Conte Madellena, Imbert Elizabeth, Avila Rodrigo, Christopoulos Katerina, Taylor Grace, Erguera Xavier A, Charlebois Edwin D, Havlir Diane V, Gandhi Monica, Koester Kimberly A, Hickey Matthew D
Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA.
Division of HIV, ID and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
AIDS Patient Care STDS. 2025 Apr;39(4):141-150. doi: 10.1089/apc.2024.0228. Epub 2025 Mar 19.
Homelessness adversely impacts continuity of care for people with HIV (PWH). The POP-UP program is a low-barrier drop-in care model embedded within an HIV clinic in San Francisco and is designed to serve PWH experiencing homelessness. We conducted a pilot study of mobile outreach for PWH in POP-UP who remain out-of-care despite the drop-in program. We conducted a mixed-methods study to evaluate the effectiveness of mobile outreach through a retrospective cohort of PWH eligible for this outreach and semistructured interviews. Patients with POP-UP were eligible for outreach if they had (1) HIV viral load ≥200 copies/mL and no visit in ≥30 days, (2) no clinic visit in ≥180 days, or (3) urgent re-engagement need identified by the clinic team. We report the proportion of patients re-engaging in clinic-based care within 30 days and thematic findings from semistructured interviews with patients who experienced mobile outreach. Of 74 patients eligible for outreach, 55 were outreached, 48 located, and 30 returned to clinic within 30 days. Most were currently housed in a single-room occupancy hotel (39%) or permanent supportive housing (25%), 87% had a substance use disorder, and 51% had a mental health diagnosis. Qualitative findings highlighted the value of mobile outreach in terms of interpersonal relationships with the clinical team and the perception that outreach was a helpful nudge to return to clinic. Among PWH with housing instability who are out-of-care despite access to drop-in clinic-based services, mobile outreach was acceptable and promising for locating patients and facilitating care re-engagement.
无家可归对艾滋病毒感染者（PWH）的护理连续性产生不利影响。“弹出式”项目是一种低门槛的即时护理模式，融入了旧金山的一家艾滋病毒诊所，旨在为无家可归的艾滋病毒感染者提供服务。我们对“弹出式”项目中尽管有即时护理项目但仍未接受护理的艾滋病毒感染者进行了移动外展试点研究。我们进行了一项混合方法研究，通过对符合该外展条件的艾滋病毒感染者的回顾性队列研究和半结构化访谈来评估移动外展的有效性。如果“弹出式”项目的患者符合以下条件，则有资格接受外展服务：（1）艾滋病毒病毒载量≥200拷贝/毫升且在≥30天内未就诊，（2）在≥180天内未到诊所就诊，或（3）诊所团队确定有紧急重新参与护理的需求。我们报告了在30天内重新参与基于诊所护理的患者比例，以及对接受移动外展服务的患者进行半结构化访谈的主题结果。在74名符合外展条件的患者中，55名接受了外展服务，48名被找到，30名在30天内返回诊所。大多数患者目前居住在单人居住酒店（39%）或永久性支持性住房（25%）中，87%有物质使用障碍，51%有心理健康诊断。定性研究结果强调了移动外展在与临床团队的人际关系方面的价值，以及认为外展是促使患者返回诊所的有益推动。在尽管可以获得基于即时诊所服务但仍护理中断且住房不稳定的艾滋病毒感染者中，移动外展对于找到患者并促进护理重新参与是可接受且有前景的。
