Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico.
Departments of Family Medicine (O'Brien, Skerritt, Andersson, de Pokomandy) and Epidemiology, Biostatistics and Occupational Health (Cox), McGill University; Chronic Viral Illness Service (O'Brien, Proulx-Boucher, Ménard, Cox, de Pokomandy), Department of Medicine, McGill University Health Centre, Montréal, Que.; Institute for Better Health (Law), Trillium Health Partners, Mississauga, Ont.; Institute for Health Policy, Management & Evaluation (Law), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Boucoiran), Centre hospitalier universitaire Sainte-Justine; Departments of Social and Preventive Medicine (Boucoiran) and Obstetrics and Gynecology (Boucoiran), Université de Montréal, Montréal Que.; Centro de Investigación de Enfermedades Tropicales (Andersson), Universidad Autónoma de Guerrero, Acapulco, Mexico
CMAJ Open. 2020 Apr 17;8(2):E264-E272. doi: 10.9778/cmajo.20190158. Print 2020 Apr-Jun.
Care services have not been sufficiently adapted to meet the comprehensive care needs of women living with HIV. Our study objective was to engage patients and providers in codesigning care recommendations to improve care for this population in the province of Quebec.
We conducted a 5-hour deliberative dialogue workshop in April 2019 in Montréal as the final phase of a mixed-methods study investigating comprehensive care for women living with HIV. The study drew on data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Recruitment was guided by a purposive maximum-variation sampling strategy to ensure an appropriate mix of participants and was facilitated by our existing CHIWOS networks. Participants included patients (women living with HIV) and HIV care providers (doctors, nurses, pharmacists). The workshop was facilitated professionally and included a synthesis of the evidence, small- and large-group deliberations, and voting on care improvements.
Eight patients and 8 HIV care providers participated. Drawing on identified care priorities, the participants identified 4 relatively rapid care improvements and 3 longer-term improvements. The rapid care improvements included delegating medical acts to members of multidisciplinary care teams; greater involvement of HIV community members within care settings and health care decision-making; creating a women's health information booklet; and increasing HIV education among all health care providers and raising awareness of women's care needs beyond HIV-specific care among HIV care providers. The longer-term care improvements included advocating for complete financial coverage of antiretroviral therapy within the government-sponsored Medicare program, facilitating access to allied care providers (e.g., physiotherapists and psychologists) and launching a population-wide campaign to increase awareness about the Undetectable = Untransmittable (U=U) initiative and other HIV advances.
The deliberative dialogue workshop yielded evidence-based, stakeholder-driven recommendations to improve the comprehensive care of women living with HIV in Quebec.
护理服务尚未充分适应以满足艾滋病毒感染者妇女的全面护理需求。我们的研究目的是让患者和提供者共同设计护理建议，以改善魁北克省这一人群的护理。
我们于 2019 年 4 月在蒙特利尔举办了一个 5 小时的审议对话研讨会，作为一项混合方法研究的最后阶段，该研究调查了艾滋病毒感染者妇女的综合护理。该研究借鉴了加拿大艾滋病毒妇女性健康和生殖健康队列研究（CHIWOS）的数据。通过有针对性的最大变异抽样策略进行招募，以确保参与者的适当组合，并通过我们现有的 CHIWOS 网络提供便利。参与者包括患者（艾滋病毒感染者妇女）和艾滋病毒护理提供者（医生、护士、药剂师）。研讨会由专业人员主持，包括综合证据、小组和大组审议以及对护理改进的投票。
8 名患者和 8 名艾滋病毒护理提供者参加了会议。根据确定的护理重点，参与者确定了 4 项相对快速的护理改进措施和 3 项长期改进措施。快速护理改进措施包括将医疗行为委托给多学科护理团队成员；在护理环境和医疗保健决策中更多地让艾滋病毒社区成员参与；制作一本妇女健康信息手册；并增加所有医疗保健提供者的艾滋病毒教育，提高艾滋病毒护理提供者对艾滋病毒特定护理以外的妇女护理需求的认识。长期护理改进措施包括倡导在政府资助的医疗保险计划中全面涵盖抗逆转录病毒疗法，促进获得辅助护理提供者（如物理治疗师和心理学家），并开展一场全人群运动，提高对无法检测即无法传播（U=U）倡议和其他艾滋病毒进展的认识。
审议对话研讨会产生了循证的、利益相关者驱动的建议，以改善魁北克省艾滋病毒感染者妇女的综合护理。
