Department of Global Health, University of Washington, Seattle, Washington, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
AIDS Patient Care STDS. 2020 Jun;34(6):267-274. doi: 10.1089/apc.2019.0310.
Ending the HIV epidemic will require dedicated efforts to engage the highest need persons living with HIV (PLWH) in treatment. We assessed patient perceptions of a clinic in Seattle, Washington, that is designed for PLWH who do not engage in conventional HIV care. The Max Clinic provides walk-in access to care, incentives for blood draws and achieving viral suppression, and intensive case management. We conducted semistructured individual interviews with 25 patients purposively recruited to obtain diverse viewpoints. Interviews were audio-recorded and transcribed. Analysis used a constant comparative approach to identify major themes related to the components of the program. For many participants, engagement in the Max Clinic was the first time they had success with HIV treatment. Relationships with clinic staff and the ability to receive care on a walk-in basis had the strongest influences on engagement. Participants felt that Max Clinic staff attended to their social circumstances in ways that were distinct from prior care experiences. Walk-in visits removed perceived stigma associated with failure to keep appointments and provided immediate attention to acute concerns. Financial incentives initially motivated participants to attend clinic and take medications, but were less important for supporting ongoing engagement in care. Food incentives motivated patients to seek care and helped them focus on health issues. In summary, patients identified walk-in access to care, monetary and food incentives, and relationships with clinic staff, particularly case managers, as the key elements of an HIV clinic model for high-need PLWH.
终结艾滋病疫情需要付出专门努力，让那些最需要接受治疗的艾滋病毒感染者（PLWH）参与其中。我们评估了华盛顿州西雅图市一家诊所的患者看法，该诊所面向那些未接受常规艾滋病毒护理的 PLWH。Max 诊所提供随到随诊服务，为抽血和实现病毒抑制提供奖励，并提供强化病例管理。我们对 25 名患者进行了半结构化个人访谈，他们是经过有目的的招募，以获得不同的观点。访谈进行了录音并转录。分析采用了恒定比较方法，以确定与该项目组成部分相关的主要主题。对许多参与者来说，参与 Max 诊所是他们首次成功接受艾滋病毒治疗。与诊所工作人员的关系以及随到随诊的能力对参与度有最强的影响。参与者认为 Max 诊所的工作人员以不同于以往护理经历的方式关注他们的社会环境。随到随诊消除了因未能预约而产生的污名感，并为急性问题提供了即时关注。经济奖励最初促使参与者参加诊所并服用药物，但对支持他们持续参与护理的作用不大。食物奖励激励患者寻求治疗，并帮助他们关注健康问题。总之，患者认为随到随诊、金钱和食物奖励以及与诊所工作人员的关系，特别是病例管理人员的关系，是满足高需求 PLWH 的艾滋病毒诊所模式的关键要素。
