Wood Elizabeth M, Zani Babalwa, Esterhuizen Tonya M, Young Taryn
Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
BMC Health Serv Res. 2018 Mar 27;18(1):219. doi: 10.1186/s12913-018-3002-4.
Home-based care is used in many countries to increase quality of life and limit hospital stay, particularly where public health services are overburdened. Home-based care objectives for HIV/AIDS can include medical care, delivery of antiretroviral treatment and psychosocial support. This review assesses the effects of home-based nursing on morbidity in people infected with HIV/AIDS.
The trials studied are in HIV positive adults and children, regardless of sex or setting and all randomised controlled. Home-based care provided by qualified nurses was compared with hospital or health-facility based treatment. The following electronic databases were searched from January 1980 to March 2015: AIDSearch, CINAHL, Cochrane Register of Controlled Trials, EMBASE, MEDLINE and PsycINFO/LIT, with an updated search in November 2016. Two authors independently screened titles and abstracts from the electronic search based on the study design, interventions and types of participant. For all selected abstracts, full text articles were obtained. The final study selection was determined with use of an eligibility form. Data extraction was performed independently from assessment of risk of bias. The results were analysed by narrative synthesis, in order to be able to obtain relevant effect measures plus 95% confidence intervals.
Seven studies met the inclusion criteria. The trial size varied from 37 to 238 participants. Only one trial was conducted in children. Five studies were conducted in the USA and two in China. Four studies looked at home-based adherence support and the rest at providing home-based psychosocial support. Reported adherence to antiretroviral drugs improved with nurse-led home-based care but did not affect viral load. Psychiatric nurse support in those with existing mental health conditions improved mental health and depressive symptoms. Home-based psychological support impacted on HIV stigma, worry and physical functioning and in certain cases depressive symptoms.
Nurse-led home-based interventions could help adherence to antiretroviral therapy and improve mental health. Further larger scale studies are needed, looking in more detail at improving medical care for HIV, especially related to screening and management of opportunistic infections and co-morbidities.
许多国家采用居家护理来提高生活质量并缩短住院时间，尤其是在公共卫生服务负担过重的地区。针对艾滋病毒/艾滋病的居家护理目标可包括医疗护理、抗逆转录病毒治疗的提供以及心理社会支持。本综述评估了居家护理对艾滋病毒/艾滋病感染者发病率的影响。
所研究的试验针对艾滋病毒呈阳性的成人和儿童，不分性别或环境，均为随机对照试验。将合格护士提供的居家护理与基于医院或医疗机构的治疗进行比较。从1980年1月至2015年3月检索了以下电子数据库：AIDSearch、CINAHL、Cochrane对照试验注册库、EMBASE、MEDLINE和PsycINFO/LIT，并于2016年11月进行了更新检索。两位作者根据研究设计、干预措施和参与者类型，独立筛选电子检索中的标题和摘要。对于所有选定的摘要，获取全文文章。最终的研究选择通过使用合格表格来确定。数据提取与偏倚风险评估独立进行。结果通过叙述性综合分析，以便能够获得相关效应量及95%置信区间。
七项研究符合纳入标准。试验规模从37名至238名参与者不等。仅一项试验针对儿童。五项研究在美国进行，两项在中国进行。四项研究关注居家依从性支持，其余研究关注提供居家心理社会支持。报告显示，由护士主导的居家护理可提高对抗逆转录病毒药物的依从性，但不影响病毒载量。对已有心理健康问题者提供精神科护士支持可改善心理健康和抑郁症状。居家心理支持对艾滋病毒污名、担忧和身体功能有影响，在某些情况下对抑郁症状也有影响。
由护士主导的居家干预措施有助于对抗逆转录病毒疗法的依从性，并改善心理健康。需要开展进一步的大规模研究，更详细地探讨改善艾滋病毒医疗护理，特别是与机会性感染和合并症的筛查及管理相关的问题。
