整合监狱预约和 HIV 监控数据,促进护理协调。

Tigran Avoundjian, Matthew R Golden, Brandon L Guthrie, James P Hughes, Janet Baseman, Jennifer G Jones-Vanderleest, Julia C Dombrowski
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引用次数: 0

摘要

许多监狱中的艾滋病病毒感染者(PWH)并没有很好地参与社区的艾滋病治疗。本研究旨在评估数据交换和护理协调对监狱中的艾滋病病毒感染者出狱后的治疗效果的影响。我们开发了一个自动流程,将监狱登记记录与 HIV 监控数据进行匹配。卫生部门的 HIV 重链接专家和监狱释放规划人员在每周的病例会议上使用这些数据,以促进对入狱前未接受治疗(过去 12 个月内未报告 CD4 或病毒载量 [VL])或病毒血症(VL ≥ 200 copies/mL)的艾滋病感染者的护理协调。我们使用 Cox 比例危险模型比较了干预前(2016 年 10 月 1 日至 2017 年 10 月 1 日)与干预后(2018 年 4 月 1 日至 2019 年 2 月 1 日)期间释放后 3 个月内的 VL 检测和释放后 6 个月内的病毒抑制(VL < 200 copies/mL)情况。比较干预前与干预后的 153 名 PWH 和 80 名 PWH,释放后的 VL 检测没有差异(47% 对 55%;调整后危险比 [aHR]:1.05,95% 置信区间:1.05,95% 置信区间 [CI]:病毒抑制率也没有差异(35% 对 44%;aHR:1.28 [95% CI:0.80-2.05])。如果不在监狱和社区采取额外干预措施,数据交换和护理协调不足以改善感染者释放后的治疗效果。
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Integration of Jail Booking and HIV Surveillance Data to Facilitate Care Coordination.

Many people with HIV (PWH) in jail have not been well engaged in HIV treatment in the community. This study aimed to assess the impact of a data exchange paired with care coordination for PWH on HIV outcomes after jail release. We developed an automated process to match jail booking records with HIV surveillance data. Health department HIV relinkage specialists and jail release planners used the data in weekly case conferences to facilitate care coordination for PWH who were out of care (no CD4 or viral load [VL] reported in the past 12 months) or viremic (VL ≥ 200 copies/mL) before booking. We compared VL testing within 3 months after release and viral suppression (VL < 200 copies/mL) within 6 months after release in preintervention (October 1, 2016-October 1, 2017) versus postintervention (April 1, 2018-February 1, 2019) periods using Cox proportional hazard models. Comparing 153 bookings among PWH in the preintervention period to 80 in the postintervention period, VL testing after release did not differ (47% vs. 55%; adjusted hazard ratio [aHR]: 1.05, 95% confidence interval [CI]: 0.68-1.64) nor did viral suppression (35% vs. 44%; aHR: 1.28 [95% CI: 0.80-2.05]). Data exchange and care coordination are insufficient to improve postrelease outcomes among PWH without additional interventions in the jail and community.

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