Scaling person-centred psycho-socioeconomic support for people living with HIV experiencing homelessness and unemployment in the Philippines: lessons learnt from the Open-Doors Home programme

IF 4.6 1区 医学 Q2 IMMUNOLOGY Journal of the International AIDS Society Pub Date : 2024-08-08 DOI:10.1002/jia2.26347
Rodenie A. Olete, Joseph S. Cadelina, Charmaine Faye M. Chu, Emerson A. Arriola, Inad Q. Rendon
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ODH is a temporary shelter programme with the main goal of addressing psychosocial and socioeconomic needs (also termed “psycho-socioeconomic” or “PsySE”) among PLHIV experiencing mental distress because of homelessness, unemployment, disrupted education, domestic violence or discrimination.</p><p>The ODH programme complements biomedical interventions by providing PsySE support (i.e. shelter, nutrition, education, individualized psychosocial counselling, career guidance and livelihood trainings) as social determinants of the HIV care cascade. Guided by the person-centred care (PCC) framework [<span>2</span>], individualized physical, mental, and socioeconomic needs assessments are done to ensure that the PsySE support is aligned with clients’ preferences and priorities. Clients, termed “housemates,” receive tailored PsySE support based on the individual needs assessment and individualized PCC plan. For example, if the intake interview shows that unemployment is the housemate's main concern, PsySE support will prioritize career path enhancement and referral to GPLI's network of entrepreneurs for hiring while also addressing other basic needs. ODH emphasizes empowerment, with healthcare providers serving only as facilitators to improve the housemates’ problem-solving capacities.</p><p>Due to limited shelter capacity, a passive intake process is used where potential clients reach out via social media (Twitter/X or Facebook) or through partner organizations (e.g. HIV &amp; AIDS Support House, Positive Action Foundation of the Philippines Inc. and other social hygiene clinics). The requirements for ODH intake are: (a) a summative case study from their medical doctor or a referral letter from the social welfare department or a community-based organization; (b) HIV confirmatory test result; (c) a medical abstract from the last 6 months showing no concurrent opportunistic infections; and (d) copies of two valid identifications for proper coordination with their respective HIV care facilities.</p><p>Based on a previous study, SEGT demonstrated improved mental health after engagement within a mutually supportive group environment [<span>3</span>]. In ODH, SEGT was designed into four domains with 12 modules that guide housemates in expressing their emotions through focused group discussions. The modules adapted the Filipino core values of social psychology [<span>4</span>]. Conducted weekly over 3 months, these sessions incorporated activities like journal writing, catharsis training, role-playing and positive reframing as different outlets of emotional expression. An on-call psychologist is available for those experiencing severe distress (see Table 1).</p><p>To monitor the mental wellbeing of the housemates during SEGT sessions, a 9-item Patient Health Questionnaire (PHQ-9) [<span>5</span>] was used to screen depression-related symptoms, while a 7-item Generalized Anxiety Disorder questionnaire (GAD-7) [<span>6</span>] for anxiety-related symptoms and evaluated every 2 weeks. Results from August to October 2022 from 22 housemates experiencing either homelessness or unemployment demonstrated a significant reduction in depression and anxiety after the SEGT sessions. The participants’ age ranged between 19 and 52 years old (mean = 33.3 years old, SD = 7.9). While attending the SEGT, averages in PHQ-9 and GAD-7 at baseline were at moderate levels (12.2 and 12.4, respectively) and significantly decreased to be at low to no risk by the last week of the SEGT session (4.8 and 4.8, respectively) [<span>7</span>]. Despite the limitations in the small sample size, SEGT showed potential in improving the housemates’ mental wellbeing.</p><p>ODH extends its support beyond mental wellbeing to include education, professional career guidance and livelihood training, equipping housemates with the skills needed for future opportunities. Additionally, the programme incorporates a sustainable financing element, exemplified by the establishment of a convenience store, fostering self-sufficiency among housemates. The organization provides start-up capital for the convenience store's grocery items, and the housemates manage the business. The net income generated each day is used as an additional food allowance in the shelter. Career path counselling is particularly emphasized during the last two SEGT sessions, where housemates are encouraged to express their future plans beyond the ODH shelter. By this stage, most housemates have initial plans to seek paid work, start an income-generating project, or return to school. Those without concrete career directions are referred to GPLI's network of local business owners for temporary employment, such as at barbershops, convenience stores, and vegetable and meat markets, ensuring they have a source of income while planning their next steps. Among the 22 housemates who participated in the SEGT sessions from August to October 2022, 17 were linked to employment, four received educational support, and one was linked to both employment and educational support.</p><p>While the ODH programme includes a strong focus on meeting the non-biomedical needs of clients, it also supports their biomedical needs. ODH refers housemates to in-house physicians or partner HIV facility, ensuring that participants receive essential medical care. Adherence counselling and monitoring are crucial to ensure individuals follow their treatment plans. Throughout the ODH stay, support staff closely monitored housemates’ adherence to antiretroviral therapy (ART) through pill-counting and verbal reminders to take their medication. An advantage of ODH is re-engaging PLHIV with treatment, facilitated by GPLI's daily pill-taking monitoring, weekly career tracking, and monthly/quarterly coordination with partner HIV facilities for medication refills and viral load results. 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引用次数: 0

Abstract

Founded in 2018, Gabay sa Pulang Laso Inc. (GPLI) (in English, “Guide to the Red Ribbon”) is a non-for-profit organization providing non-biomedical interventions to support people living with HIV (PLHIV) in the Philippines. As a response to a nationwide survey showing significant associations between unemployment, homelessness and mental distress among PLHIV during the COVID-19 pandemic [1], GPLI established the flagship programme, “Open Doors Home” (ODH). ODH is a temporary shelter programme with the main goal of addressing psychosocial and socioeconomic needs (also termed “psycho-socioeconomic” or “PsySE”) among PLHIV experiencing mental distress because of homelessness, unemployment, disrupted education, domestic violence or discrimination.

The ODH programme complements biomedical interventions by providing PsySE support (i.e. shelter, nutrition, education, individualized psychosocial counselling, career guidance and livelihood trainings) as social determinants of the HIV care cascade. Guided by the person-centred care (PCC) framework [2], individualized physical, mental, and socioeconomic needs assessments are done to ensure that the PsySE support is aligned with clients’ preferences and priorities. Clients, termed “housemates,” receive tailored PsySE support based on the individual needs assessment and individualized PCC plan. For example, if the intake interview shows that unemployment is the housemate's main concern, PsySE support will prioritize career path enhancement and referral to GPLI's network of entrepreneurs for hiring while also addressing other basic needs. ODH emphasizes empowerment, with healthcare providers serving only as facilitators to improve the housemates’ problem-solving capacities.

Due to limited shelter capacity, a passive intake process is used where potential clients reach out via social media (Twitter/X or Facebook) or through partner organizations (e.g. HIV & AIDS Support House, Positive Action Foundation of the Philippines Inc. and other social hygiene clinics). The requirements for ODH intake are: (a) a summative case study from their medical doctor or a referral letter from the social welfare department or a community-based organization; (b) HIV confirmatory test result; (c) a medical abstract from the last 6 months showing no concurrent opportunistic infections; and (d) copies of two valid identifications for proper coordination with their respective HIV care facilities.

Based on a previous study, SEGT demonstrated improved mental health after engagement within a mutually supportive group environment [3]. In ODH, SEGT was designed into four domains with 12 modules that guide housemates in expressing their emotions through focused group discussions. The modules adapted the Filipino core values of social psychology [4]. Conducted weekly over 3 months, these sessions incorporated activities like journal writing, catharsis training, role-playing and positive reframing as different outlets of emotional expression. An on-call psychologist is available for those experiencing severe distress (see Table 1).

To monitor the mental wellbeing of the housemates during SEGT sessions, a 9-item Patient Health Questionnaire (PHQ-9) [5] was used to screen depression-related symptoms, while a 7-item Generalized Anxiety Disorder questionnaire (GAD-7) [6] for anxiety-related symptoms and evaluated every 2 weeks. Results from August to October 2022 from 22 housemates experiencing either homelessness or unemployment demonstrated a significant reduction in depression and anxiety after the SEGT sessions. The participants’ age ranged between 19 and 52 years old (mean = 33.3 years old, SD = 7.9). While attending the SEGT, averages in PHQ-9 and GAD-7 at baseline were at moderate levels (12.2 and 12.4, respectively) and significantly decreased to be at low to no risk by the last week of the SEGT session (4.8 and 4.8, respectively) [7]. Despite the limitations in the small sample size, SEGT showed potential in improving the housemates’ mental wellbeing.

ODH extends its support beyond mental wellbeing to include education, professional career guidance and livelihood training, equipping housemates with the skills needed for future opportunities. Additionally, the programme incorporates a sustainable financing element, exemplified by the establishment of a convenience store, fostering self-sufficiency among housemates. The organization provides start-up capital for the convenience store's grocery items, and the housemates manage the business. The net income generated each day is used as an additional food allowance in the shelter. Career path counselling is particularly emphasized during the last two SEGT sessions, where housemates are encouraged to express their future plans beyond the ODH shelter. By this stage, most housemates have initial plans to seek paid work, start an income-generating project, or return to school. Those without concrete career directions are referred to GPLI's network of local business owners for temporary employment, such as at barbershops, convenience stores, and vegetable and meat markets, ensuring they have a source of income while planning their next steps. Among the 22 housemates who participated in the SEGT sessions from August to October 2022, 17 were linked to employment, four received educational support, and one was linked to both employment and educational support.

While the ODH programme includes a strong focus on meeting the non-biomedical needs of clients, it also supports their biomedical needs. ODH refers housemates to in-house physicians or partner HIV facility, ensuring that participants receive essential medical care. Adherence counselling and monitoring are crucial to ensure individuals follow their treatment plans. Throughout the ODH stay, support staff closely monitored housemates’ adherence to antiretroviral therapy (ART) through pill-counting and verbal reminders to take their medication. An advantage of ODH is re-engaging PLHIV with treatment, facilitated by GPLI's daily pill-taking monitoring, weekly career tracking, and monthly/quarterly coordination with partner HIV facilities for medication refills and viral load results. A treatment re-engagement example is a housemate from the August to October 2022 group who, after stopping HIV treatment in 2015, was promptly referred to GPLI's partner HIV facility for re-initiation.

The success of the ODH PsySE support in enhancing the mental wellbeing and socioeconomic capacity of Filipino PLHIV underscores the need to integrate PsySE programmes into the existing HIV care cascade in the Philippines. This integration should prioritize mental health counselling and training on healthy emotional expression. Advocating for the optimal use of social welfare funding for psychosocial care aligns with the Department of Social Welfare and Development (DSWD) Administrative Order No. 4 series of 2013 [8] and No. 15 series of 2022 [9]. Strengthening collaboration with the city social welfare department is crucial for sustainable, scaled-up PsySE support. Additionally, enhancing the ODH model involves reinforcing professional career pathway and education support programmes. Collaboration between community-based organizations and private agencies can broaden job opportunities while reducing HIV-related stigma and discrimination in the workplace.

The lessons learnt from the ODH programme guided the capacity-building programme for mental health and social welfare professionals, currently implemented by the Sustained Health Initiatives of the Philippines (SHIP). As of this writing, SHIP has conducted a co-design workshop to design the training curriculum in collaboration with Network Plus, UNAIDS, DSWD, the Department of Health, and other PLHIV-led community-based organizations. The goal is to widen HIV service delivery network to include mental health and social welfare professionals who can competently integrate PsySE support and other non-biomedical needs into the HIV care cascade in the Philippines. Sustained gains after the completion of the programme warrant further investigation.

All authors declare no competing interests.

RAO developed the ODH framework, sought funding for implementation, designed the Supportive-Expressive Group Therapy (SEGT) module with CMC, JSC, and IQR as co-developers. CMC was the resident psychologist who supervised the implementation of the SEGT module and was available to do psychological interventions for clients who had mental distress. EAA was responsible for participant recruitment. JSC and CMC counterchecked the accuracy of data analysis for the GAD-7 and PHQ-9 monitoring. All authors provided feedback and evaluation during the manuscript development and approved the final manuscript for submission.

The ODH programme was supported by the IAS Person-Centred Care Programme. No funding was provided for the preparation of this manuscript.

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为菲律宾无家可归和失业的艾滋病毒感染者提供以人为本的心理-社会-经济支持:从 "开放之家 "计划中汲取的经验教训。
那些没有具体职业方向的舍友会被介绍到 GPLI 的当地企业主网络中从事临时工作,如理发店、便利店、蔬菜和肉类市场等,以确保他们在规划下一步计划时有收入来源。在 2022 年 8 月至 10 月参加 SEGT 课程的 22 名舍友中,17 人获得了就业链接,4 人获得了教育支持,1 人同时获得了就业和教育支持。ODH 将房客转介给内部医生或合作伙伴艾滋病毒防治机构,确保参与者获得基本的医疗护理。坚持治疗的咨询和监测对于确保个人遵守治疗计划至关重要。在入住 ODH 的整个过程中,支持人员通过药片计数和口头提醒服药,密切监测舍友坚持抗逆转录病毒疗法(ART)的情况。通过 GPLI 的每日服药监测、每周职业生涯跟踪以及每月/每季度与合作 HIV 机构协调药物补充和病毒载量结果,ODH 的优势在于帮助 PLHIV 重新参与治疗。2022年8月至10月组中的一位房客就是一个重新参与治疗的例子,他在2015年停止艾滋病治疗后,被迅速转介到GPLI的合作艾滋病机构重新开始治疗。ODH的PsySE支持在提高菲律宾艾滋病毒感染者的心理健康和社会经济能力方面取得了成功,这突出表明有必要将PsySE计划纳入菲律宾现有的艾滋病护理体系。这种整合应优先考虑心理健康咨询和健康情绪表达培训。社会福利与发展部(DSWD)2013 年第 4 号系列行政命令[8]和 2022 年第 15 号系列行政命令[9]倡导将社会福利资金优化用于社会心理关怀。加强与城市社会福利部的合作对于可持续地扩大 PsySE 支持至关重要。此外,加强职业发展与健康模式还包括强化专业职业途径和教育支持计划。社区组织与私营机构之间的合作可以扩大就业机会,同时减少工作场所与艾滋病毒有关的羞辱和歧视。从 ODH 计划中吸取的经验教训指导了目前由菲律宾持续健康倡议(SHIP)实施的心理健康和社会福利专业人员能力建设计划。截至本报告撰写之时,菲律宾持续健康倡议组织已举办了一次共同设计研讨会,与 Network Plus、联合国艾滋病规划署、社会福利与发展部、卫生部以及其他由艾滋病毒感染者领导的社区组织合作设计培训课程。目标是扩大艾滋病服务网络,将心理健康和社会福利专业人员纳入其中,使他们能够胜任地将心理健康支持和其他非医疗需求纳入菲律宾的艾滋病护理流程。所有作者声明不存在利益冲突。RAO制定了ODH框架,寻求实施资金,并与CMC、JSC和IQR共同设计了支持-表达式团体疗法(SEGT)模块。CMC 是常驻心理学家,负责监督 SEGT 模块的实施,并对有心理困扰的客户进行心理干预。EAA 负责招募参与者。JSC和CMC对GAD-7和PHQ-9监测的数据分析的准确性进行了复核。所有作者都在稿件撰写过程中提供了反馈和评估意见,并批准了最终稿件的提交。本稿件的撰写未获得任何资助。
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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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