The Perspective of HIV Providers in Western Kenya on Provider-Patient Relationships

Wachira, Juddy; Genberg, Becky L.; Kafu, Catherine; Koech, Beatrice; Akinyi, Jacqueline; Owino, Regina; Laws, M. Barton; Wilson, Ira B.; Braitstein, Paula

doi:10.1080/10810730.2018.1493061

Cited by 8 publications

(14 citation statements)

References 36 publications

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“…25 In addition, we assessed the following domains: sociodemographic characteristics, knowledge about HIV and HIV treatment, and medication self-efficacy (HIV Self-Efficacy). 26 The selection of these constructs was informed by our previous qualitative work 7,27 and were considered potential confounders of the relationship between PPC skills and patient satisfaction with care. Socio-demographic characteristics included age in years, sex (male vs female), years in HIV care and disclosed HIV status to anyone (yes vs no).…”

Section: Data Collection Instrumentsmentioning

confidence: 99%

Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care

Wachira

Mwangi

Chemutai

et al. 2021

J Int Assoc Provid AIDS Care

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Provider-patient communication (PPC) skills are key in promoting patient satisfaction. Our study examined the relationship between clinician PPC skills and patient satisfaction with care among virally unsuppressed adult HIV patients in Busia County, Kenya. This cross-sectional study was conducted among 360 HIV patients on first line antiretroviral regimen and having a recent viral load ≥400 copies HIV RNA/ml. We conducted logistic regression analysis. The mean age of participants was 48.2 years [standard deviation (SD): 12.05]. Overall, the mean score on clinician PPC skills was 33.3 (SD: 9.0). A high proportion (85%) of participants reported satisfaction with the HIV care services. After adjusting for covariates, the odds of being satisfied with care increased by 19% (adjusted odds ratio: 1.19, 95% CI: 1.11-1.30) for every one unit increase in the clinician PPC skills score. Promoting good PPC skills may be key to improving patient satisfaction with HIV care.

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Section: Data Collection Instrumentsmentioning

confidence: 99%

Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care

Wachira

Mwangi

Chemutai

et al. 2021

J Int Assoc Provid AIDS Care

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“… 26 A qualitative study conducted among HIV care providers in Kenya revealed that lack of adequate provider training and low system-level support were barriers to the adoption of patient-centered care. 29 Patients in this region may therefore be ready to communicate freely with their clinicians about the challenges they face with their care, and to partner with their clinicians to identify solutions. However, providers, and the health systems in general, may not yet be well prepared for this level of engagement from their patients, in part due to resource constraints.…”

Section: Discussionmentioning

confidence: 99%

“… 30 Patients clearly perceived that poor adherence negatively influenced clinicians’ views of patients’ engagement with care. 29 Patients also clearly expressed the desire that clinicians provide higher quality interpersonal care, such as being more welcoming, concerned with patients’ social wellbeing, and empathetic when patients experienced challenges with care. Providers who have a higher respect for their patients tend to engage in more rapport-building, social chitchat, and positive talk with their patients, thus promoting more patient-centeredness.…”

Section: Discussionmentioning

confidence: 99%

Experiences and expectations of patients living with HIV on their engagement with care in Western Kenya

Wachira¹,

Genberg²,

Kafu³

et al. 2018

PPA

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PurposeIn resource-limited HIV care settings, effective and innovative interventions that respond to the existing challenges along the HIV care continuum are urgently needed to realize the benefits of antiretroviral therapy (ART). Initiating effective ART adherence dialog in an environment that promotes patient engagement in care is key. It is therefore critical to enhance our understanding about how patients living with HIV in these regions conceptualize and experience patient engagement. This study explores HIV patients’ perceptions, experiences and expectations of their engagement in care.Materials and methodsWe sampled 86 patients from three Academic Model for Providing Access to Healthcare (AMPATHplus) sites, one urban and two rural. We conducted 24 in-depth interviews and eight focus group discussions in either Swahili or English. Audio recordings of the interviews were transcribed, and then translated into English. We performed content analysis after thematic coding.ResultsPatients living with HIV in Kenya desire active engagement with care. However, their engagement was inconsistent and varied depending on the provider. Patients had a sense of how provider’s interpersonal behaviors influenced their level of engagement. These included various aspects of provider–patient communication and relationship dynamics. Patients also highlighted relational boundaries that influenced the level and kind of information they shared with their providers. Aspects of their psychological, social or economic wellbeing were often viewed as personal and not discussed with their clinicians. Patients identified factors that would promote or impede their engagement with care including those related to patients themselves, providers, and the healthcare system.ConclusionPatients living with HIV desired more active engagement in their care. In addition, they desired clinicians to engage in more social behaviors to promote patient engagement. To address existing patient engagement barriers, HIV care systems in the region should apply contextualized patient-centered interventions.

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“…1,2 Yet, low levels of HIV linkage, adherence, and retention in care persist in sub-Saharan Africa 1 due to a number of individual-level, social-level, and system-level barriers along the continuum of care. [3][4][5][6][7][8][9] In Kenya, system-level barriers such as poor provider-patient dynamics, lack of continuity in care, high patient burden, and long clinic hours, among others, have been well documented. [6][7][8][9] Effective and innovative system-level interventions that respond to the challenges patients' experience with HIV care are therefore urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Impact of an Enhanced Patient Care Intervention on Viral Suppression Among Patients Living With HIV in Kenya

Wachira

Genberg

Mwangi

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Effective patient-centered interventions are needed to promote patient engagement in HIV care. We assessed the impact of a patient-centered intervention referred to as enhanced patient care (EPC) on viral suppression among unsuppressed patients living with HIV in Kenya.Setting:Two rural HIV clinics within the Academic Model Providing Access to Health care.Methods:This was a 6-month pilot randomized control trial. The EPC intervention incorporated continuity of clinician–patient relationships, enhanced treatment dialog, and improved patients' clinic appointment scheduling. Provider–patient communication training was offered to all clinicians in the intervention site. We targeted 360 virally unsuppressed patients: (1) 240 in the intervention site with 120 randomly assigned to provider–patient communication (PPC) training + EPC and 120 to PPC training + standard of care (SOC) and (2) 120 in the control site receiving SOC. Logistic regression analysis was applied using R (version 3.6.3).Results:A total of 328 patients were enrolled: 110 (92%) PPC training + EPC, 110 (92%) PPC training + SOC, and 108 (90%) SOC. Participants' mean age at baseline was 48 years (SD: 12.05 years). Viral suppression 6 months postintervention was 84.4% among those in PPC training + EPC, 83.7% in PPC training + SOC, and 64.4% in SOC (P ≤ 0.001). Compared with participants in PPC training + EPC, those in SOC had lower odds of being virally suppressed 6 months postintervention (odds ratio = 0.36, 95% confidence interval: 0.18 to 0.72).Conclusions:PPC training may have had the greatest impact on patient viral suppression. Hence, adequate training and effective PPC implementation strategies are needed.

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The Perspective of HIV Providers in Western Kenya on Provider-Patient Relationships

Cited by 8 publications

References 36 publications

Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care

Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care

Experiences and expectations of patients living with HIV on their engagement with care in Western Kenya

Impact of an Enhanced Patient Care Intervention on Viral Suppression Among Patients Living With HIV in Kenya

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