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.
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。