scholarly journals Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study

2020 ◽  
Author(s):  
Odala Sande ◽  
Doris Burtscher ◽  
Daneck Kathumba ◽  
Hannock Tweya ◽  
Sam Phiri ◽  
...  
Keyword(s):  
Care Delivery ◽  
Quality Care ◽  
Waiting Times ◽  
Physical Structure ◽  
Models Of Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Care Providers ◽  
Health Care Information ◽  
Community Based

Abstract Background Differentiated models of care (DMOC) are used to make antiretroviral therapy (ART) accessible to people living with HIV (PLHIV). In Malawi, Lighthouse Trust has piloted various DMOCs aimed at providing quality care while reducing personal and logistical barriers when accessing clinic-based healthcare. One of the approaches was community-based provision of ART by nurses to stable patients. Methods To explore how the nurse-led community ART programme (NCAP) is perceived, we interviewed eighteen purposively selected patients receiving ART through NCAP and the four nurses providing the community-based health care. Information obtained from them was complemented with observations by the study team. Interviews were recorded and transcribed. Data was analysed using manual coding and thematic analysis. Results Through the NCAP, patients were able to save money on transportation and the time it took them to travel to a health facility. Caseloads and waiting times were also reduced, which made patients more comfortable and gave nurses the time to conduct thorough consultations. Closer relationships were built between patients and care providers, creating a space for more open conversations (although this required care providers to set clear boundaries and stick to schedule). Patients’ nutritional needs and concerns related to stigma remain a concern, while operational issues affect the quality of the services provided in the community. Considerations for community-led healthcare programmes include the provision of transportation for care providers; the physical structure of community sites (in regard to private spaces); the timely consolidation of data collected in the field to a central database; and the need for care providers to cover multiple facility-based staff roles. Conclusions The patients interviewed in this study preferred the NCAP approach to the facility-based model of care because it saved them money on transport, reduced waiting-times, and allowed for a more thorough consultation, while continuing to provide quality HIV care. However, when considering a community-level DMOC approach, certain factors – including staff transportation and workload – must be taken into consideration and purposefully planned.

scholarly journals Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study

2020 ◽  
Author(s):  
Odala Sande ◽  
Doris Burtscher ◽  
Daneck Kathumba ◽  
Hannock Tweya ◽  
Sam Phiri ◽  
...  
Keyword(s):  
Care Delivery ◽  
Quality Care ◽  
Waiting Times ◽  
Physical Structure ◽  
Models Of Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Care Providers ◽  
Health Care Information ◽  
Community Based

Abstract Background Differentiated models of care (DMOC) are used to make antiretroviral therapy (ART) accessible to people living with HIV (PLHIV). In Malawi, Lighthouse Trust has piloted various DMOCs aimed at providing quality care while reducing personal and logistical barriers when accessing clinic-based healthcare. One of the approaches was community-based provision of ART by nurses to stable patients. Methods To explore how the nurse-led community ART programme (NCAP) is perceived, we interviewed eighteen purposively selected patients receiving ART through NCAP and the four nurses providing the community-based health care. Information obtained from them was complemented with observations by the study team. Interviews were recorded and transcribed. Data was analysed using manual coding and thematic analysis. Results Through the NCAP, patients were able to save money on transportation and the time it took them to travel to a health facility. Caseloads and waiting times were also reduced, which made patients more comfortable and gave nurses the time to conduct thorough consultations. Closer relationships were built between patients and care providers, creating a space for more open conversations (although this required care providers to set clear boundaries and stick to schedule). Patients’ nutritional needs and concerns related to stigma remain a concern, while operational issues affect the quality of the services provided in the community. Considerations for community-led healthcare programmes include the provision of transportation for care providers; the physical structure of community sites (in regard to private spaces); the timely consolidation of data collected in the field to a central database; and the need for care providers to cover multiple facility-based staff roles. Conclusions The patients interviewed in this study preferred the NCAP approach to the facility-based model of care because it saved them money on transport, reduced waiting-times, and allowed for a more thorough consultation, while continuing to provide quality HIV care. However, when considering a community-level DMOC approach, certain factors – including staff transportation and workload – must be taken into consideration and purposefully planned.

scholarly journals Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges

2020 ◽  
Author(s):  
Benedikt Christ ◽  
Janneke van Dijk ◽  
Marie Ballif ◽  
Talent Nyandoro ◽  
Martina L. Reichmuth ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Rural Areas ◽  
Fast Track ◽  
Care Delivery ◽  
Waiting Times ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Linear Regression Models ◽  
Travel Costs ◽  
Art Delivery

Introduction: The traditional “one-size-fits-all” model of HIV care whereby people living with HIV (PLWH) have regular individual clinical visits does not reflect the various preferences and needs of PLWH and stretches the capacity of health facilities (HFs). Little is known about the availability and the experience of differentiated HIV care delivery in the rural areas of Zimbabwe.Methods: We used a mixed-method approach to collect data from clients and providers at 26 HFs in Zimbabwe in 2019. We collected quantitative data about antiretroviral therapy (ART) delivery and time spent at the HF during a visit from one representative healthcare providers (HCP) and a stratified sample of PLWH at each HF. We performed semi-structured interviews among HCPs and focus group discussions (FGDs) among PLWH to collect information about the implementation of differentiated ART delivery (DART) models and their experience. We performed linear regression models to assess factors associated with the time spent in the HFs. We analyzed the interviews using an inductive approach. Transcripts were coded and constricted down to themes significant to the research objectives.Results: The majority (77%) of participating HFs offered at least one of the five DART models recommended in Zimbabwe: 13 (50%) offered community ART refill group (CARG), 1 (4%) club refill, 6 (23%) family refill, and 8 (31%) fast-track refill models. Mobile outreach was not available at any participating HF. In an unadjusted linear model, PLWH enrolled in the fast-track refill model spent 0.40 (95% confidence interval (CI): 0.15-0.56) less time at the HF than PLWH on routine care, whereas PLWH in the family refill model and delegated to go to the HF spent 2.63 (95% CI 1.42-4.88) more time at the HF during visit. Confidentiality and disclosure concerns were highlighted as the major barriers affecting the implementation of DART models, together with travel costs and waiting times. HCPs reported on the challenge of excessive workloads. Fast-track refill was perceived as the most adapted DART model to meet clients’ needs, followed by CARG and family refill.Conclusions: Confidentiality, travel costs and waiting times are key elements to consider in the implementation of differentiated care in rural Zimbabwe. More implementation research is needed to support the roll-out of differentiated HIV services in that region, especially DART models addressing the needs of PLWH. Our study supports the call for personalized care at ART programs in rural Africa.

scholarly journals Integrated community-based HIV and non-communicable disease care within microfinance groups in Kenya: study protocol for the Harambee cluster randomised trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042662
Author(s):  
Becky L. Genberg ◽  
Juddy Wachira ◽  
Jon A Steingrimsson ◽  
Sonak Pastakia ◽  
Dan N Tina Tran ◽  
...  
Keyword(s):  
Care Delivery ◽  
Communicable Disease ◽  
Clinical Care ◽  
Randomised Trial ◽  
Hiv Care ◽  
Cluster Randomised Trial ◽  
People Living With Hiv ◽  
Community Based ◽  
Cluster Randomised ◽  
Retention In Hiv Care

IntroductionIn Kenya, distance to health facilities, inefficient vertical care delivery and limited financial means are barriers to retention in HIV care. Furthermore, the increasing burden of non-communicable diseases (NCDs) among people living with HIV complicates chronic disease treatment and strains traditional care delivery models. Potential strategies for improving HIV/NCD treatment outcomes are differentiated care, community-based care and microfinance (MF).Methods and analysisWe will use a cluster randomised trial to evaluate integrated community-based (ICB) care incorporated into MF groups in medium and high HIV prevalence areas in western Kenya. We will conduct baseline assessments with n=900 HIV positive members of 40 existing MF groups. Group clusters will be randomised to receive either (1) ICB or (2) standard of care (SOC). The ICB intervention will include: (1) clinical care visits during MF group meetings inclusive of medical consultations, NCD management, distribution of antiretroviral therapy (ART) and NCD medications, and point-of-care laboratory testing; (2) peer support for ART adherence and (3) facility referrals as needed. MF groups randomised to SOC will receive regularly scheduled care at a health facility. Findings from the two trial arms will be compared with follow-up data from n=300 matched controls. The primary outcome will be VS at 18 months. Secondary outcomes will be retention in care, absolute mean change in systolic blood pressure and absolute mean change in HbA1c level at 18 months. We will use mediation analysis to evaluate mechanisms through which MF and ICB care impact outcomes and analyse incremental cost-effectiveness of the intervention in terms of cost per HIV suppressed person-time, cost per patient retained in care and cost per disability-adjusted life-year saved.Ethics and disseminationThe Moi University Institutional Research and Ethics Committee approved this study (IREC#0003054). We will share data via the Brown University Digital Repository and disseminate findings via publication.Trial registration numberNCT04417127.

scholarly journals “Breaking the Silence” to Improve Cancer Survivorship Care for First Nations Peoples

2018 ◽  
Vol 17 (1) ◽  
pp. 160940691877413
Author(s):  
Wendy Gifford ◽  
Roanne Thomas ◽  
Gwen Barton ◽  
Viviane Grandpierre ◽  
Ian D. Graham
Keyword(s):  
Health Care ◽  
First Nations ◽  
Cancer Survivorship ◽  
Health Care Providers ◽  
Large Scale ◽  
Care Delivery ◽  
Survivorship Care ◽  
Care Providers ◽  
Community Based ◽  
Knowledge To Action

There is a significant knowledge-to-action gap in cancer survivorship care for First Nations (FN) communities. To date, many approaches to survivorship have not been culturally responsive or community-based. This study is using an Indigenous knowledge translation (KT) approach to mobilize community-based knowledge about cancer survivorship into health-care programs. Our team includes health-care providers and cancer survivors from an FN community in Canada and an urban hospital that delivers Cancer Care Ontario’s Aboriginal Cancer Program. Together, we will study the knowledge-to-action process to inform future KT research with Indigenous peoples for improving health-care delivery and outcomes. The study will be conducted in settings where research relations and partnerships have been established through our parent study, The National Picture Project. The inclusion of community liaisons and the continued engagement of participants from our parent study will foster inclusiveness and far-reaching messaging. Knowledge about unique cancer survivorship needs co-created with FN people in the parent study will be mobilized to improve cancer follow-up care and to enhance quality of life. Findings will be used to plan a large-scale implementation study across Canada.

scholarly journals Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986821
Author(s):  
Claire E. Kendall ◽  
Janessa E. Porter ◽  
Esther S. Shoemaker ◽  
Rachel Seoyeon Kang ◽  
Michael Fitzgerald ◽  
...  
Keyword(s):  
At Risk ◽  
Primary Care Providers ◽  
Question Type ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Local Health ◽  
Care Providers ◽  
Patients At Risk ◽  
Survey Responses ◽  
Living With Hiv

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

scholarly journals Does Informatics Enable or Inhibit the Delivery of Patient-centred, Coordinated, and Quality-assured Care: a Delphi Study

2015 ◽  
Vol 24 (01) ◽  
pp. 22-29 ◽  
Author(s):  
H. Liyanage ◽  
S-T. Correa ◽  
C. Kuziemsky ◽  
A. L. Terry ◽  
S. de Lusignan
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Delphi Study ◽  
Care Delivery ◽  
Quality Care ◽  
Care Providers ◽  
Coordinated Care ◽  
International Panel ◽  
Other Information ◽  
Core Concepts

Summary Background: Primary care delivers patient-centred and coordinated care, which should be quality-assured. Much of family practice now routinely uses computerised medical record (CMR) systems, these systems being linked at varying levels to laboratories and other care providers. CMR systems have the potential to support care. Objective: To achieve a consensus among an international panel of health care professionals and informatics experts about the role of informatics in the delivery of patient-centred, coordinated, and quality-assured care.Method: The consensus building exercise involved 20 individuals, five general practitioners and 15 informatics academics, members of the International Medical Informatics Association Primary Care Informatics Working Group. A thematic analysis of the literature was carried out according to the defined themes. Results:The first round of the analysis developed 27 statements on how the CMR, or any other information system, including paper-based medical records, supports care delivery. Round 2 aimed at achieving a consensus about the statements of round one. Round 3 stated that there was an agreement on informatics principles and structures that should be put in place. However, there was a disagreement about the processes involved in the implementation, and about the clinical interaction with the systems after the implementation. Conclusions: The panel had a strong agreement about the core concepts and structures that should be put in place to support high quality care. However, this agreement evaporated over statements related to implementation. These findings reflect literature and personal experiences: whilst there is consensus about how informatics structures and processes support good quality care, implementation is difficult.

scholarly journals Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Odala Sande ◽  
Doris Burtscher ◽  
Daneck Kathumba ◽  
Hannock Tweya ◽  
Sam Phiri ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Care Delivery ◽  
Hiv Care ◽  
Community Based

scholarly journals Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind

2020 ◽  
Vol 17 (5) ◽  
pp. 458-466
Author(s):  
Anna Grimsrud ◽  
Lynne Wilkinson ◽  
Ingrid Eshun-Wilson ◽  
Charles Holmes ◽  
Izukanji Sikazwe ◽  
...  
Keyword(s):  
Quality Care ◽  
Treatment Interruption ◽  
Patient Choice ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Engagement In Care ◽  
Hiv Status ◽  
Hiv Care Cascade ◽  
Left Behind ◽  
Living With Hiv

Abstract Purpose of Review Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. Recent Findings There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. Summary There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.

scholarly journals Collaborative TB/HIV activities in the European Region

2020 ◽  
pp. 00721-2020
Author(s):  
Gerard de Vries ◽  
Sarah van de Berg ◽  
Anke van Dam ◽  
Sayohat Hasanova ◽  
Manish Pareek ◽  
...  
Keyword(s):  
World Health Organisation ◽  
Models Of Care ◽  
World Health ◽  
Hiv Care ◽  
European Region ◽  
People Living With Hiv ◽  
Hiv Services ◽  
Ltbi Screening ◽  
Selective Approach ◽  
Latent Tb Infection

IntroductionAn estimated 12% of tuberculosis (TB) patients are coinfected with HIV in the World Health Organisation European Region (Region). Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with integrated people-centred models of care.MethodsWe collected information on the current models of integration of TB and HIV services in the Region via a comprehensive survey among the TB and HIV National Focal Points, and identified challenges and opportunities.ResultsForty-seven of 55 countries (85%) responded. HIV testing in all TB patients and screening for active TB in all people living with HIV (PLHIV) was recommended in 40 (85%) and 34 (72%) respectively. Thirty countries (64%) recommended latent TB infection (LTBI) screening in all PLHIV, while 13 (28%) had a selective approach and 4 countries (9%) did not recommend LTBI screening. In most countries testing for HIV and screening for active TB and LTBI was done by the specialist that is treating the patient, i.e. TB patients were tested for HIV by a TB specialist in 42 countries (89%) and PLHIV were screened for active TB by an HIV specialist in 34 countries (72%).ConclusionTB and HIV care are well integrated in policies of especially high TB and high HIV burden countries. Implementation though needs to be improved. Continuous monitoring of HIV and TB services integration enables assessing the quality of HIV/TB care and to identify where further improvements are needed.

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