Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
Tufts University School of Medicine, Boston, MA, 02111, USA.
Addict Sci Clin Pract. 2017 Oct 2;12(1):24. doi: 10.1186/s13722-017-0088-7.
Contemporary studies about HIV care continuum (HCC) outcomes within substance using populations primarily focus on individual risk factors rather than provider- or systems-level influences. Over 25% of people living with HIV (PLWH) have substance use disorders that can alter their path through the HCC. As part of a study of HCC outcomes in nine small cities in Southern New England (population 100,000-200,000 and relatively high HIV prevalence particularly among substance users), this qualitative analysis sought to understand public health staff and HIV service providers' perspectives on how substance use may influence HCC outcomes.
Interviews with 49 participants, collected between November 2015 and June 2016, were analyzed thematically using a modified social ecological model as the conceptual framework and codes for substance use, HCC barriers and facilitators, successes and failures of initiatives targeting the HCC, and criminal justice issues.
Eight themes were identified concerning the impact of substance use on HCC outcomes. At the individual level, these included coping and satisfying basic needs and could influence all HCC steps (i.e., testing, treatment linkage, adherence, and retention, and viral load suppression). The interpersonal level themes included stigma issues and providers' cultural competence and treatment attitudes and primarily influenced treatment linkage, retention, and viral load suppression. These same HCC steps were influenced at the health care systems level by organizations' physical environment and resources as well as intra-/inter-agency communication. Testing and retention were the most likely steps to affect at the policy/society level, and the themes included opposition within an organization or community, and activities with unintended consequences.
The most substantial HCC challenges for PLWH with substance use problems included linking and retaining in treatment those with multiple co-morbidities and meeting their basic living needs. Recommendations to improve HCC outcomes for PLWH with substance use problems include increasing easy access to effective drug and mental health treatment, expanding case management and peer navigation services, training staff about harm reduction, de-stigmatizing, and culturally competent approaches to interacting with patients, and increasing information-sharing and service coordination among service providers and the social service and criminal justice systems.
关于物质使用人群中艾滋病毒护理连续体（HCC）结果的当代研究主要关注个体风险因素，而不是提供者或系统层面的影响。超过 25%的艾滋病毒感染者（PLWH）有物质使用障碍，这可能改变他们通过 HCC 的路径。作为在新英格兰南部九个小城市（人口 10 万至 20 万，艾滋病毒流行率相对较高，特别是在物质使用者中）进行的 HCC 结果研究的一部分，这项定性分析旨在了解公共卫生工作人员和艾滋病毒服务提供者对物质使用如何影响 HCC 结果的看法。
2015 年 11 月至 2016 年 6 月期间，对 49 名参与者进行了访谈，采用改良的社会生态学模型作为概念框架，对访谈内容进行了主题分析，并使用了物质使用、HCC 障碍和促进因素、针对 HCC 的干预措施的成败以及刑事司法问题的代码。
确定了八个主题，涉及物质使用对 HCC 结果的影响。在个人层面上，这些主题包括应对和满足基本需求，这可能影响所有 HCC 步骤（即检测、治疗联系、依从性和保留以及病毒载量抑制）。人际层面的主题包括污名问题和提供者的文化能力以及治疗态度，主要影响治疗联系、保留和病毒载量抑制。在卫生保健系统层面上，组织的物理环境和资源以及机构内/机构间的沟通也影响着同样的 HCC 步骤。检测和保留是最有可能影响政策/社会层面的步骤，主题包括组织或社区内部的反对以及活动带来的意外后果。
物质使用问题艾滋病毒感染者面临的最大 HCC 挑战包括将有多种合并症的患者联系并保留在治疗中，并满足他们的基本生活需求。为改善有物质使用问题的艾滋病毒感染者的 HCC 结果提出的建议包括增加获得有效药物和心理健康治疗的机会，扩大病例管理和同伴导航服务，培训工作人员了解减少伤害、去污名化以及以文化上合适的方式与患者互动，增加服务提供者以及社会服务和刑事司法系统之间的信息共享和服务协调。
