Linking HIV-positive people in addiction care to HIV services in St. Petersburg, Russia - Mixed-methods implementation study of strengths-based case management.

Autor: Lunze K; Boston University School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA., Kiriazova T; Ukrainian Institute on Public Health Policy, Kyiv, Ukraine., Blokhina E; First Pavlov State Medical University, St. Petersburg, Russia., Bushara N; First Pavlov State Medical University, St. Petersburg, Russia., Bridden C; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA., Gnatienko N; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA., Bendiks S; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA., Quinn E; Boston University School of Public Health, Boston, MA, USA., Krupitsky E; First Pavlov State Medical University, St. Petersburg, Russia.; Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia., Raj A; Department of Medicine, Center on Gender Equity and Health, University of California - San Diego School of Medicine, La Jolla, California, USA., Samet JH; Boston University School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Global public health [Glob Public Health] 2021 Nov; Vol. 16 (11), pp. 1711-1723. Date of Electronic Publication: 2020 Oct 22.
DOI: 10.1080/17441692.2020.1834599
Abstrakt: Access to HIV services for HIV-positive patients in addiction care is challenging in Russia, because both care systems are organised independently from each other. Strengths-based case management is an effective strategy to connect people with HIV (PHIV) to HIV care. This mixed-methods study's objective was to investigate implementation of a case management intervention in St. Petersburg, Russia, designed to connect PHIV who inject drugs to HIV care. We analysed survey data from 118 HIV-positive patients in addiction care and conducted six focus groups (n=38). Quantitative analyses of fidelity and satisfaction outcomes and qualitative text analysis assessed intervention implementation. Participants who linked to HIV services embraced empowerment and motivation resulting from case management as supporting self-efficacy and linkage to services. Among participants who did not link to care, drug use impeded their care engagement. Main levers to implementation were empowerment to cope with challenges of a fragmented health system and persistent stigma. Those who connected to HIV services credited case managers for facilitating linkage; those who did not link attributed it to personal issues. Implementation of case management for HIV care in Russia should focus on effective substance use treatment and empowerment, motivation and support in addressing personal and system factors.
Databáze: MEDLINE
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