학술논문
Person-centred interventions to improve patient-provider relationships for HIV services in low- and middle-income countries: a systematic review.
Document Type
Academic Journal
Author
Beres LK; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Underwood A; Washington University in St. Louis School of Medicine, St Louis, Missouri, USA.; Le Tourneau N; Washington University in St. Louis School of Medicine, St Louis, Missouri, USA.; Kemp CG; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Kore G; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Yaeger L; Washington University in St. Louis School of Medicine, St Louis, Missouri, USA.; Li J; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Aaron A; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Keene C; Oxford University, Oxford, UK.; Mallela DP; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Khalifa BAA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Mody A; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Schwartz SR; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Baral S; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Mwamba C; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Sikombe K; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Eshun-Wilson I; Washington University in St. Louis School of Medicine, St Louis, Missouri, USA.; Geng EH; Washington University in St. Louis School of Medicine, St Louis, Missouri, USA.; Lavoie MC; Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Source
Publisher: John Wiley & Sons, Inc Country of Publication: Switzerland NLM ID: 101478566 Publication Model: Print Cited Medium: Internet ISSN: 1758-2652 (Electronic) Linking ISSN: 17582652 NLM ISO Abbreviation: J Int AIDS Soc Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient-provider interactions and how these interventions have improved HIV care continuum outcomes and person-reported outcomes (PROs) among people living with HIV in low- and middle-income countries.
Methods: We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs.
Results: We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs.
Discussion: Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression.
Conclusions: Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
(© 2024 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
Methods: We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs.
Results: We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs.
Discussion: Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression.
Conclusions: Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
(© 2024 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)