School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Queensland Positive People (QPP), Brisbane, Queensland, Australia.
Health Soc Care Community. 2022 Jul;30(4):1353-1362. doi: 10.1111/hsc.13465. Epub 2021 Jun 7.
The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV-based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi-structured in-depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic.
人类免疫缺陷病毒（HIV）从急性疾病重新定义为可控制的慢性疾病，这改变了护理重点，强调临床结果，而将许多 HIV 感染者（PLHIV）仍然面临的复杂社会障碍置于次要地位。这与澳大利亚 HIV 护理地点的变化相吻合，许多 PLHIV 寻求私人全科医生的护理，而这些全科医生解决复杂社会问题的能力受到时间和资源的限制。作为回应，同伴导航已经成为一些基于 HIV 的社区卫生组织实施的一种护理模式，旨在支持 PLHIV 的生物医学和心理社会需求。然而，对于同伴导航在社区环境中的运作方式或这些项目与初级保健的整合方式，了解有限。本文首次从治疗 PLHIV 的经验丰富的全科医生（GP）的角度探讨同伴导航，以了解他们认为同伴导航员（PN）在支持 PLHIV 方面的作用。对六位全科医生（澳大利亚昆士兰州专门治疗 HIV 的全科医生的 11.5%）进行了半结构化深入访谈，以了解他们在 HIV 护理背景下对同伴导航的看法和经验。全科医生强调了照顾 PLHIV 的复杂性，以及对心理社会护理的额外资源和支持的需求。全科医生认为同伴导航是患者支持网络的一部分，也是连接卫生和社会保健系统的桥梁。PN 使 HIV 正常化，减轻了患者的恐惧和耻辱感，为患者提供教育并翻译临床信息。然而，一个关键挑战是与 PN 缺乏直接沟通途径。同伴导航在支持 PLHIV 的护理方面具有明显的潜力，可以缓解全科医生设置中的限制，并将 HIV 护理扩展到诊所之外。
