Gómez Cynthia A, Tat Susana A, Allen Debra, Gordon Danielle, Browe Dennis
Health Equity Institute, San Francisco State University , San Francisco, California.
AIDS Patient Care STDS. 2017 Mar;31(3):122-128. doi: 10.1089/apc.2016.0241.
The 2015 National HIV/AIDS Strategy renewed its goal of increasing access to care for people living with HIV/AIDS (PLWHA) and called for an increased focus on linkage to care efforts. As many PLWHA face multiple barriers to care and live on the margins of society, adoption of intensive outreach activities is necessary to engage the most disenfranchised PLWHA into care and to ultimately end the HIV epidemic. The Bay Area Network for Positive Health (BANPH), comprising 12+ agencies, established a network outreach model for our linkage-to-care project to engage the hardest-to-reach populations in the San Francisco Bay Area. During the years 2010-2013, BANPH agencies conducted street outreach, analyzed internal tracking systems to identify out-of-care individuals and individuals experiencing tenuous care, and surveyed participants using Apple iPod Touch devices. During the 3-year project, BANPH agencies engaged 602 out-of-care PLWHA and linked 440 to care. On average, outreach workers made 10 contact attempts with a client to link them to care. Sixty-three percent of participants were linked to care on an average of 56 days after initial contact. Factors, including lack of case management, lack of transportation, competing concerns, substance abuse, and HIV stigma, were significantly associated with linkage-to-care outcomes. Intensive outreach efforts could help to reduce barriers to care for hard-to-reach PLWHA, but these efforts require a tremendous amount of time and resources. A network outreach model could help facilitate sharing of limited resources and increase regional outreach capacity for linkage-to-care programs.
《2015年国家艾滋病毒/艾滋病战略》重申了其增加艾滋病毒/艾滋病感染者（PLWHA）获得护理机会的目标，并呼吁更加关注与护理工作的衔接。由于许多艾滋病毒/艾滋病感染者面临多重护理障碍且生活在社会边缘，因此有必要开展强化外展活动，以使最被剥夺权利的艾滋病毒/艾滋病感染者获得护理，最终终结艾滋病毒流行。由12个以上机构组成的湾区积极健康网络（BANPH）为我们的护理衔接项目建立了一个网络外展模式，以接触旧金山湾区最难接触到的人群。在2010年至2013年期间，BANPH各机构开展了街头外展活动，分析内部跟踪系统以识别失访者以及接受不稳定护理的人，并使用苹果iPod Touch设备对参与者进行了调查。在这个为期三年的项目中，BANPH各机构接触了602名失访的艾滋病毒/艾滋病感染者，并使440人获得了护理。外展工作人员平均与一名客户进行10次联系尝试，以使其获得护理。63%的参与者在初次接触后平均56天获得了护理。包括缺乏病例管理、缺乏交通、存在其他需要关注的问题、药物滥用以及艾滋病毒污名化等因素，与护理衔接结果显著相关。强化外展努力有助于减少难以接触到的艾滋病毒/艾滋病感染者获得护理的障碍，但这些努力需要大量时间和资源。网络外展模式有助于促进有限资源的共享，并提高护理衔接项目的区域外展能力。
