Health Systems Collaborative, Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
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.
J Int AIDS Soc. 2022 Oct;25(10):e26025. doi: 10.1002/jia2.26025.
INTRODUCTION: Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programme-level decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. METHODS: We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. RESULTS AND DISCUSSION: We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. CONCLUSIONS: Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.
简介:与 HIV 护理的互动是一个多维度、动态的过程,对维持成功的治疗结果至关重要。然而,参与度的衡量标准既不标准化,也不全面。这阻碍了我们对参与度挑战范围的理解,以及干预措施是否产生影响,从而使患者和项目层面的决策复杂化。本研究旨在确定和描述可以用于评估接受抗逆转录病毒治疗的 HIV 护理的参与度的措施,以支持更一致和全面的评估。
方法:我们进行了一项范围研究,以系统地分类卫生系统可以用来评估接受抗逆转录病毒治疗的 HIV 护理的参与度的措施。使用关键词在文献数据库(Embase、PsychINFO、Ovid Global-Health、PubMed、Scopus、CINAHL、Cochrane 和世界卫生组织医学索引)、Google Scholar 和利益攸关方确定的文献中进行搜索,最终纳入了 2014 年至 2021 年期间在撒哈拉以南非洲发表的英文证据。提取、组织措施,然后与关键利益攸关方一起审查。
结果与讨论:我们筛选了 14885 篇标题/摘要,纳入了 118 篇全文,确定了 110 项参与度措施,分为三个参与维度(“保留”、“依从性”和“积极自我管理”)、一个组合类别(“多维参与”)和“治疗结果”类别(例如,病毒载量作为反映参与发生的最终结果)。保留反映了护理中的地位、就诊的连续性和就诊时间。依从性通过各种措施进行评估,分为主要措施(未开处方)和次要措施(未按指示服用药物)。积极的自我管理反映了参与护理和自我管理。确定了三个总体用例:用于提出建议的研究、用于质量改进的常规监测以及战略决策和评估个体患者。
结论:参与 HIV 护理的概念的异质性反映在广泛的确定措施和缺乏“黄金标准”指标的共识上。本研究根据参与度的维度将指标组织成五类;进一步的工作可以确定一套标准化的、最低限度的措施,用于不同用例的参与度的全面评估。在此期间,可以通过评估多个类别来推进参与度的衡量,以进行更全面的评估,使用常用措施进行敏感性分析以获得更可比的结果,并使用纵向措施来评估参与模式。这可以改善 HIV 护理的研究、项目评估和个体患者参与情况的细致评估。
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