Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America.
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, United States of America.
PLoS One. 2018 Aug 27;13(8):e0202917. doi: 10.1371/journal.pone.0202917. eCollection 2018.
Few interventions have been shown to improve retention in HIV care. We recently completed a randomized, controlled trial of a peer mentoring intervention, which failed to increase retention in care or HIV suppression. We sought to gain insight into this negative result and elicit suggestions for future interventions. We conducted semi-structured one-on-one interviews with a sub-sample of participants and all available interventionists after completion of the primary study. Interviews were coded by two researchers and thematically analyzed. Participants in the intervention arm (N = 16) reported good rapport with and benefit from peer mentoring and found the mentors helpful in facilitating the transition from hospital to out-patient clinic. Control arm participants (N = 9) reported similar emotional and social support benefits from the health educators. In both arms, ongoing challenges including completing paperwork, securing transportation, and rescheduling missed appointments were cited, along with internalized stigma and lack of will to seek care, despite the mentors' best efforts. Suggested improvements to the intervention included: more frequent contact with interventionists; additional support for mental health problems; and targeting overall health rather than a more selective focus on HIV. Mentors and health educators agreed with the participant-reported barriers and added that some participants were too sick to meaningfully participate in the intervention, while others appeared unwilling to engage with the interventionists in a meaningful way. Mentoring was highly acceptable and felt to be impactful, however it was not sufficient to overcome structural barriers or stigma and low motivation in some participants. The attention control intervention may have had an unintended positive impact. Future interventions should focus on broad aspects of health and well-being.
很少有干预措施被证明可以提高 HIV 护理的保留率。我们最近完成了一项同伴辅导干预的随机对照试验，该试验未能提高护理保留率或 HIV 抑制率。我们试图深入了解这一负面结果，并为未来的干预措施提出建议。我们在主要研究完成后，对参与者的一个子样本和所有可用的干预者进行了半结构化的一对一访谈。访谈由两名研究人员进行编码，并进行主题分析。干预组的参与者（N = 16）报告说与同伴辅导关系良好，并从中受益，他们发现导师在帮助他们从医院过渡到门诊方面很有帮助。对照组的参与者（N = 9）报告说从健康教育者那里获得了类似的情感和社会支持。在两个组中，都提到了持续存在的挑战，包括填写文书工作、确保交通和重新安排错过的预约，以及内在的污名化和缺乏寻求护理的意愿，尽管导师们尽了最大的努力。对干预措施的改进建议包括：与干预者更频繁地联系；为心理健康问题提供额外支持；以及针对整体健康，而不是更有选择性地关注 HIV。导师和健康教育者同意参与者报告的障碍，并补充说，一些参与者病得太重，无法有效地参与干预，而另一些参与者似乎不愿意以有意义的方式与干预者接触。辅导是高度可接受的，并且感觉有影响力，然而，它不足以克服一些参与者的结构性障碍、污名化和低动力。关注控制干预可能产生了意外的积极影响。未来的干预措施应侧重于健康和幸福感的广泛方面。
