Medical Practice Evaluation Center.
Division of Infectious Diseases, Massachusetts General Hospital.
Curr Opin HIV AIDS. 2019 Nov;14(6):494-502. doi: 10.1097/COH.0000000000000579.
We present recent literature describing interventions for linkage to HIV care in the era of Universal Test and Treat (UTT) policies. We also provide information for ongoing studies of linkage to care strategies registered with ClinicalTrials.gov.
Differentiated service delivery for linkage to care involves implementing strategies that simplify and adapt HIV services to better serve individual needs and reduce unnecessary burdens on the health system. Recent strategies have focused not only on clinic-based populations testing for HIV but also emphasize community-based services and HIV self-testing, which create different challenges for linkage to the healthcare system. Some recent developments in linkage to care strategies include: case management, care integration with other desirable health services, financial incentives, home-based, and peer-led services. The demonstrated strategies have varying levels of success and engagement in care; further work is needed to address ongoing barriers in HIV care.
Progress towards meeting the 90-90-90 benchmarks has left gaps in linkage to care that require care-system development to facilitate increased access to care under UTT policies. Most notably, new strategies will need to focus on addressing the distinct needs of key populations and bolstering linkage to care from community-based and self-testing services.
我们介绍了最近描述在普遍检测和治疗（UTT）政策时代将 HIV 感染者与艾滋病关怀相联系的干预措施的文献。我们还提供了正在进行的与在美国临床试验注册中心注册的关怀联系策略相关的研究信息。
为关怀联系提供差异化服务包括实施简化和适应 HIV 服务的策略，以更好地满足个人需求并减轻卫生系统的不必要负担。最近的策略不仅侧重于为 HIV 检测而设立的诊所人群，而且还强调了基于社区的服务和 HIV 自我检测，这为与医疗保健系统建立联系带来了不同的挑战。关怀联系策略的一些最新进展包括：病例管理、将关怀与其他理想的卫生服务相结合、经济激励、上门服务和同伴领导的服务。已证明的策略在关怀参与和效果方面存在差异；需要进一步开展工作，以解决 HIV 关怀方面持续存在的障碍。
在实现 90-90-90 目标方面取得的进展留下了关怀联系方面的差距，需要发展关怀系统，以促进在 UTT 政策下获得更多的关怀。特别需要新的策略来解决关键人群的独特需求，并加强从社区和自我检测服务的关怀联系。
