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推进艾滋病毒患者导航服务:评估住房和就业护理模式。

Advancing Patient Navigation for HIV: Evaluating Models of Care for Housing and Employment.

机构信息

School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, USA.

Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA.

出版信息

AIDS Behav. 2024 Nov;28(11):3910-3918. doi: 10.1007/s10461-024-04464-2. Epub 2024 Aug 22.

Abstract

People with HIV face challenges securing housing and employment. Patient navigation is an effective intervention that can improve the receipt of these services, which have been linked to better health outcomes. The purpose of this study was to assess implementation of patient navigation in diverse delivery settings. We also evaluated the relationship between these services and health outcomes among participants. Twelve sites in the United States (N = 1,082) implemented navigation using single or multiple navigator interventions to improve housing, employment, viral suppression, and retention in care. Sites included health departments, health centers, and AIDS service organizations (ASO). Client-level data were used to model relationships of interest. Across the 12 sites, regardless of model, housing (odds ratio (OR) = 1.18, p < .001), employment (OR = 1.09, p < .001) and retention in care (OR 1.11, p = .007) improved significantly over time; however, viral suppression did not (OR = 1.04, p = .120). Regardless of model of care, patient navigation improved housing, employment, and retention in care. This study demonstrated that while navigation supports people with HIV in securing housing and employment, models using a more intensive format worked best in specific settings. While most studies focus on unimodal strategies, this study builds on the evidence by examining how navigation models can be delivered to reduce barriers to care.

摘要

HIV 感染者在获得住房和就业方面面临挑战。患者导航是一种有效的干预措施,可以改善这些服务的获得情况,这些服务与更好的健康结果相关。本研究旨在评估患者导航在不同服务环境中的实施情况。我们还评估了这些服务与参与者健康结果之间的关系。美国 12 个地点(N=1082)实施了导航,使用单一或多种导航干预措施来改善住房、就业、病毒抑制和护理保留率。参与地点包括卫生部门、卫生中心和艾滋病服务组织。采用客户层面的数据来模拟感兴趣的关系。在 12 个地点中,无论采用哪种模型,住房(优势比(OR)=1.18,p<0.001)、就业(OR=1.09,p<0.001)和护理保留率(OR 1.11,p=0.007)都随着时间的推移显著改善;然而,病毒抑制并没有改善(OR=1.04,p=0.120)。无论护理模式如何,患者导航都能改善住房、就业和护理保留率。本研究表明,尽管导航支持 HIV 感染者获得住房和就业,但在特定环境中,使用更密集模式的导航模型效果最佳。虽然大多数研究都集中在单一模式策略上,但本研究通过检查导航模型如何提供以减少护理障碍来扩展证据。

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