Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA.
Department of Psychological Science, School of Social Ecology, University of California Irvine. 4220 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, USA.
BMC Health Serv Res. 2024 May 31;24(1):690. doi: 10.1186/s12913-024-11146-1.
There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare-as well as co-located sites providing both-sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic.
We interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis.
Commonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices.
Though COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.
长期以来，人们一直致力于将行为健康和艾滋病毒护理整合起来，为同时患有艾滋病毒和行为健康需求的人提供服务，包括患有严重精神疾病 (SMI) 的人。由于这部分人群经常同时前往行为健康和艾滋病毒护理机构，他们在 COVID-19 大流行期间很可能会遇到新的障碍，影响护理的质量和可及性。本研究旨在描述艾滋病毒服务或行为保健诊所——以及提供两者的联合或共置场所——如何迅速调整方案，为同时患有艾滋病毒和 SMI 的人维持患者护理标准，同时适应大流行的前所未有的情况。
我们采访了艾滋病毒和行为保健提供者、诊所领导以及为同时患有艾滋病毒和 SMI 的客户提供服务的支持服务机构。2022 年，在三个地点（艾滋病毒护理地点、行为保健护理地点和整合或共置护理地点）采访了 17 名关键信息提供者。访谈重点是 COVID-19 大流行期间和大流行开始时临床服务、方案和护理提供策略的变化。访谈记录被转录并使用主题分析进行编码。
共同认可的主题包括大流行期间护理和护理提供的积极和消极变化。大流行的负面影响包括物理空间的丧失、加剧的心理健康需求和对艾滋病毒护理的脱离、患者对远程医疗和数字鸿沟的障碍、以及医疗保健劳动力的倦怠增加。积极的变化包括通过远程医疗改善医疗服务提供和护理参与、提供广泛的社会服务的新机会、某些患者参与艾滋病毒护理的悖论性增加，以及广泛实施劳动力健康实践。
尽管 COVID-19 给为同时患有 HIV 和 SMI 的患者提供服务的提供者带来了一些复杂的护理障碍，但远程医疗带来的更大灵活性和更注重患者护理的协作方法可能会使这一患者群体受益。此外，对劳动力健康的关注可能有助于提高提供者的保留率并避免倦怠。从适应 COVID-19 中吸取的策略和经验教训在医疗系统应对未来的大流行时可能具有巨大的价值。
