摘要：The Enhancing Care Initiative of Puerto Rico assessed services available to people living with HIV/AIDS in the western region of Puerto Rico. Participants were 212 people living with HIV/AIDS and 116 employees from 6 agencies providing HIV/AIDS services in the region. Two main findings were that depression symptoms were present in 98.1% of people living with HIV/AIDS, and 7 of the 15 municipalities in the region did not provide any specific services to this population. Most urgent needs identified by people living with HIV/AIDS were economic support, housing, mental and psychological services, medicines, medical treatment, and transportation. The Enhancing Care Initiative provides an example of a successful multisectoral, multidimensional volunteer team effectively overcoming challenges while translating research into interventions to enhance HIV/AIDS care. THE ENHANCING CARE Initiative of Puerto Rico’s Western Region (ECI PR) was one of the 5 ECI projects around the world (Brazil, Puerto Rico, Senegal, South Africa, and Thailand). The projects were designed to systematically assess and enhance the care of people living with HIV/AIDS in resource-constrained settings. Like the work of other ECI project teams, ECI PR’s work occurred in 4 phases: (1) situation analysis, (2) research and planning, (3) implementation, and (4) evaluation. As a central component of the ECI framework, local AIDS care teams were formed to take advantage of each member’s expertise, and to encourage collaboration across sectors. 1 The ECI PR team used their experience and commitment to formulate 3 objectives: (1) to systematically assess the care of people living with HIV/AIDS in the western region of Puerto Rico, (2) to identify gaps in services, and (3) to facilitate concrete improvements, thereby enhancing the care of people living with HIV/AIDS, their families, their care-givers, and their friends. Multisectoral collaboration has been studied from many different perspectives. This approach has various names such as the partnership approach, 2 multidisciplinary health care team or multidisciplinary team, 3 – 4 community-based effort, 5 and multisectoral collaboration. 6 Regardless of the term, this approach addresses specific health care problems through collaboration within a multisectoral framework. The multisectoral approach to the HIV/AIDS epidemic has been defined as a response that involves “all sectors of society—governments, business, civil society organizations, communities and people living with HIV/AIDS at all levels … in addressing the causes and impact of the HIV/AIDS epidemic. Such a response requires action to engender political will, leadership and coordination, to develop and sustain new partnerships and ways of working, and strengthen the capacity of all sectors to make an effective contribution.” 6 (p2) A wide range of problems can be addressed with the multisectoral approach. These include HIV infection health care problems faced by Latinos, 5 , 7 – 9 assessment of community health services, 4 , 7 , 9 communication between patients and service providers, 5 primary health care reform, 3 quality of mental health care, 7 and rural health service delivery. 2 , 5 There is a growing trend among agencies and institutions providing services to recognize and promote the importance of working through partnerships or teams to improve the effectiveness of their specific endeavors.
