Wohl Amy Rock, Ludwig-Barron Natasha, Dierst-Davies Rhodri, Kulkarni Sonali, Bendetson Jesse, Jordan Wilbert, Bolan Robert, Smith Terry, Cunningham William, Pérez Mario J
*Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA; †OASIS Clinic, MLK-OC, Los Angeles, CA; ‡LA LGBT Center, Los Angeles, CA; §AIDS Project Los Angeles, Los Angeles, CA; and ‖UCLA Department of Medicine and School of Public Health, Los Angeles, CA.
J Acquir Immune Defic Syndr. 2017 Jun 1;75(2):190-197. doi: 10.1097/QAI.0000000000001312.
Innovative strategies are needed to identify and link hard-to-find persons living with HIV (PLWH) who are out of care (OOC). Project Engage, a health department-based project in Los Angeles County, used a mixed-methods approach to locate and provide linkage for PLWH who have limited contact with HIV medical and nonmedical services.
Incentivized social network recruitment (SNR) and direct recruitment (DR) was used to identify eligible OOC alters for a linkage intervention that included HIV clinic selection, appointment and transportation support, reminder calls/texts, and clinic navigation.
Between 2012 and 2015, 112 alters were identified using SNR (n = 74) and DR (n = 38). Most alters were male (80%), African American (38%), and gay (60%). Sizable percentages were homeless (78%), had engaged in sex work (32%) in the previous 6 months, had injected drugs (47%), were incarcerated in the previous 12 months (50%), and had only received HIV care during the previous 5 years while incarcerated (24%). SNR alters were more likely than DR alters to be African American, uninsured, unemployed, homeless, sex workers, injection drug users, recently incarcerated, and have unmet service needs. Alters linked to care within 3 (69%), 4-6 (5%), and 7-12 months (8%), and 72% were retained at 6-12 months. The percent virally suppressed increased (27% vs. 41%) and the median viral load decreased (P = 0.003) between linkage and follow-up at 6-12 months.
The alternative approaches presented were effective at locating marginalized HIV-positive persons who are OOC for linkage and retention. The SNR approach was most successful at identifying alters with serious social challenges and gaps in needed medical/ancillary services.
需要创新策略来识别并联系那些失访的难以找到的艾滋病毒感染者（PLWH）。“参与项目”是洛杉矶县一个基于卫生部门的项目，采用混合方法来定位并为那些与艾滋病毒医疗和非医疗服务接触有限的PLWH提供联系服务。
采用激励性社交网络招募（SNR）和直接招募（DR）来识别符合条件的失访者，以便进行一项联系干预措施，该措施包括艾滋病毒诊所选择、预约和交通支持、提醒电话/短信以及诊所导航。
在2012年至2015年期间，通过SNR（n = 74）和DR（n = 38）共识别出112名失访者。大多数失访者为男性（80%）、非裔美国人（38%）、同性恋者（60%）。相当比例的人无家可归（78%），在过去6个月内从事过性工作（32%），注射过毒品（47%），在过去12个月内曾被监禁（50%），且仅在过去5年被监禁期间接受过艾滋病毒护理（24%）。与DR识别出的失访者相比，SNR识别出的失访者更有可能是非裔美国人、未参保、失业、无家可归、性工作者、注射吸毒者、近期被监禁者，且有未满足的服务需求。失访者在3个月内（69%）、4 - 6个月内（5%）、7 - 12个月内（8%）与护理机构取得联系，72%的人在6 - 12个月内持续接受服务。在6 - 12个月的联系和随访之间，病毒抑制率有所上升（27%对41%），病毒载量中位数下降（P = 0.003）。
所采用的替代方法在定位那些失访的边缘化艾滋病毒阳性者以进行联系和留存方面是有效的。SNR方法在识别面临严重社会挑战以及所需医疗/辅助服务存在缺口的失访者方面最为成功。
