Janet J. Myers, Mi-Suk Kang Dufour, Kimberly A. Koester, Rebecca Packard, Brie Williams, and Jacqueline Tulsky are with University of California, San Francisco. Mark Morewitz, Kate Monico Klein, and Milton Estes are with San Francisco Department of Public Health. Alissa Riker is with San Francisco Sheriff's Department.
Am J Public Health. 2018 Mar;108(3):385-392. doi: 10.2105/AJPH.2017.304250. Epub 2018 Jan 18.
To compare the effectiveness of patient navigation-enhanced case management in supporting engagement in HIV care upon release from jail relative to existing services.
We randomized 270 HIV-infected individuals to receive navigation-enhanced case management for 12 months or standard case management for 90 days following release from jail between 2010 and 2013. Participants were interviewed at 2, 6, and 12 months after release. We abstracted medical data from jail and city health records.
Patient navigation-enhanced case management resulted in greater linkage to care within 30 days of release (odds ratio [OR] = 2.15; 95% confidence interval [CI] = 1.23, 3.75) and consistent retention over 12 months (OR = 1.95; 95% CI = 1.11, 3.46). Receipt of treatment for substance use disorders in jail also resulted in early linkage (OR = 4.06; 95% CI = 1.93, 8.53) and retention (OR = 2.52; 95% CI = 1.21, 5.23). Latinos were less likely to be linked to (OR = 0.35; 95% CI = 0.14, 0.91) or retained in (OR = 0.28; 95% CI = 0.09, 0.82) HIV care.
Patient navigation supports maintaining engagement in care and can mitigate health disparities, and should become the standard of care for HIV-infected individuals leaving jail.
比较患者导航增强型个案管理在支持从监狱获释后参与艾滋病毒护理方面的效果，与现有服务相比。
我们在 2010 年至 2013 年间，将 270 名感染艾滋病毒的个体随机分配接受 12 个月的导航增强型个案管理或 90 天的标准个案管理。参与者在释放后 2、6 和 12 个月接受了访谈。我们从监狱和城市卫生记录中提取了医疗数据。
患者导航增强型个案管理在释放后 30 天内实现了更大的护理衔接（优势比[OR] = 2.15；95%置信区间[CI] = 1.23，3.75），并在 12 个月内保持一致的保留率（OR = 1.95；95%置信区间[CI] = 1.11，3.46）。在监狱中接受物质使用障碍治疗也导致了早期衔接（OR = 4.06；95%置信区间[CI] = 1.93，8.53）和保留率（OR = 2.52；95%置信区间[CI] = 1.21，5.23）。拉丁裔更不可能与（OR = 0.35；95%置信区间[CI] = 0.14，0.91）或保留（OR = 0.28；95%置信区间[CI] = 0.09，0.82）艾滋病毒护理。
患者导航支持维持护理参与度，并可以缓解健康差距，应该成为从监狱释放的艾滋病毒感染者的护理标准。
