1 University of Michigan-Ann Arbor, Ann Arbor, MI, USA.
2 Columbia University, New York, NY, USA.
Health Educ Behav. 2018 Oct;45(5):714-722. doi: 10.1177/1090198118760681. Epub 2018 Mar 16.
The U.S. Centers for Disease Control and Prevention (CDC) Diffusion of Effective Behavioral Interventions project has disseminated HIV behavioral interventions (EBIs) across the United States since the 1990s. In 2011, the CDC launched the High-Impact HIV Prevention (HIP) project, providing EBIs plus high-impact services (HIV testing, primary care, and support services). Providers (nurses, social workers, educators) are unable to consistently make linkages; thus, numerous at-risk individuals are not benefitting from HIP. Research on providers' roles in the HIV Continuum of Care-linking clients to HIV testing, primary care, and support services-is lacking. This article helps fill this gap with evidence that providers exposed to EBIs, whose agencies offer EBIs, more frequently link clients to high-impact services. This is based on diffusion of innovations theory, where individuals in social networks influence one another's adoption of innovations. We hypothesize that providers are exposed to EBIs via training, reading and hearing about EBIs, and/or discussing EBIs with colleagues. We used cross-sectional data from 379 providers from 36 agencies in New York City. We used multilevel ordinal logistic regression models to test associations between provider exposure to EBIs (agency provides EBIs) and frequency of linkages to high-impact services. Providers exposed to greater numbers of EBIs more frequently link clients to HIV, hepatitis C (HEP-C), and sexually transmitted infections testing; to primary care; and to drug treatment and mental health services. Providers link clients most frequently to primary care and HIV testing and least frequently to HEP-C testing and syringe exchange. Findings suggest a dose effect, with exposure to more EBIs resulting in more linkages. Findings show a staged, evidence-based prevention approach that includes exposure to EBIs, leading to providers linking clients to high-impact services. There needs to be emphasis on inspiring providers to engage with high-impact services at the elevated levels needed to end the epidemic.
美国疾病控制与预防中心（CDC）自 20 世纪 90 年代以来，一直在全美范围内推广艾滋病毒行为干预措施（EBIs）。2011 年，CDC 启动了高影响力艾滋病毒预防（HIP）项目，提供 EBIs 加高影响力服务（艾滋病毒检测、初级保健和支持服务）。提供者（护士、社会工作者、教育工作者）无法持续进行联系，因此，许多处于高危状态的个人无法从 HIP 中受益。缺乏关于提供者在艾滋病毒连续护理中的作用的研究——将客户与艾滋病毒检测、初级保健和支持服务联系起来。本文通过提供证据，填补了这一空白，证明接触过 EBIs 的提供者，其机构提供 EBIs，更频繁地将客户与高影响力服务联系起来。这是基于创新扩散理论，即社交网络中的个人相互影响彼此对创新的采用。我们假设提供者通过培训、阅读和听取有关 EBIs 的信息，以及/或与同事讨论 EBIs 来接触 EBIs。我们使用了来自纽约市 36 个机构的 379 名提供者的横断面数据。我们使用多级有序逻辑回归模型，检验提供者接触 EBIs（机构提供 EBIs）与与高影响力服务建立联系的频率之间的关联。接触更多 EBIs 的提供者更频繁地将客户与艾滋病毒、丙型肝炎（HEP-C）和性传播感染检测、初级保健以及药物治疗和心理健康服务联系起来。提供者最频繁地将客户与初级保健和艾滋病毒检测联系起来，最不频繁地与 HEP-C 检测和注射器交换联系起来。研究结果表明存在剂量效应，接触更多的 EBIs 会导致更多的联系。研究结果表明了一种分阶段的、基于证据的预防方法，包括接触 EBIs，从而使提供者将客户与高影响力的服务联系起来。需要强调的是，激励提供者以结束这一流行病所需的更高水平参与高影响力的服务。
