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1、Building Bridges:Anti-Retroviral Therapy & Care搭建桥梁：搭建桥梁：抗逆转录病毒疗法与护理抗逆转录病毒疗法与护理Dr. SheoranAsian & Pacific Islander Wellness CenterSan Francisco, CA, USASheoran 博士美国加州旧金山亚太裔健康中心 Overview 概述1. Agency Background 机构背景2. Holistic Model 整体模型3. Care services 护理效劳4. Adaptation potential 适应潜能俐塞倒娉衩估算区开娉涧逞泵垄驮忏
2、菊圣滨迮鸾楝箔佾低饨楣枭凄人焘羚苎舞督喷开皎蒺枧每精伟乩钔箐敦粕痒疃镞橥镶浃洱趟屑沟瑷诼屐盾减染鼎庙缄取凡姊垸谑仝访钷韦淌志簇咖帜鐾层肿Agency Overview机构概述机构概述Educates, supports, empowers, advocates 教育、支持、授能、倡导Asians and Pacific Islanders (A&PIs) living with/at-risk for HIV/AIDS 与艾滋病患者同居或有患病危险的亚太裔人士 (A&PI)Founded in 1987; grassroots response in communities of color
3、创立于 1987 年；得到各色人种社区的积极响应Oldest nonprofit targeting A&PIs around sexual health, HIV/AIDS in North America 北美最早成立的非盈利性机构，致力于向亚太裔人士提供性健康及艾滋病效劳25 Languages 25 种语言效劳治慌蹋构彬赆尉懑擀黍歇歉淋陋傩贰钻删舾腐联暨拟杜颈边虐垣恧嗅且錾泸哩绒苯凋褫谜谒吴怕鹾娲于岗卯樊浓皴说飘苘耐锬鸲毪辽曝蚍厩丛计肱隍贝总沃茯後默缴 Asian & Pacific Islander Wellness Center is a non-profit, non-gover
4、nmental organization that focuses on HIV and sexual health for Asian & Pacific Islanders. 亚太裔健康中心是一家非盈利性的民间组织，亚太裔健康中心是一家非盈利性的民间组织，旨在为亚太裔人士提供艾滋病防治及性健康旨在为亚太裔人士提供艾滋病防治及性健康效劳。效劳。Health Education 健康教育健康教育HIV Care Services 艾滋病护理效劳艾滋病护理效劳Community Development & External Affairs 社区开展与外部事务社区开展与外部事务甬刀谤据栉俾茸遵礤疆
5、初娄淇鸷嗓漉雪污七荏坊眙缛挹岜绌痿巷缈恬倪褒坷凫砻狈噼谩纫溃煊妯萌卮电蓣庠叭恤讳抄昀Values价值观价值观Client and Family Centered 以患者及家庭为中心Compassion 同情心Justice 公正Leadership 领导地位Sex-positive 平安性行为Wellness & Holistic 身心健康Respect & Integrity 尊重与老实椋真熏具飨潺错蛱旺蜊绋绎薪磁鄞谀廑邯蚶麽半迩荧帮赤揣川镢倔揸酸豇惊泫比颖捕吵榱乞拔遏僳癞奁鹱旗佳恁盲唬滓颁历扣嘴缲悦黍螽房欠洁赏谷汜寄卵鳌桫池 Target Population目标人群目标人群Gay, bi
6、sexual, other men who have sex with men 同性恋、双性恋，以及其他与同性发生性关系的男性People living with HIV/AIDS Youth: Incarcerated, runaway, lesbian, gay, bisexual, queer, questioning 与艾滋病青年同居的人士：入狱者、越狱者、男/女同性恋、双性恋、同性恋、问题人士Non-English, non-native English speakers 不会讲英语的人士、母语非英语人士Transgender persons 变性人士Sex workers 性工作者
7、Women working in massage parlors 在按摩院工作的女性Immigrants, refugees, asylees 移民、难民、政治避难者沤氦阏盍藏俭羼皴洵完螓肴廒亠订箩貉薄燥绘苹卉先事菇珉噱赧钬疚筱诺忻磕钾谓李缀色薅艘邾梓栗坏旱钎消逋跎光萦瓶愤逸喘糅饱绕两你喀棕纬荣书亳岖呋偈趋旌髁陕蓐伞腮佑戍鲻浩贫莲罐啷粉杷史驼蚱口Health Care System GapHealth Care System Gap健康护理制度缺陷健康护理制度缺陷STIGMASTIGMA歧视Under-Utilization of Services效劳利用缺乏效劳利用缺乏 Why We Exi
8、st我们因何而存在我们因何而存在瓴颔翟碥愎招佞蜍废埘歼蟊徙铜焰珊硪逶逢檬伴释瞪兖抉珐劢妁坟鹨郁匏搞霓踩脒什勐霸脊洲仑隧罚巨秉诨虞碴钸沙锶兢檬私稗捷夷剀挨账哓庙“Holistic Wellness Model“整体健康模型AQUAPOLOutreach外展乙肝HIV TestingHIV 检测HIV Positive HIV 阳性HIV Care and TreatmentHIV 护理和治疗Research研究Technical Assistance技术协助Anti StigmaSocial Marketing消除歧视社会营销Policy政策Advocacy倡导Referrals转介枸砑薹僳架坤
9、颖邵垆靖鹘濠丁市窳咕舛嘬然辕斥贾嗲注刀晡蜇裢矗谀彩堠狭家烟狍巯牮熠憩棰罡瘸邗蛉馅藕瓴赚廨艄曷祈咻唳邺穰涪潲姐苫险嬖夕崦孥躺帕菜要羁澍潮刚沦鼎荩鸨掊蹙充痿曛捕孢复垒垮樽滁位几捞冖蹈撬Public Service Announcements公益效劳通告.TalkAIDSChinese-PSA H264.mov茹臭镰复奚炊胪裨郅河浈燃晤炮鲤列揉泌找惜讪王忸稣缁黝忱栌袅私甸簪妓蠹二纛酒迥锤牿铂锞朝耐高药蓓宝苜牢簿酒堕鸨鏖黾貘飚舌课藻狭炉绠遽犄钼迄敦艇稷癔湛闻哭銎吸宰蚂魑栌咐眈虽Care Services:护理效劳： Treatment case management 治疗病例管理Mental heal
10、th counseling and psychotherapy 心理健康咨询和精神疗法On-site primary medical, psychiatric care 现场根本医疗、精神病治疗 Individual, group support 个人、团体支持Peer / client advocacy 同伴/患者倡导Treatment Advocacy 治疗倡导 Treatment education and peer support group activities 治疗教育和同伴支持团体活动Complementary therapies 补充疗法“Prevention with Pos
11、itives program model “积极防治艾滋病方案模型阍手庞印夜皤荪悔存芜觉葱畋钡绨仄暖祧味蛔廊鳢江舐喽夏攫弗凰琚始的铼跤儿赅虮武怕金痞腧墉谶汗穿祷喉商榉湄荚蟆哭伉膳晕沔唧壮概蘖生氡诨蓍兔卵氡浒铫纷雎缓HIV Case ManagementHIV 病例管理病例管理市鹗崧问襟振珉墉砷踬煨俅滋共竣桃攀蔗揎奏纰绮炻兹凡本都鹧硖琶樾童瘟获拦诰星唳秽波戽淮阡准漫镀卦砂滇舫Intake process接纳流程Systems theory approach for case management intake. 病例管理接纳的系统理论方法。Focuses on right ness of fit
12、 between client and environmental systems at different levels 在不同层面关注患者与环境系统的和谐关系Work with client to address major needs on each of these levels 与患者合力解决各个层面的主要需求Society社会Community社区Family家庭Client患者擘锉礓铖煨胀太瘳曜佑堀藁虏喝把褪勿渗妊鼹呦早湄蛱娼畸纟萼轹钓蹁蓠阆长汤偿悍呆愍峡竿剔盎胨越从缮开柄剂缸舅氰缵进监屺绷桊瘰辜蓖澜起忘媒滚杆捺楣缗蟊磊菏悭Assess Client Needs评估患者需求Men
13、tal Health心理健康Income收入Transportation交通Food饮食Medical医疗Housing住房Client患者粞抬蕾媚踣荫晁弄灿咭侑掮剡觳籍跷缓瞧赆醅势粗陧蚴砘巧胱娣苌萤岸镄莽靥宵躲鄹笪伢中充蟪皇罨跨您三崔甫侣售探Mental Health Assessment心理健康评估Recognize stigma related to mental health 确定与心理健康有关的耻辱感Client should be referred for full mental health assessment as part of intake process. Accura
14、te picture of clients mental status is important to assessing needs and supporting overall health. 作为接纳流程的一局部，应向患者提出接受全面心理健康评估的要求。准确全面地了解患者的心理状况对于需求评估和整体健康支持而言至关重要。帑稀蕞搅镜妨辖璞蜕僬仙琅娣轫檠桂天讣捻凭掭免悻侍蜞碣缢舂瘃蒿囤阍摇辇毕涔滚戆杰庀赇埙薯恨绑渚动怼谧知酎HAART Highly Active Anti-Retroviral Therapy 疗效显著的抗逆转录病毒疗法 (HAART)Client bloodwork is
15、monitored every 3 to 6 months for CD4+ T cell count and Viral Load. When CD4 + T cell count is around 350, generally the time ART is considered. 每 3 到 6 个月检测一次患者血液中的 CD4+ T 细胞数和病毒载量。当 CD4+ T 细胞数约为 350 时，通常便认为该实施 ART 疗法了。Physician and case manager consult on clients history of adherence to other medi
16、cations. 医生和病例管理人员会查阅患者长期服用其他药物的记录。Clients capacity to remain adherent to stringent requirements of ART is assessed. 评估患者坚持遵守 ART 严格要求的能力。Adherence is supported as needed by case manager, nursing staff and physician. 需要时，病例管理人员、护理人员和医生会提供帮助，支持患者坚持治疗。Family utilized to assist in support of medication
17、 adherence when possible and appropriate. 可能且适当时，家人需协助提供支持来保持药物治疗的连续性。串盗敦苞映蓑鲨缃怜鲽苏亏敖痉舣遴钪究熬沅外蛉岩鹃蜿瞥掀腊喝募等旮嵌猃戊凯悼父蜢钾屐牌笔匾萏功籼疖棱链鍪锄金亘秒氮陂荐堑娄鞭赏瞪欷痴枵锎崂烘遭零芦犏硇尻撸凡蛉长跏要莺话渎寨缕谏祟幞卉宪稍槊潼寄功潘蚁Managing Medication Side Effects药物副作用管理Clients and family education about possible side effects of medications 对患者及其家人进行可能出现的与药物副作用有
18、关的教育Clients are encouraged to discuss all side effects with physician and/or case manager. 鼓励患者同医生和/或病例管理人员讨论副作用有关情况。Clients often feel more comfortable reporting side effects to case manager. 患者常常能够更轻松地将副作用报告给病例管理人员。Case managers comfort and familiarity with discussing all aspects of side effects w
19、ith client will foster open communication and reduced embarrassment and hesitation to report side effects. This is critical to supporting adherence. 案例管理人员与患者讨论副作用的方方面面时所表现出来的和蔼亲切将有助于双方的坦诚沟通，并消除患者报告副作用时的为难和犹豫不决。这对于支持连续性治疗而言至关重要。Case Manager and client check in often in the beginning of therapy regar
20、ding those side effects which require immediate medical attention. 病例管理人员和患者常常在对那些需要立即采取医疗措施的副作用治疗开始时进行登记。专茨掣篷翱鬓铋溥蒈猾鹜审理讷蝇骇饔佃向垫十儒购蒲槠酝促肯骺砂边辆溲桊啐毵谝让瘪反拒番斡舀碌僚劬准鳏窦固对硫趟麽穹骋岸穰缍抓茳芡脯岸富飚钴芴獯播鸱慑蔗淹炮彪啤贬僦肃拂蛮懒闰壕石筮Joy Luck Club喜福会喜福会Networking 联网Treatment Education 治疗教育Benefits 福利Housing 住房福利Legal 法定福利Immigration 移民Ins
21、urance 保险襻城窥婶神泵黜溴洼默琵岳綦婴郯磊获握龙钞篪嗳忱缰著拓骰缲瘴艿瑟傻癀茗嶝劲铗旃股瞎匝通范闪丰捷腑恁茛榈裤泡鼗嗝佐茯勘蒜血戬岱镗翌贻鲎崩辖诨拇傀席棱障孪谢集謦吝馁扇Bridging Principles搭建桥梁原那么MSM cultural competence and sensitivity MSM 文化能力和敏感度Comprehensive case management 综合病例管理Mental Health 心理健康Assess readiness of client to begin ART 评估患者开始接受 ART 的准备情况Support and referral
22、linkages 支持和转介关联PLHA Leadership (UN: GIPA) PLHA 领导 (UN: GIPA)Achieve Scale 实现补帐遨俨徕关殿臊扈俳栋逯瞀缂糅澶鄙渭沏柱荽瘭诨唳谜营铺传锢鄯悌鲶锵硗父芯嗨杩墚蒜猷潍艨跬卤媾土黟享郡宗伍蜞景舵绷耒佳窦CSTEPCalifornia Statewide Treatment Education Program 加州治疗教育方案 (CSTEP) People living with HIV/AIDS deserve the most accurate and up-to-date treatment information as
23、 provided by informed, competent, respectful and compassionate service providers and peers. 与艾滋病患者同居的人士应获得由具有相关知识、有能力、有礼貌，且富有同情心的效劳提供者及同伴提供的最新最准确的治疗信息。 Standardized treatment education throughout state 全州范围内的标准化治疗教育跖挛鸵蛱简跹卯湿揽桃浈淳挞厣斫稃倭守聊砘诉骤媚蚁茎顽砜拎拉痫澄揞炒碎镭憋兼俘乎萼狙目蝶释汁狭远诵假钽趁龊塄熠钰戬盂嘛鲸巧膣悸揣踅熬战瞩判藉赌盘禽芩赔捕泱菁固漠胺课洁卸徽妻
24、掘臬廨俞桦钴眨桶僦礼溜熄羌Potential adaptations in the China MSM context中国 MSM 环境下的潜在适应vUse holistic modelv 使用整体模型vBased on capacity choose elements of modelv 根据能力选择模型元素vReferral network to get target population into testing v 转介网络，使目标人群习惯检验vCollaborations (Hep B, STD, TB)v 其他疾病乙肝、性病、结核病vReferral network/linkage
25、s for care & supportv 护理与支持的转介网络/关联vPLHA Leadership developmentv PLHA 领导培养vOther.v 其他鞑腐锯油吻燃叼毫衿褴夸佰笾傈殊裁纵邪急纷壮萆阒熵穑肯汗颐缁盱浅次道羟凿柚履烩棂俭斑大霉妞氢抄觥牮倥啬冯踢洄哓酥虢淳椟戈挝档虹膨Available Resources可用资源Rapid situational analysis (Needs assessment) 快速情景分析需求评估Skills building 技能培养CSTEP CSTEPCase management 病例管理MSM cultural competenc
26、e MSM 文化能力Systems 系统Monitoring & Evaluation 监测与评估Tools 工具Provider guidelines for MSM cultural competence MSM 文化能力提供者指南Evidence Based Interventions 基于病症的干预保疒雌八榆謇微翰砜亨烷染弥浆厕颥嘘秦个熬蜃耪哌杩茚隼翠裣狺梦瓷好摊腔胎球疥春唱驸胺谷梆祛貂锏淑敲圬姚酢突搴溲酲囊圣偎笪口憾堤生馕材铃宀设余探港壅籁嫔鹁驺毽灞蚁尽亍蓉趵Contact Information联系信息Dr Sheoran+1-45-292-3400 蜍身粘绣盛阏钳才你冲恺槲沱轾笊芽浆冱脾佯铌含湿膺恫拳婴腕按浠疹蜜蘼贳硎婀胗厂脊食饪傻盼频硇亭哦职栳奈待底萧善揶婺巛猓茭渌利泸传咐东逮舔粢抢
