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首页> 外文期刊>JMIR public health and surveillance. >The RSVP Project: Factors Related to Disengagement From Human Immunodeficiency Virus Care Among Persons in San Francisco
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The RSVP Project: Factors Related to Disengagement From Human Immunodeficiency Virus Care Among Persons in San Francisco

机译：RSVP项目：与旧金山人群中的人类免疫缺陷病毒护理脱离相关的因素

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Background: In the United States, an estimated two-thirds of persons with human immunodeficiency virus (HIV) infection do not achieve viral suppression, including those who have never engaged in HIV care and others who do not stay engaged in care. Persons with an unsuppressed HIV viral load might experience poor clinical outcomes and transmit HIV. Objective: The goal of the Re-engaging Surveillance-identified Viremic Persons (RSVP) project in San Francisco, CA, was to use routine HIV surveillance databases to identify, contact, interview, and reengage in HIV care persons who appeared to be out of care because their last HIV viral load was unsuppressed. We aimed to interview participants about their HIV care and barriers to reengagement. Methods: Using routinely collected HIV surveillance data, we identified persons with HIV who were out of care (no HIV viral load and CD4 laboratory reports during the previous 9-15 months) and with their last plasma HIV RNA viral load 200 copies/mL. We interviewed the located persons, at baseline and 3 months later, about whether and why they disengaged from HIV care and the barriers they faced to care reengagement. We offered them assistance with reengaging in HIV care from the San Francisco Department of Public Health linkage and navigation program (LINCS). Results: Of 282 persons selected, we interviewed 75 (26.6%). Of these, 67 (89%) reported current health insurance coverage, 59 (79%) had ever been prescribed and 45 (60%) were currently taking HIV medications, 59 (79%) had seen an HIV provider in the past year, and 34 (45%) had missed an HIV appointment in the past year. Reasons for not seeing a provider included feeling healthy, using alcohol or drugs, not having enough money or health insurance, and not wanting to take HIV medicines. Services needed to get to an HIV medical care appointment included transportation assistance, stable living situation or housing, sound mental health, and organizational help and reminders about appointments. A total of 52 (69%) accepted a referral to LINCS. Additionally, 64 (85%) of the persons interviewed completed a follow-up interview 3 months later and, of these, 62 (97%) had health insurance coverage and 47 (73%) reported having had an HIV-related care appointment since the baseline interview. Conclusions: Rather than being truly out of care, most participants reported intermittent HIV care, including recent HIV provider visits and health insurance coverage. Participants also frequently reported barriers to care and unmet needs. Health department assistance with HIV care reengagement was generally acceptable. Understanding why people previously in HIV care disengage from care and what might help them reengage is essential for optimizing HIV clinical and public health outcomes.
机译：背景：在美国，估计有三分之二的人类免疫缺陷病毒（HIV）感染者无法实现病毒抑制，包括那些从未从事过HIV护理的人和其他未从事护理的人。 HIV病毒载量未抑制的人可能会出现较差的临床结果并传播HIV。目标：加利福尼亚州旧金山的“重新参与监视的病毒感染者”（RSVP）项目的目标是使用常规的HIV监测数据库来识别，联系，访谈和重新参与似乎不在活动范围内的HIV护理人员因为他们的最后HIV病毒载量没有被抑制，所以要小心。我们旨在采访参与者有关他们的艾滋病毒护理和重新参与的障碍。方法：使用常规收集的HIV监测数据，我们识别出失控的HIV感染者（在过去9-15个月内没有HIV病毒载量和CD4实验室报告），并且他们的最后血浆HIV RNA病毒载量> 200拷贝/ mL 。在基线和三个月后，我们采访了现场人员，以了解他们是否，为什么脱离艾滋病治疗以及他们在重新参与治疗方面面临的障碍。我们通过旧金山公共卫生部链接与导航计划（LINCS）向他们提供了帮助其重新参与艾滋病毒治疗的帮助。结果：在282人中，我们采访了75人（26.6％）。在这些人中，有67人（占89％）报告了当前的健康保险承保范围，有59人（占79％）曾经开过处方，目前有45人（占60％）正在服用HIV药物，在过去的一年中有59人（占79％）已经有艾滋病毒提供者，在过去的一年中，有34位（45％）错过了艾滋病毒预约。没有见到提供者的原因包括感觉健康，使用酒精或毒品，没有足够的钱或健康保险以及不想服用HIV药物。预约HIV医疗护理所需的服务包括交通援助，稳定的生活状况或住房，良好的心理健康以及组织帮助和有关预约的提醒。共有52个（69％）接受了LINCS的推荐。此外，受访者中有64名（85％）在3个月后完成了一次随访采访，其中62名（97％）拥有医疗保险，47名（73％）报告称自此以来已经接受了艾滋病毒相关的护理基线面试。结论：大多数参与者并没有真正失去医疗服务，而是报告了间歇性的HIV护理，包括最近的HIV提供者访问和健康保险覆盖范围。参与者还经常报告护理和未满足需求的障碍。卫生部门在重新参与艾滋病毒护理方面的援助通常是可以接受的。理解为什么以前接受HIV护理的人们会脱离护理，以及可能帮助他们重新参与的原因，对于优化HIV临床和公共卫生成果至关重要。

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