Patient-centered Care and Treatment in HIV Infection

Lanzafame, Massimiliano; Vento, Sandro

doi:10.1016/j.eclinm.2019.01.001

Cited by 7 publications

(10 citation statements)

References 7 publications

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“…Exploring adherence challenges and addressing these through patientcentered treatment plans may be a next step in further improving HIV viral suppression rates among mobile PWH who are engaged in care but remain nonsuppressed. 7 We did not observe a difference in viral suppression between participants who received the patient-centered intervention for mobile PWH versus standard care despite demonstrating a greater increase in viral suppression in the intervention compared with the control group from baseline to week 48 visit (5% increase from 80% to 85% vs. a 1% increase from 85% to 86%, respectively). We suspect that this finding may have been due to several factors.…”

Section: Discussioncontrasting

confidence: 56%

Randomized Trial of a “Dynamic Choice” Patient-Centered Care Intervention for Mobile Persons With HIV in East Africa

Ayieko,

Balzer,

Inviolata

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Persons with HIV (PWH) with high mobility face obstacles to HIV care engagement and viral suppression. We sought to understand whether a patient-centered intervention for mobile PWH would improve viral suppression and retention in care, and if so, which subgroups would benefit most. Methods: In a randomized trial, we evaluated the effect of an intervention designed to address barriers to care among mobile (≥2 weeks out of community in previous year) PWH with viral nonsuppression or recent missed visits in Kenya and Uganda (NCT04810650). The intervention included dynamic choice of a “travel pack” (emergency antiretroviral therapy [ART] supply, discrete ART packaging, and travel checklist), multimonth and offsite refills, facilitated transfer to out-of-community clinics, and hotline access to a mobility coordinator. The primary outcome was viral suppression (<400 copies/mL) at 48 weeks. Secondary outcomes included retention in care and ART possession. Results: From April 2021 to July 2022, 201 participants were enrolled and randomized (102 intervention, 99 control): 109 (54%) were female participants and 101 (50%) from Kenya; median age was 37 years (interquartile range: 29–43). At 48 weeks, there was no significant difference in viral suppression in intervention (85%) vs. control (86%). The intervention improved retention in care (risk ratio: 1.06[1.02–1.1]; P < 0.001) and ART possession (risk ratio: 1.07[1.03–1.11]; P < 0.001), with larger effect sizes among persons with baseline nonsuppression and high mobility (≥2 weeks out of community in previous 3 months). Conclusions: Mobile PWH-centered care should be considered for high-risk mobile populations, including nonsuppressed and highly mobile PWH, to improve retention in care and sustain viral suppression over time. Trial registration: NCT04810650.

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Section: Discussioncontrasting

confidence: 56%

Randomized Trial of a “Dynamic Choice” Patient-Centered Care Intervention for Mobile Persons With HIV in East Africa

Ayieko,

Balzer,

Inviolata

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…These findings indicate the importance of joint decisionmaking and patient-centered HIV care, concepts that ensure consensus between patients and providers on the approach to care, leading to improved health care utilization and treatment adherence. 58 Joint decision-making and patient-centered care requires that provider-patient communication is open, the needs of the patient are put first, and the care is tailored to the individual patient resulting in improved patient HIV-related outcomes. 51,58 In conclusion, our study attempted to advance knowledge on a complex issue regarding ethnoracial disparities in the patient-provider relationship among HIVpositive heterosexual men of color.…”

Section: Discussionmentioning

confidence: 99%

“…58 Joint decision-making and patient-centered care requires that provider-patient communication is open, the needs of the patient are put first, and the care is tailored to the individual patient resulting in improved patient HIV-related outcomes. 51,58 In conclusion, our study attempted to advance knowledge on a complex issue regarding ethnoracial disparities in the patient-provider relationship among HIVpositive heterosexual men of color. Greater understanding of the role of poor communication and mistrust in the HIV care continuum will help guide improvements in the quality of care and quality of life to reduce the health disparities among PLWHA with different ethnoracial backgrounds.…”

Section: Discussionmentioning

confidence: 99%

Association of Medical Mistrust and Poor Communication with HIV-Related Health Outcomes and Psychosocial Wellbeing Among Heterosexual Men Living with HIV

Zhang

McMahon

Leblanc

et al. 2020

AIDS Patient Care and STDs

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Studies have suggested that effective patient-provider relationships may reduce health disparities and foster engagement across the HIV care continuum among people living with HIV/AIDS. However, no studies have explored specific mechanisms between medical mistrust/poor communication and HIV-related/psychosocial health outcomes among HIV-positive men of color who have sex with women (MCSW) in the United States. From 2011 to 2012, the research team recruited 317 eligible participants in New York City. Using validated explanatory and predictive modeling strategies, we explored the associations between mistrust/poor communication and HIV-related/psychosocial health outcomes among this group. Subgroup analyses were further conducted to assess the different effects of non-Hispanic black and Hispanic men. A total of 313 males (204 black, 93 Hispanic, and 16 others) reported that valid responses were included in the current analysis. In the explanatory models, both mistrust and poor communication were negatively associated with various HIV-related and psychosocial outcomes among this group of HIV-positive MCSW. In the predictive models, predictors of mistrust for the overall sample and the black subsample were nearly the same. On the contrary, predictors of poor communication were substantially different when comparing black and Hispanic HIV-positive MCSW. Our findings confirm that patient-provider relationship quality is associated with poor HIV-related and psychosocial outcomes in black and Hispanic MCSW. A different set of multi-level predictors are associated with mistrust and poor communication comparing black and Hispanic MCSW. We call for interventions addressing patient-provider relationship quality that are tailored differently for black and Hispanic men.

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“…Evidence suggests that person-centred HIV treatment activities lead to improved health outcomes. Clients offered choices for ART collection demonstrated at least equal adherence, retention, and viral suppression (VS) outcomes as clients under a standard of care (SOC), and in some cases, significantly improved outcomes across the continuum while reducing gender disparity gaps [8][9][10]. Other activities characterised by PCC, such as offering adolescent-friendly HIV services, have demonstrated improvements in treatment adherence [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Systematic review: Development of a person‐centered care framework within the context of HIV treatment settings in sub‐Saharan Africa

Duffy

Madevu‐Matson

Posner

et al. 2022

Tropical Med Int Health

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Objectives: Person-centred care (PCC) meets the needs of individuals by increasing convenience, providing supportive and culturally appropriate services to diverse populations, and engaging families, communities, and stakeholders in planning and provision of care. While the evidence demonstrates that PCC approaches can lead to clinical improvements across the HIV care continuum, it is not yet well defined in the context of HIV service delivery. Methods: A systematic review was conducted to define PCC practices for HIV treatment services in health facilities in sub-Saharan Africa. Data synthesis led to the development of a PCC framework including domain and sub-domain development. The study team used the Effective Public Health Project Practice tool for quantitative studies to assess the quality of the included studies. Results: Thirty-one studies from 12 countries met the inclusion criteria, including 56,586 study participants (females 42%-100% and males 0%-58%), resulting in three major domains and 11 sub-domains. These include staffing (sub-domains of composition, availability, and competency); service delivery standards (sub-domains of client feedback mechanisms; service efficiency and integration; convenience and access; and digital health worker support tools); and direct client support services (sub-domains of psychosocial services, logistics support, client-agency, and digital client support tools). Twenty-five of the person-centred interventions within these domains resulted in improvements in linkage to care, treatment retention, and/or viral suppression. Conclusions: The PCC framework can help to provide a more consistent classification of HIV treatment interventions and will support improved assessment of these interventions to ensure that people receive personalised care. K E Y W O R D S client-centred care, HIV, HIV care continuum, HIV treatment, person-centred care, sub-

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Patient-centered Care and Treatment in HIV Infection

Abstract: In this issue of EclinicalMedicine, Diaco and colleagues describe a retrospective, secondary analysis of routinely collected data of 103 patients followed by two infectious diseases specialists in the HIV outpatient clinic of the

Cited by 7 publications

References 7 publications

Randomized Trial of a “Dynamic Choice” Patient-Centered Care Intervention for Mobile Persons With HIV in East Africa

Randomized Trial of a “Dynamic Choice” Patient-Centered Care Intervention for Mobile Persons With HIV in East Africa

Association of Medical Mistrust and Poor Communication with HIV-Related Health Outcomes and Psychosocial Wellbeing Among Heterosexual Men Living with HIV

Systematic review: Development of a person‐centered care framework within the context of HIV treatment settings in sub‐Saharan Africa

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