PDF(Pubmed)
Abstract：
BACKGROUND: Engagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), retention in care, and engagement in care. We have previously identified effective care cascade strategies in a systematic review. Initiation of ART could be improved by mobile health interventions, and changes in healthcare delivery. Adherence to ART could be improved by mobile health interventions, incentives, counselling, and psychotherapy. Retention in care could be improved by mobile health interventions, incentives, education, and electronic interventions. The aim of this study was to investigate barriers and facilitators to implementing these effective interventions in HIV clinics in Ontario, Canada.
METHODS: We conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences.
RESULTS: Twenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support.
CONCLUSIONS: Clinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH.
METHODS: We conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences.
RESULTS: Twenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support.
CONCLUSIONS: Clinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH.
摘要：
背景：参与护理对于HIV感染者（PLH）获得最佳结果很重要。已经制定了几种策略来改善通过艾滋病毒护理级联的客户流量，特别是靶向治疗的开始，坚持抗逆转录病毒治疗（ART），保留在护理中，和参与护理。我们以前在系统评价中确定了有效的护理级联策略。ART的启动可以通过移动健康干预措施得到改善，以及医疗保健服务的变化。对ART的坚持可以通过移动健康干预来改善，激励机制，咨询,还有心理治疗.通过移动医疗干预措施可以改善护理的保留，激励机制，教育,电子干预。这项研究的目的是调查在安大略省的HIV诊所实施这些有效干预措施的障碍和促进者。加拿大。
方法：我们进行了一项连续的解释性混合方法研究。在定量链中，我们对向PLH提供护理的卫生工作者进行了一项调查,以确定障碍和促进者.在定性链中，我们根据理论领域框架(TDF)对卫生工作者和PLH进行了深入访谈,以解释我们的定量结果.将定性和定量数据合并以创建元推断。
结果：来自安大略省9个城市的8个诊所的20名卫生工作者参加了这项调查。9名PLH和10名卫生工作者参加了定性访谈。安大略省的诊所实施了从文献中确定的所有有效干预措施，用于开始治疗，坚持ART，尽管担心资源，但仍保留在护理中。物理和财务上获得护理的障碍，定制护理的工作量，卫生工作者和PLH都确定了专业知识。主要促进者是通过教育和同伴支持进行虚拟护理和客户准备。
结论：安大略省的诊所似乎实施了几种基于证据的策略来提高PLH参与度。需要更多具有技能的卫生工作者来满足独特的PLH需求。虚拟护理对卫生工作者和PLH都有益。
方法：我们进行了一项连续的解释性混合方法研究。在定量链中，我们对向PLH提供护理的卫生工作者进行了一项调查,以确定障碍和促进者.在定性链中，我们根据理论领域框架(TDF)对卫生工作者和PLH进行了深入访谈,以解释我们的定量结果.将定性和定量数据合并以创建元推断。
结果：来自安大略省9个城市的8个诊所的20名卫生工作者参加了这项调查。9名PLH和10名卫生工作者参加了定性访谈。安大略省的诊所实施了从文献中确定的所有有效干预措施，用于开始治疗，坚持ART，尽管担心资源，但仍保留在护理中。物理和财务上获得护理的障碍，定制护理的工作量，卫生工作者和PLH都确定了专业知识。主要促进者是通过教育和同伴支持进行虚拟护理和客户准备。
结论：安大略省的诊所似乎实施了几种基于证据的策略来提高PLH参与度。需要更多具有技能的卫生工作者来满足独特的PLH需求。虚拟护理对卫生工作者和PLH都有益。
