Implementing enhanced patient care to promote patient engagement in HIV care in a rural setting in Kenya

BMC Health Services Research

Diana Chemutai¹  Juddy Wachira²  Becky Genberg³  Omar Galarraga⁴  Ira Wilson⁴  Siika Abraham⁵  Ann Mwangi⁶ 

[1] Academic Model Providing Access to Healthcare, Eldoret, Kenya;Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Social Behavioral Team, AMPATH, Moi University, P.O Box 4604-30100, Eldoret, Kenya;Department of Media Studies, School of Literature, Language and Media, University of Witwatersrand, Johannesburg, South Africa;Department of Epidemiology, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA;Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA;Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;Institute of Biomedical Informatics, College of Health Sciences, Moi University, Eldoret, Kenya;

关键词: Patient engagement;    Implementation;    Adaptation;    HIV care;   

DOI  :  10.1186/s12913-021-06538-6

来源: Springer

【 摘 要 】

BackgroundPatient engagement is effective in promoting adherence to HIV care. In an effort to promote patient-centered care, we implemented an enhanced patient care (EPC) intervention that addresses a combination of system-level barriers including provider training, continuity of clinician-patient relationship, enhanced treatment dialogue and better clinic scheduling. We describe the initial implementation of the EPC intervention in a rural HIV clinic in Kenya, and the factors that facilitated its implementation.MethodsThe intervention occurred in one of the rural Academic Model Providing Healthcare (AMPATHplus) health facilities in Busia County in the western region of Kenya. Both qualitative and quantitative data were collected through training and meeting proceedings/minutes, a patient tracking tool, treatment dialogue and a peer confirmation tool. Qualitative data were coded and emerging themes on the implementation and adaptation of the intervention were developed. Descriptive analysis including percentages and means were performed on the quantitative data.ResultsOur analysis identified four key factors that facilitated the implementation of this intervention. (1) The smooth integration of the intervention as part of care that was facilitated by provider training, biweekly meetings between the research and clinical team and having an intervention that promotes the health facility agenda. (2) Commitment of stakeholders including providers and patients to the intervention. (3) The adaptability of the intervention to the existing context while still maintaining fidelity to the intervention. (4) Embedding the intervention in a facility with adequate infrastructure to support its implementation.ConclusionsThis analysis demonstrates the value of using mixed methods approaches to study the implementation of an intervention. Our findings emphasize how critical local support, local infrastructure, and effective communication are to adapting a new intervention in a clinical care program.

【 授权许可】

CC BY