Pôle DELTA, Samusocial de Paris, Paris, France.
Observatoire du Samusocial de Paris, Samusocial de Paris, Paris, France.
Front Public Health. 2024 Jan 12;11:1305874. doi: 10.3389/fpubh.2023.1305874. eCollection 2023.
Homeless individuals face exacerbated risks of infectious diseases, including sexually transmitted infections (STIs). Programs led by Community Health Workers (CHWs) have demonstrated potential to enhance healthcare access for marginalized groups such as homeless families. This study aims to evaluate the feasibility and effectiveness of a novel CHW-based outreach program addressing sexual health issues among individuals residing in homeless hostels.
Twelve social homeless hostels in the greater Paris region were selected as program implementation sites. An outreach program was developed consisting of two interventions: sexual health workshops and STI screening sessions (HIV and hepatitis B and C) accompanied by individual interviews, both conducted by CHWs within each hostel over an 8-week period and scheduled weekly. Feasibility, participation and engagement were evaluated using complementary methods including qualitative field observations, semi-structured interviews and focus groups with CHWs, satisfaction questionnaires for participants, and quantitative outcome data collection of each intervention.
A total of 80 program activities (workshops and screening sessions) were conducted. Among the participants, 542 women and 30 men engaged in workshops. During the 30 Rapid Diagnostic Testing sessions, 150 individuals underwent testing for HIV, hepatitis B, and/or hepatitis C. Positivity rates were 6.7% for hepatitis B and 0.9% for hepatitis C. No HIV infections were detected. Participant satisfaction rates were consistently high (>76%) across workshops. Qualitative analysis unveiled two critical axes influencing program feasibility and effectiveness: program organization and CHW involvement.
This assessment of the program highlights its feasibility among a population that is difficult to reach through conventional healthcare efforts. The intervention's potential effectiveness is suggested by self- and CHW-reported improvements in sexual health literacy and high rates of referral to the healthcare system, as well as holistic well-being considerations. CHW involvement is a vital determinant of program success, as are robust coordination among stakeholders, deep understanding of the target population, and strong partner engagement.
This outreach program amplifies the voices of often-overlooked populations while empowering them to navigate health and social challenges. Although these workshops serve as lifelines for those frequently excluded from mainstream services, long-term improvements to the health and wellbeing of homeless populations will necessitate systemic governmental intervention.
无家可归者面临着传染病风险的加剧，包括性传播感染（STIs）。由社区卫生工作者（CHWs）领导的项目已证明有潜力为无家可归家庭等边缘化群体增加获得医疗保健的机会。本研究旨在评估一种新的基于 CHW 的外展计划在解决居住在无家可归者收容所中的个体的性健康问题方面的可行性和有效性。
在大巴黎地区选择了 12 个社会无家可归者收容所作为项目实施地点。开发了一个外展计划，其中包括两个干预措施：性健康研讨会和性传播感染筛查（HIV 和乙型肝炎和丙型肝炎），同时由 CHWs 在每个收容所内进行个人访谈，共进行 8 周，每周安排一次。使用补充方法评估可行性、参与度和参与度，包括对 CHWs 的定性现场观察、半结构化访谈和焦点小组、参与者满意度问卷以及每个干预措施的定量结果数据收集。
共开展了 80 项活动（研讨会和筛查）。在参与者中，542 名女性和 30 名男性参加了研讨会。在 30 次快速诊断测试中，有 150 人接受了 HIV、乙型肝炎和/或丙型肝炎的检测。乙型肝炎的阳性率为 6.7%，丙型肝炎为 0.9%。未检测到 HIV 感染。对研讨会的满意度一直很高（>76%）。定性分析揭示了影响计划可行性和有效性的两个关键因素：计划组织和 CHW 的参与。
本研究对该计划进行了评估，重点关注其在通过传统医疗保健努力难以接触到的人群中的可行性。该干预措施的潜在有效性体现在自我报告和 CHW 报告的性健康知识提高以及向医疗保健系统的高转诊率以及整体福祉考虑方面。CHW 的参与是计划成功的重要决定因素，还有利益相关者之间的强有力协调、对目标人群的深刻理解以及强大的合作伙伴参与。
该外展计划增强了经常被忽视的人群的声音，使他们能够应对健康和社会挑战。尽管这些研讨会是那些经常被排除在主流服务之外的人的生命线，但要改善无家可归者群体的健康和福祉，需要政府采取系统干预措施。
