Compliance with laboratory monitoring guidelines in outpatient HIV care: a qualitative study in the Netherlands

Abstract

Evidence-based guidelines in HIV care aim to improve patients' health outcomes, quality of care, and cost-effectiveness. Laboratory monitoring plays an important role in assessing clinical status of patients and forms an integral part of HIV treatment guidelines. The Dutch HIV monitoring foundation (Stichting HIV Monitoring) previously observed variation between HIV treatment centres in the Netherlands in terms of compliance with guidelines for performing laboratory tests. Drawing on qualitative research methods, this article aims to describe factors that influence guideline compliance for laboratory monitoring in outpatient HIV care in the Netherlands. Twelve semi-structured in-depth interviews were conducted with a convenience sample of physicians from four HIV treatment centres. In general, physicians perceived laboratory guidelines as useful. However, unclear online visual representation of the guidelines, a lack of set reminders for tests, and assessment of patients' risk behaviour, which differs per patient, were identified as barriers to guideline compliance. The compartmentalisation of the Dutch healthcare system was viewed as hampering guideline compliance. A clinical-decision-support tool could possibly facilitate compliance with laboratory monitoring guidelines. Moreover, better alignment of HIV outpatient care, municipal health services and primary care, in terms of laboratory testing, could optimize efficiency, increase cost-effectiveness, and improve quality of HIV care.

Access to HIV Viral Load Testing and Antiretroviral Therapy Switch Practices: A Multicountry Prospective Cohort Study in Sub-Saharan Africa

“…More sophisticated, innovative, point-of-care or affordable technologies are often proposed as solutions to address diagnostic gaps in resource limited settings, and to improve individual patient and public health outcomes. Despite their initial promises, the implementation of diagnostic devices requires supportive systems such as rigorous quality assurance, robust systems for test demand, results' return and effective use, as well as efficient operation management 25 to ensure optimal clinical benefits and returns on investment. Our observations highlight the critical importance of appropriate treatment adherence monitoring and support, as an indispensable enabler of the clinical utility of HIV VL monitoring.…”

“…This requires systemstrengthening approaches 26 based on multidisciplinary, multistakeholder interventions, specifically coordinated to improve the implementation of VL testing for appropriate patient management. 25,27 The implementation of actionable data dashboards linked to treatment outcomes, adequate and supervised staff, continuous quality improvement at the laboratory/clinic interface and sufficient allocation of resources to conduct corrective actions at the site level are important and should be pursued concomitantly with data-informed laboratory system strengthening at the national level.…”

Acute hepatitis C infection among adults with HIV in the Netherlands: a capture-recapture analysis

“…This may, to some extent, be explained by centres applying a policy of targeted screening guided by the presence of incident transaminase elevations[27]. Furthermore, complimentary qualitative investigation has identified additional guideline, patient, physician, and environmental factors influencing the compliance to guidelines for laboratory monitoring in outpatient HIV care in the Netherlands[28]. At the RIVM, cases are reported through the local GGD, which receives case notifications from the diagnostic laboratories and physicians in or outside of HIV care.…”

Resilience factors contributing to healthcare professionals’ adaptive capacity with hospital standardization: a scoping review

“…Various attitudes and beliefs were reported in several studies as in uencing healthcare professionals' adaptive capacity or compliance to hospital standardization [29, 30, 34, 38, 42, 46, 48-49, 53, 56, 62-63, 70, 74, 76]. Some of these attitudes and beliefs were patient related [42,46,53,63,70,[75][76]. For example, in a study on the use of personal protective equipment in the emergency room during the COVID-19 pandemic, 46% of healthcare professionals believed that the equipment did not protect patients from COVID-19, while 52% believed that it was protective for patients [53].…”