請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/42390
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 丁志音 | |
dc.contributor.author | Chu-Ming Chiou | en |
dc.contributor.author | 邱珠敏 | zh_TW |
dc.date.accessioned | 2021-06-15T01:13:01Z | - |
dc.date.available | 2011-09-16 | |
dc.date.copyright | 2009-09-16 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-07-29 | |
dc.identifier.citation | 中文部分
1. 衛生署疾病管制局:HIV/AIDS統計月報表。http://www.cdc.gov.tw/sp.asp?xdurl=disease/disease_content.asp&id=2215&mp=1&ctnode=1498#7。引用2009/6/4。 2. 洪健清等:愛滋病學第二版。台北:健康文化事業股份有限公司,2005。 3. 衛生署疾病管制局:愛滋病個案管理師計畫書。台北:衛生署疾病管制局。2007。 4. 柯乃熒、劉曉穎、賴霈妤、李欣純、柯文謙:HIV個案管理模式及其成效評估。 感染控制雜誌2006;16(4):237-45。 英文部分 1. Kalichman SC, Carey MP, Johnson BT. Prevention of sexually transmitted HIV infection:A meta-analytic review of the behavioral outcome literature.Ann Behav Med 1996;18(1):6-15. 2. Hung CC, Chang HJ, Chen MY, et al: The current state of human immunodeficiency virus infection and antiretroviral care in Taiwan.AIDS 2000;14:1669-71. 3. Twu SJ, Huang YF, Lai AC, et al: Update and Projection on HIV/AIDS in Taiwan. AIDS Edu Prev 2004;16: 53–63. 4. Yang CH , Yang SY , Shen MH, et al: The changing epidemiology of prevalent diagnosed HIV infections in Taiwan, 1984–2005. Int J Drug Policy 2008;19 :317–23. 5. Sowell RL, Meadows TM: An integrated case management model: Developing standards evaluation and outcome criteria.Nurs Adm Q 1994;18(2):53-64. 6. Baldwin S, Woods PA: Case management and needs assessment: Some issues of concern for the caring professions. J Men Health 1994;3: 311-322. 7. Rothman J: Guidelines for case management: Putting research to professional use. Itasca, IL: F.E.Peacock Publishers, Inc.1992. 8. Murphy R, Tobias C, Rajabium S, et al: HIV case management: A review of literature. Edited by Department of Public Health M: Boston University, School of Public Health;2003. 9. Orwin, RG, Sonnefeld, LJ,Garrison-Mogren R, et al: Pitfalls in evaluating the effectiveness of case management programs for homeless persons: Lessons from the NIAAA Community Demonstration Project. Evaluation Review1994;18:153-207. 10. Rubin A: Is case management effective for people with serious mental illness? A research review.Health Soc Work 1992;17:138-50. 11. Brennan JP, Kaplan C: Setting new standards for social work case management. Hosp a Community Psychiatry 1993;44:219-22. 12. Holloway F, Oliver N, Collins E: Case management: A critical review of the outcome literature. Eur Psychiatry 1995;10:113-28. 13. Rothman J: A model of case management: Toward empirically based practice. Soc Work 1991; 36: 520-28. 14. Thornicroft G:The concept of case management for long term mental illness. Int Rev Psychiol 1991;3:125-32. 15. Fleisher P, Henrickson M:Towards a typology of case management. Health Services and Resources Administration, HIV/AIS Bureau;2002. 16. Murphy R, Tobias C, Rajabium S, et al: HIVcase management: A review of literature. In Edited by Department of Public Health M: Boston University, School of Public Health ; 2003. 17. Mor V, Fleishman JA, Piette JD, et al: Developing AIDS Community Service Consortia Health Aff 1993;186-99. 18. Aday LA, Pounds MB, Marconi K, et al: A framework for evaluating the Ryan White CARE Act: Toward a CIRCLE of caring for persons with HIV/AIDS. AIDS and Pub Policy J 1994; 9:138-45. 19. USA.Health Resources and Services Administration(HRSA).The HIV/AIDS Program.Available at: http://www.hrsa.gov/ourStories/AIDS.shtm。Accessed June 3,2009. 20. USA CDC: HIV prevention case management: Literature review and current prctice. September 1997. Department of Health and Human Services. 1997. 21. USA CDC: HIV prevention case management: Guidance. September 1997. Department of Health and Human Services. 1997. 22. Piette J, Fleishman JA, Mor V, et al: A comparison of hospital and community case management programs for persons with AIDS. Med Care 1990;28:746-55. 23. USA CDC: HIV prevention through case management for HIV-infected persons--selected sites,United States, 1989-1992. MMWR 1993;42:448-9,455-6. 24. Sorensen JL, Dilley J, London J, et al: Case management for substance abusers with HIV/AIDS: a randomized clinical trial. Am J Drug Alcohol Abuse 2003;29:133-50. 25. Gasiorowicz M, Llanas MR, DiFranceisco W, et al: Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project.AIDS Edu Prev, 2005;17:40–52. 26. Gardner LI, Metsch LR, Anderson-Mahoney P, et al:Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS 2005;19(4):423-31. 27. Kushel MB, Colfax G, Ragland K, et al. Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection.Clin Infect Dis 2006;43(2 ):34-42. 28. Craw JA, Gardner LI, Marks G, et al:Brief strengths-based case management promotes entry into HIV medical Care. J Acquir Immune Defic Syndr 2008 ;47(25):597-606. 29. USA Virginia Department of Health: HIV/AIDS CaseManagement Standards.2007. 30. USA CDC: 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR 1992. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.html /。Accessed June 3, 2009. 31. Aidala AA, Lee G, Garbers S,et al:Sexual behaviors and sexual risk in a prospective cohort of HIV–positive men and women in New York city, 1994—2002:implications for prevention. AIDS Edu Prev2006; 18(1): 12–32. 32. Katz MH, Cunningham WE, Fleishman JA, et al: Effect of case management on unmet needs and utilization of medical care and medications among HIV-Infected persons. Am Coll of Physicians 2001;135(8) :557-65. 33. Dukers NH, Goudsmitb J, deWit JB, et al : Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS 2001; 15:369-378. 34. Janssen RS, Holtgrave DR, Valdiserri RO et al:The Serostatus Approach to Fighting theHIV Epidemic: Prevention strategies for infected individuals.Am J Public Health 2001;91(7):1019–24. 35. Purcell DW, DeGroff AS, Wolitski RJ : HIV Prevention Case Management: Current Practice and Future Directions. Health Soc Work 1998;23(4):282-9. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/42390 | - |
dc.description.abstract | 背景:自抗愛滋病毒藥物(highly active antiretroviral therapy; HAART)引進,免費提供給國內HIV感染者後,HIV感染者預期壽命逐年增加,伺機性感染之比率及死亡率顯著下降,但相對地卻也由於感染者健康狀況的改善,因此導致不安全性行為(如:未固定性伴侶、未戴保險套與他人發生性行為)及對HAART藥物服藥遵從性不佳等情形之發生,因而造成愛滋病毒傳播,形成人類嚴重之威脅;有鑒於此,疾病管制局於2005年10月開始進行愛滋病個案管理試辦計畫,並於2007年1月擴大實施該計畫。本研究主要目的為了解台灣的『愛滋病個案管理師計畫』的介入,對於HIV感染者在性行為、服藥遵從性及健康狀況等方面是否有所影響,如有影響其改變型態分布與趨勢變化結果,同時亦探討個管計畫成效與研究對象社會人口學特質及行為特性之相關性。
方法:本研究為評價研究(evaluation research),採取單組實驗設計方式,包含1次前測及2次後測,以2007年疾病管制局『愛滋病個案管理師計畫』資料庫為主要研究工具,並以2007年1月至12月加入疾病管制局『愛滋病個案管理師計畫』之連續就診3次(包含初診1次同時複診2次)且年滿15歲以上之HIV感染者為研究對象,研究方法除以群體層次分析方式,分別描述研究對象接受3次個管之不同行為面向及健康狀況面向整體結果分布外,並以個體層次分析方式,進行同一名個案接受3次個管前後行為及健康狀況變化之分析,最後則採多變量分析方式,藉以檢視個管計畫成效與研究對象個人特質(如:社會人口學及行為等)之相關性。 結果:研究結果發現研究對象經接受3次的個案管理後,在性行為、就醫行為、HAART服藥遵從及健康狀況等方面,均有正向之改善,且大部分的個案在初診及複診第1次之間的變化幅度較大,其中以性行為之「保險套的使用情形」變化最大,進步最為明顯,HIV感染者家人知情部分,改善情形則最少,顯示社會對於愛滋病的歧視及標籤化,很難單純經由個管計畫介入而獲得改善。此外,依多變量迴歸分析結果顯示,女性相較於男性、大學教育程度以上者相較於高中職教育程度者,以及異性間性行為者相較於同性及雙性間性行為者,於保險套使用行為之表現均較差,進一步研究結果亦發現,個案自覺健康狀況愈好且CD4值愈高,較容易發生性行為,個案自覺健康狀況愈差且CD4值愈低,則較不容易發生性行為。 結論:個案管理計畫的介入,使HIV感染者在行為及健康狀況等方面均有顯著且正向之改善,建議應加以推廣及宣導,讓更多HIV感染者早日加入個管計畫;而個管計畫的成效亦應進行更長期的評估及監測,以確保其成本效益;建議個管計畫未來應將醫院個案管理模式與其他社會資源服務及介入措施進行有效整合。 | zh_TW |
dc.description.abstract | Background: Since the highly active antiretroviral therapy (HAART) was introduced and freely provided for HIV infected persons, their lives have been prolonged, and the opportunistic infections and death rate are also significantly reduced accordingly. However, parallel to this improvement of health status has been the increase of unsafe sexual behaviors (e.g. lack of fixed sexual partners, and sex without condom) and poor adherence to HAART, which pose serious threat to further HIV transmission. In response to this newly emerged hazard, the HIV Case Management Program (HIVCMP) has been launched by Taiwan CDC since October, 2005, and was greatly extended on January 2007. The purpose of this study is to assess the effects of HIVCMP on sexual behaviors, adherence to HAART, and health status among HIV positive clients in Taiwan, and, if any, what are the patterns and distributions of changes in these regards? Furthermore, in what ways are clients’ sociodemographics and behavioral characteristics associated with the effects of HIVCMP.
Method: This evaluation research applies a one group experimental design with one pre-test and two post-tests. Data for the study comes from the database of 2007 CDC HIV Case Management Program. Only clients 15 years and older and have made three consecutive visits (one baseline and two regular visits) were included in the study. In addition to describe the distribution of different aspects of behavior and health status outcomes at the group level in each visit, the data analysis also present behavioral and health status changes at the individual level. Finally, multivariate analyses were conducted to examine which individual characteristics (sociodemographics and behavioral) associated significantly to the program effects. Results: The initial stage of HIVCMP has shown significant effects on clients’ sexual practices, medical care visits, HAART adherence, and health outcomes, and a sharp improvement was found from the baseline to the first regular visit in virtually all behavioral and health outcomes. “Condom use,” among participants who reported having engaged in sexual behavior, in particular, improved most drastically. “Disclosure of HIV status to family member,” however, was least improved, indicating a profound social discrimination attached to HIV/AIDS that is hard to be tackled with by HIVCMP. Multivariate analysis through regression indicated that female, college education and beyond, heterosexual performed poorer in behavior related to condom use. Further analysis also showed that self-reported better health status and higher CD4 counts tended to practice sex, as compared to those who perceived poor health status and had lower CD4 counts. Conclusion: The initial effects of HIVCMP on HIV clients’ behavior and health status were significant, supporting an extended outreach effort to recruit more HIV infected persons to participate. However, the effect should be monitored and assessed for a longer period of time to assure its sustainment and pursue cost-benefit as well. It is suggested that future HIV case management should be beyond medical model to integrate with other social services and interventions. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T01:13:01Z (GMT). No. of bitstreams: 1 ntu-98-P96845101-1.pdf: 649472 bytes, checksum: e140a1879750512b051475f572096b61 (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 封面……………………………………………………………………………………Ⅰ
口試委員審定書………………………………………………………………………Ⅱ 誌謝……………………………………………………………………………………Ⅲ 中文摘要………………………………………………………………………………Ⅳ 英文摘要………………………………………………………………………………VI 目錄……………………………………………………………………………………VIII 圖目錄…………………………………………………………………………………X 表目錄………………………………………………………………………………… XI 第一章 緒論…………………………………………………………………………1 第一節 研究背景……………………………………………………………………1 第二節 研究動機與重要性…………………………………………………………2 第三節 研究目的……………………………………………………………………3 第二章 文獻探討……………………………………………………………………4 第一節 什麼是個案管理……………………………………………………………4 第二節 愛滋病個案管理的源起及成效……………………………………………6 第三節 台灣愛滋病個案管理………………………………………………………11 第三章 研究方法……………………………………………………………………15 第一節 研究架構……………………………………………………………………15 第二節 研究假說……………………………………………………………………16 第三節 研究對象……………………………………………………………………16 第四節 研究工具……………………………………………………………………16 第五節 資料處理與分析……………………………………………………………19 第四章 研究結果……………………………………………………………………21 第一節 研究對象的特質……………………………………………………………21 第二節 研究變項分布………………………………………………………………22 第三節 研究變項雙變項分析………………………………………………………31 第四節 研究變項多變量分析………………………………………………………35 第五章 討論…………………………………………………………………………42 第一節 個管計畫介入結果…………………………………………………………42 第二節 性行為研究結果……………………………………………………………43 第三節 HAART服藥行為及就醫行為研究結果……………………………………45 第四節 自覺健康狀況研究結果……………………………………………………46 第五節 研究限制……………………………………………………………………46 第六章 結論與建議…………………………………………………………………48 第一節 結論…………………………………………………………………………48 第二節 建議…………………………………………………………………………49 參考文獻……………………………………………………………………………53 附錄1 相關研究結果表格…………………………………………………………57 附錄2 原始問卷個案管理紀錄表…………………………………………………84 個案管理紀錄表1(收案時填寫)………………………………………………84 個案管理紀錄表2(複診追蹤問卷)……………………………………………89 | |
dc.language.iso | zh-TW | |
dc.title | 「愛滋病個案管理師計畫」對於HIV感染者性行為、服藥遵從性及健康狀況的影響 | zh_TW |
dc.title | Effects of the HIV Case Management Program on Clients’ Sexual Behavior, Adherence to HAART, and Health Status | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 王永衛,蔡慈儀 | |
dc.subject.keyword | 愛滋病個案管理計畫,安全性行為,服藥遵從,CD4值,健康狀況,梅毒,家人支持, | zh_TW |
dc.subject.keyword | HIV case management program,safer sex,HAART adherence,CD4 counts,health status,syphilis,family support, | en |
dc.relation.page | 93 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2009-07-29 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 衛生政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-98-1.pdf 目前未授權公開取用 | 634.25 kB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。