Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach

Abstract

Objective To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU). Methods The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann–Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM. Results In the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p<0.0001, and 3.9 vs. 4.1, p<0.05); 27 (90%) centers developed plans to sustain routine CCM. Conclusion Implementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers’ perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.

Perfil da coorte de pessoas em tratamento da infecção por HIV no SUS, Brasil, 2015–2018

“…The service profile confirms the structural and performance heterogeneity pointed out in previous studies 6 . It highlights the insufficiency of quality management and monitoring, which particularly affects the identification and intervention of people who fail treatment and/or abandon treatment 28 , 29 and plays a crucial role in improving the overall performance of the care service 30 .…”

Improving Retention and HIV Viral Load Suppression among the Adolescents Living with HIV in TASO Soroti and TASO Mbale Centers of Excellence using Operation Triple Zero Model: A before and after study protocol

“…Similarly, RE-AIM was also applied in Mexico to identify barriers and facilitators of Pre-Exposure Prophylaxis (PrEP) among the men who have sex with men and transgender women [38]. Lastly, in Brazil, RE-AIM helped a team of researchers to evaluate the integration of the continuum of care monitoring (CCM) intervention [39]. Therefore, RE-AIM shall be used in both before and the after evaluation of the OTZ implementation.…”

Moving toward equity: fostering transdisciplinary research between the social and behavioral sciences and implementation science to end the HIV epidemic

“…Hybrid trials simultaneously evaluate intervention effectiveness and implementation [15], and have been underutilized in SBS HIV interventions [4 ▪▪ ] (see Table 2). We located several studies reporting results from type 1 [17,18], type 2 [19 ▪▪ ,20,21 ▪▪ ,22 ▪▪ ,23], and type 3 [24 ▪▪ ] trials. More hybrid trials with better reporting of IS TMFs are needed to successfully deliver HIV EBIs in real-world settings.…”

“…Addressing a key gap, several studies [21 ▪▪ ,22 ▪▪ ,24 ▪▪ ,41 ▪▪ ,59 ▪▪ ] mapped implementation strategies to the Expert Recommendations for Implementing Change, which established conceptual clarity for 73 strategies [55]. SBS interventions also evaluated implementation strategies using qualitative [22 ▪▪ ,24 ▪▪ ,41 ▪▪ ,59 ▪▪ ] and quantitative methods [19 ▪▪ ,40 ▪▪ ]. Gichane et al [22 ▪▪ ] and Garner et al [19 ▪▪ ] provide excellent examples of defining and specifying strategies.…”

“…For example, whereas some scholars used an IS framework to develop strategies [44 ▪▪ ,48 ▪▪ ], others did not [59 ▪▪ ,60–62]. Addressing a key gap, several studies [21 ▪▪ ,22 ▪▪ ,24 ▪▪ ,41 ▪▪ ,59 ▪▪ ] mapped implementation strategies to the Expert Recommendations for Implementing Change, which established conceptual clarity for 73 strategies [55]. SBS interventions also evaluated implementation strategies using qualitative [22 ▪▪ ,24 ▪▪ ,41 ▪▪ ,59 ▪▪ ] and quantitative methods [19 ▪▪ ,40 ▪▪ ].…”