Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework

BMC Health Services Research

Research Article

Jonathan Euvrard¹  Catherine Orrell²  K . Rivet Amico³  Claire M. Keene⁴  Ayesha Ragunathan⁴  Jacob McKnight⁴  Mike English⁴ 

[1] Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA;Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK;

关键词: Adherence;    Antiretroviral therapy;    Engagement;    HIV care continuum;    Retention;    Self-management;   

DOI  :  10.1186/s12913-023-09433-4

 received in 2022-08-12, accepted in 2023-04-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAs the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, ‘engagement’ is a complex concept and ambiguous definitions limit its evaluation. To guide engagement evaluation and development of interventions to improve HIV outcomes, we sought to identify critical, measurable dimensions of engagement with HIV care for people on treatment from a health service-delivery perspective.MethodsWe used a pragmatic, iterative approach to develop a framework, combining insights from researcher experience, a narrative literature review, framework mapping, expert stakeholder input and a formal scoping review of engagement measures. These inputs helped to refine the inclusion and definition of important elements of engagement behaviour that could be evaluated by the health system.ResultsThe final framework presents engagement with HIV care as a dynamic behaviour that people practice rather than an individual characteristic or permanent state, so that people can be variably engaged at different points in their treatment journey. Engagement with HIV care for those on treatment is represented by three measurable dimensions: ‘retention’ (interaction with health services), ‘adherence’ (pill-taking behaviour), and ‘active self-management’ (ownership and self-management of care). Engagement is the product of wider contextual, health system and personal factors, and engagement in all dimensions facilitates successful treatment outcomes, such as virologic suppression and good health. While retention and adherence together may lead to treatment success at a particular point, this framework hypothesises that active self-management sustains treatment success over time. Thus, evaluation of all three core dimensions is crucial to realise the individual, societal and public health benefits of antiretroviral treatment programmes.ConclusionsThis framework distils a complex concept into three core, measurable dimensions critical for the maintenance of engagement. It characterises elements that the system might assess to evaluate engagement more comprehensively at individual and programmatic levels, and suggests that active self-management is an important consideration to support lifelong optimal engagement. This framework could be helpful in practice to guide the development of more nuanced interventions that improve long-term treatment success and help maintain momentum in controlling a changing epidemic.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

41116_2023_36_Article_IEq70.gif

40517_2023_256_Article_IEq11.gif

Fig. 3