PDF(Pubmed)
Abstract：
Maintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare\'s impact on participants\' ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers.
We used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare\'s success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests.
In the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare.
Homecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.
We used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare\'s success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests.
In the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare.
Homecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.
摘要：
背景：在临床护理中维持HIV感染者（PLWHIV）是全球优先事项。在密歇根州的底特律都会区,大约30％的PLWHIV没有得到治疗。为了重新吸引失访患者，韦恩健康传染病诊所在2017年推出了一项创新的家庭护理计划。除了家庭医疗保健服务，该计划包括指向社区资源和季度社区会议的链接。我们旨在评估Homecare对参与者保持参与HIV护理和达到病毒抑制能力的影响。我们纳入了PLWHIV及其医护人员的数据。
方法：我们使用了收敛混合方法设计，包括第一年的计划记录审查，半结构化面试,和经过验证的Likert量表问卷评估家庭护理前后的疾病感知。采访数据来自底特律都会区的15名PLWHIV和两名负责计划交付的医护人员。半结构化访谈侧重于诊所护理的障碍，支持网络,和疾病观念。采访数据使用主题方法进行转录和分析。使用完全编码的分析来创建有助于Homecare成功的因素的概念框架。使用配对T检验比较了八类短暂疾病感知（IPQ）的平均值。
结果：在家庭护理的第一年，34名参与者中有28名（82％）至少一次受到病毒抑制。该计划通过与医护人员的牢固关系提供（1）社会支持和减少污名化，(2)消除交通等物理和资源障碍，(3)疾病认知的积极变化。PLWHIV致力于功能性应对策略，包括改善情绪调节，接受他们的诊断，和更积极的控制观点。Brief-IPQ在家庭护理前后在六个域中显示出显着变化。
结论：家庭护理提供了一个创新的系统，可以成功地重新参与和维持失去随访的PLWHIV护理。这些发现对艾滋病毒控制工作有影响，并可能为难以接触人群的未来计划的制定提供信息。
方法：我们使用了收敛混合方法设计，包括第一年的计划记录审查，半结构化面试,和经过验证的Likert量表问卷评估家庭护理前后的疾病感知。采访数据来自底特律都会区的15名PLWHIV和两名负责计划交付的医护人员。半结构化访谈侧重于诊所护理的障碍，支持网络,和疾病观念。采访数据使用主题方法进行转录和分析。使用完全编码的分析来创建有助于Homecare成功的因素的概念框架。使用配对T检验比较了八类短暂疾病感知（IPQ）的平均值。
结果：在家庭护理的第一年，34名参与者中有28名（82％）至少一次受到病毒抑制。该计划通过与医护人员的牢固关系提供（1）社会支持和减少污名化，(2)消除交通等物理和资源障碍，(3)疾病认知的积极变化。PLWHIV致力于功能性应对策略，包括改善情绪调节，接受他们的诊断，和更积极的控制观点。Brief-IPQ在家庭护理前后在六个域中显示出显着变化。
结论：家庭护理提供了一个创新的系统，可以成功地重新参与和维持失去随访的PLWHIV护理。这些发现对艾滋病毒控制工作有影响，并可能为难以接触人群的未来计划的制定提供信息。
