实施数据到关怀策略，改善艾滋病毒感染者的健康结果：来自美国护理和预防示范项目的报告。
Implementing a Data to Care Strategy to Improve Health Outcomes for People With HIV: A Report From the Care and Prevention in the United States Demonstration Project.
机构信息
1 HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Program and Performance Improvement Office, Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
出版信息
Public Health Rep. 2018 Nov/Dec;133(2_suppl):60S-74S. doi: 10.1177/0033354918805987.
OBJECTIVES
The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia.
METHODS
The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services.
RESULTS
Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression.
CONCLUSIONS
The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality.
目的
美国关怀与预防示范项目包含实施数据至关怀策略，利用监测和其他数据：(1) 确定需要艾滋病毒医疗护理或其他服务的艾滋病毒感染者；(2) 促进与这些服务的联系，以改善健康结果。我们介绍了 4 个州卫生部门的经验：伊利诺伊州、路易斯安那州、田纳西州和弗吉尼亚州。
方法
这 4 个州卫生部门使用多个数据库，生成自 2013 年 10 月 1 日至 2016 年 9 月 29 日以来被认为未接受艾滋病毒医疗护理或难以保持病毒抑制的艾滋病毒感染者（PWH）的清单。每个州卫生部门都对清单进行了优先级排序（例如，根据未接受护理的时间长短、病毒载量），对其准确性进行了审查，然后将清单分发给工作人员，以将 PWH 与艾滋病毒护理和服务联系起来。
结果
在 16391 名被认为未接受艾滋病毒医疗护理的 PWH 中，有 9852 人（60.1%）被选中进行随访；在这些人中，有 4164 人（42.3%）被联系，其中有 1479 人（35.5%）被确认为未接受护理。在接受服务的 794 名 PWH 中，有 694 人（87.4%）与艾滋病毒医疗护理联系。路易斯安那州卫生部门还确定了 1559 名未抑制病毒的 PWH，其中 764 人（49.0%）有资格接受随访。在有资格接受随访的 764 名 PWH 中，有 434 人（56.8%）被联系，其中 269 人（62.0%）有治疗依从性问题。在接受治疗依从性服务的 153 名 PWH 中，有 104 人（68.0%）的病毒抑制情况有了显著改善。
结论
这 4 个卫生部门制定了利用监测和其他数据改善艾滋病毒感染者与艾滋病毒医疗护理和健康结果联系的程序。为了有效，卫生部门必须加强监测、护理计划和提供者之间的协调；开发数据共享机制；并解决数据系统和数据质量方面的限制。
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