“快速、简单且友好”：理解澳大利亚一种由护士和同伴主导的、临近社区矫正机构的丙型肝炎移动护理模式的可接受性和可及性。
"Quick, simple, and friendly": Understanding the acceptability and accessibility of a nurse and peer-led, mobile model of hepatitis C care adjacent to community corrections in Australia.
作者信息
Griffin Samara, Walker Shelley, Holmes Jacinta A, Reid Bridget, Callus Amanda, Belzer Mark, Dicka Jane, Papaluca Timothy, Craigie Anne, Schroeder Sophia, Lancaster Kari, Hellard Margaret, Stoové Mark, Thompson Alexander J, Winter Rebecca J
机构信息
Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; St Vincent's Hospital, Melbourne, VIC, Australia.
Disease Elimination, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia.
出版信息
Int J Drug Policy. 2025 May;139:104785. doi: 10.1016/j.drugpo.2025.104785. Epub 2025 Mar 26.
BACKGROUND
People on community corrections orders are at high-risk for hepatitis C but opportunities for hepatitis C care may be missed due to poor integration of prison-based healthcare. The C No More study is a pilot feasibility study of point-of-care hepatitis C testing and rapid treatment initiation delivered adjacent to community corrections settings in Melbourne, Australia, via a mobile, nurse and peer-led, low-threshold model of care.
METHODS
We conducted a mixed methods evaluation using Levesque's Conceptual Framework of Access to Health to understand participants' experiences and perspectives on the accessibility of this model of care. Interviewer-administered surveys were conducted with all participants after enrolment and initial testing, and qualitative in-depth interviews were conducted with a sample of those who completed the survey.
RESULTS
500 participants completed the survey, and 20 participants undertook in-depth interviews. Both quantitative and qualitative results indicated that participants found the C No More service approachable and accessible due to the informal outreach setting, the involvement of peer workers, and the convenient location of service delivery. Participants reported feeling comfortable seeking care in the van and found the service appropriate and easy to engage with due to the fingerstick point-of-care testing and individualised support provided by the nurse.
CONCLUSION
Multiple elements of the C No More model increased client-perceived service accessibility, including being located close to government services, point-of-care testing, and the person-centred, peer-based and non-judgemental nurse-led care provided. This study supports the implementation of other peer and nurse-led models of hepatitis C care in similar settings.
背景
处于社区矫正令之下的人群感染丙型肝炎的风险很高，但由于监狱医疗保健整合不佳，可能会错过丙型肝炎护理的机会。“不再有丙型肝炎”研究是一项试点可行性研究，通过移动、护士和同伴主导的低门槛护理模式，在澳大利亚墨尔本的社区矫正场所附近提供即时护理丙型肝炎检测和快速治疗启动服务。
方法
我们使用勒维克的健康可及性概念框架进行了混合方法评估，以了解参与者对这种护理模式可及性的体验和看法。在参与者登记和初次检测后，对所有参与者进行了访谈式调查，并对完成调查的部分参与者进行了定性深入访谈。
结果
500名参与者完成了调查，20名参与者接受了深入访谈。定量和定性结果均表明，由于非正式的外展环境、同伴工作者的参与以及服务提供地点的便利，参与者认为“不再有丙型肝炎”服务亲切且容易获得。参与者报告说在面包车内寻求护理感到自在，并且由于即时护理指尖检测以及护士提供的个性化支持，他们认为该服务合适且易于参与。
结论
“不再有丙型肝炎”模式的多个要素提高了客户感知的服务可及性，包括靠近政府服务机构、即时护理检测，以及提供以人为本、基于同伴且无评判的护士主导护理。本研究支持在类似环境中实施其他由同伴和护士主导的丙型肝炎护理模式。
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