Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Department of Media Studies, School of Literature, Language and Media, University of Witwatersrand, Johannesburg, South Africa.
J Acquir Immune Defic Syndr. 2022 Aug 1;90(4):434-439. doi: 10.1097/QAI.0000000000002987.
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.
Two rural HIV clinics within the Academic Model Providing Access to Health care.
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).
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).
PPC training may have had the greatest impact on patient viral suppression. Hence, adequate training and effective PPC implementation strategies are needed.
需要有效的以患者为中心的干预措施来促进患者参与 HIV 护理。我们评估了一种称为增强患者护理（EPC）的以患者为中心的干预措施对肯尼亚未抑制 HIV 患者病毒抑制的影响。
学术医疗保健提供机构的两个农村 HIV 诊所。
这是一项为期 6 个月的试点随机对照试验。EPC 干预措施包括临床医生与患者关系的连续性、增强的治疗对话以及改善患者的诊所预约安排。为干预点的所有临床医生提供了医患沟通培训。我们针对 360 名未抑制病毒的患者：（1）干预点 240 名，其中 120 名随机分配到医患沟通（PPC）培训+EPC，120 名分配到 PPC 培训+标准护理（SOC），（2）对照点 120 名接受 SOC。使用 R（版本 3.6.3）进行逻辑回归分析。
共有 328 名患者入组：110 名（92%）接受 PPC 培训+EPC，110 名（92%）接受 PPC 培训+SOC，108 名（90%）接受 SOC。参与者的平均基线年龄为 48 岁（SD：12.05 岁）。干预后 6 个月病毒抑制率在 PPC 培训+EPC 组为 84.4%，在 PPC 培训+SOC 组为 83.7%，在 SOC 组为 64.4%（P≤0.001）。与接受 PPC 培训+EPC 的参与者相比，接受 SOC 的参与者在干预后 6 个月时病毒抑制的可能性较低（优势比=0.36，95%置信区间：0.18 至 0.72）。
PPC 培训可能对患者病毒抑制产生了最大的影响。因此，需要进行充分的培训和有效的 PPC 实施策略。
