Juddy Wachira1,2, Becky Genberg3, Ann Mwangi4,5, Diana Chemutai4, Paula Braitstein6, Omar Galarraga7, Abraham Siika8, Ira Wilson7. 1. Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya. 2. Department of Media Studies, School of Literature, Language and Media, University of Witwatersrand, Johannesburg, South Africa. 3. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 4. Academic Model Providing Access to Healthcare, Eldoret, Kenya. 5. Institute of Biomedical Informatics, College of Health Sciences, Moi University, Eldoret, Kenya. 6. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; and. 7. Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI. 8. Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Abstract
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.
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.
Authors: Cyrus Mugo; Kate Wilson; Anjuli D Wagner; Irene W Inwani; Kevin Means; David Bukusi; Jennifer Slyker; Grace John-Stewart; Barbra A Richardson; Margaret Nduati; Helen Moraa; Dalton Wamalwa; Pamela Kohler Journal: AIDS Care Date: 2019-02-27
Authors: Mary Catherine Beach; Debra L Roter; Somnath Saha; P Todd Korthuis; Susan Eggly; Jonathan Cohn; Victoria Sharp; Richard D Moore; Ira B Wilson Journal: Patient Educ Couns Date: 2015-05-21
Authors: Juddy Wachira; Becky Genberg; Catherine Kafu; Beatrice Koech; Jacqueline Akinyi; Regina K Owino; Michael Barton Laws; Ira B Wilson; Paula Braitstein Journal: J Health Commun Date: 2018-07-06
Authors: Juddy Wachira; Becky Genberg; Catherine Kafu; Paula Braitstein; Michael Barton Laws; Ira B Wilson Journal: Patient Prefer Adherence Date: 2018-08-01 Impact factor: 2.711
Authors: Panmial Priscilla Damulak; Suriani Ismail; Rosliza Abdul Manaf; Salmiah Mohd Said; Oche Agbaji Journal: Int J Environ Res Public Health Date: 2021-03-03 Impact factor: 3.390
Authors: T Sonia Boender; Kim C E Sigaloff; James H McMahon; Sasisopin Kiertiburanakul; Michael R Jordan; Jhoney Barcarolo; Nathan Ford; Tobias F Rinke de Wit; Silvia Bertagnolio Journal: Clin Infect Dis Date: 2015-07-08 Impact factor: 9.079
Authors: Matthew P Fox; Sydney Rosen; Pascal Geldsetzer; Till Bärnighausen; Eyerusalem Negussie; Rachel Beanland Journal: J Int AIDS Soc Date: 2016-08-08 Impact factor: 5.396
Authors: Thibaut Davy-Mendez; Varada Sarovar; Tory Levine-Hall; Alexandra N Lea; Stacy A Sterling; Felicia W Chi; Vanessa A Palzes; Mitchell N Luu; Jason A Flamm; C Bradley Hare; Emily C Williams; Kendall J Bryant; Constance M Weisner; Michael J Silverberg; Derek D Satre Journal: AIDS Behav Date: 2022-09-28