Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol

Abstract

BackgroundA public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise curret provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US Government.Methods/DesignThis paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis.Aim 1) To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2) To determine patient health outcomes over time and principle cost drivers [Study Phase 2].The study objectives are as follows. 1) To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1) in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2) To conduct patient focus group discussions at each of these (Phase 1) to determine care received. 3) To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2). 4) To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2). 5) To undertake document analysis to appraise the clinical care procedures at each facility (Phase 2). 6) To determine principle cost drivers including staff, overhead and laboratory costs (Phase 2).DiscussionThis novel mixed methods protocol will permit transparent presentation of subsequent dataset results publication, and offers a substantive model of protocol design to measure and integrate key activities and outcomes that underpin a public health approach to disease management in a low-income setting.

Physical activity among HIV-positive patients receiving antiretroviral therapy in Hanoi and Nam Dinh, Vietnam: a cross-sectional study

“…Additionally, WHO, President’s Emergency Plan for AIDS Relief and Global Fund have proposed that social support should be considered as an effective adjunct in improving physical health among PLWH receiving ART treatment. 69 70 As PLWH were more vulnerable and withdrawn from social situations, 71 peer support can have a positive effect on patients’ health through sharing relevant personal experiences to acquire knowledge, reduce stigma and discrimination, improve physical functioning, and enhance retention in ART treatment. 72–74…”

Treatment outcomes in palliative care: the TOPCare study. A mixed methods phase III randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy

“…The data provided by this study will provide evidence to inform the provision of palliative care for people living with HIV and on ART, building on our previous work describing the palliative care problems of this group [8,10,24,46]. …”

“…The tool is sensitive to change and acceptable to patients, family and staff. Its brief nature makes it highly appropriate for use in a large-scale longitudinal study [46]. …”

Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: A cross-sectional survey with onsite verification

“…22,23 Lack of attention to the dimensions that directly assess the ability to implement simple protocols for effective care, and reduce unnecessary suffering, may undermine and diminish the gains brought by improved ART access. As part of a larger mixed-methods Public Health Evaluation of PEPFAR HIV care and support services in Kenya and Uganda, 24 this investigation aimed to determine within health facilities the availability, minimum stock levels and stock-out frequencies of drugs commonly required for the prevention and management of problems in people with HIV infection.…”