者提供了咨询。在接受培训12个月后的随访访谈中，临床医生报告称，为多5%的新患者和9%的复诊患者提供了预防信息（两者p<0.01）。12个月后，如果所在机构的其他医护人员也参与其中，临床医生更有可能开展行为预防。认同行为预防是诊所使命一部分的临床医生更有可能开展此项工作。这些干预措施成功地减轻了医护人员态度对预防工作开展的阻碍影响。干预策略可帮助临床医生更持续地向感染艾滋病病毒的患者传递行为预防信息。
