1 Department of Family Medicine, McGill University , Montreal, Canada .
2 Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre , Montreal, Canada .
AIDS Patient Care STDS. 2018 Apr;32(4):129-148. doi: 10.1089/apc.2017.0305.
Women living with HIV in high-income settings continue to experience modifiable barriers to care. We sought to determine the features of care that facilitate access to comprehensive primary care, inclusive of HIV, comorbidity, and sexual and reproductive healthcare. Using a systematic mixed studies review design, we reviewed qualitative, mixed methods, and quantitative studies identified in Ovid MEDLINE, EMBASE, and CINAHL databases (January 2000 to August 2017). Eligibility criteria included women living with HIV; high-income countries; primary care; and healthcare accessibility. We performed a thematic synthesis using NVivo. After screening 3466 records, we retained 44 articles and identified 13 themes. Drawing on a social-ecological framework on engagement in HIV care, we situated the themes across three levels of the healthcare system: care providers, clinical care environments, and social and institutional factors. At the care provider level, features enhancing access to comprehensive primary care included positive patient-provider relationships and availability of peer support, case managers, and/or nurse navigators. Within clinical care environments, facilitators to care were appointment reminder systems, nonidentifying clinic signs, women and family spaces, transportation services, and coordination of care to meet women's HIV, comorbidity, and sexual and reproductive healthcare needs. Finally, social and institutional factors included healthcare insurance, patient and physician education, and dispelling HIV-related stigma. This review highlights several features of care that are particularly relevant to the care-seeking experience of women living with HIV. Improving their health through comprehensive care requires a variety of strategies at the provider, clinic, and greater social and institutional levels.
高收入环境中患有 HIV 的女性仍然面临可改变的护理障碍。我们旨在确定促进全面初级保健（包括 HIV、合并症、性健康和生殖健康护理）的护理特征。我们使用系统混合研究综述设计，在 Ovid MEDLINE、EMBASE 和 CINAHL 数据库中检索到 2000 年 1 月至 2017 年 8 月定性、混合方法和定量研究。纳入标准包括：患有 HIV 的女性；高收入国家；初级保健；以及医疗保健的可及性。我们使用 NVivo 进行主题综合。在筛选了 3466 条记录后，我们保留了 44 篇文章，并确定了 13 个主题。借鉴关于参与 HIV 护理的社会生态学框架，我们将这些主题置于医疗保健系统的三个层面上：护理提供者、临床护理环境以及社会和机构因素。在护理提供者层面上，促进全面初级保健可及性的特征包括积极的医患关系以及同伴支持、个案经理和/或护士导航员的可用性。在临床护理环境中，促进护理的因素包括预约提醒系统、无身份识别的诊所标志、妇女和家庭空间、交通服务以及协调护理以满足妇女的 HIV、合并症和性健康和生殖健康需求。最后，社会和机构因素包括医疗保健保险、患者和医生教育以及消除与 HIV 相关的耻辱感。本综述强调了一些特别与 HIV 感染者寻求护理的体验相关的护理特征。通过全面护理改善她们的健康需要在提供者、诊所和更广泛的社会和机构层面上采取各种策略。
