Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
University of Washington St. Louis, St. Louis, Missouri, USA.
J Int AIDS Soc. 2023 Jul;26 Suppl 1(Suppl 1):e26119. doi: 10.1002/jia2.26119.
Poor client-provider communication is a critical barrier to long-term retention in care among people living with HIV. However, standardized assessments of this key metric are limited in Africa. We used the Roter Interaction Analysis System (RIAS) to quantitatively characterize patterns of person-centred communication (PCC) behaviours in Zambia.
We enrolled pairs of people living with HIV making routine HIV follow-up visit and their providers at 24 Ministry of Health-facilities supported by the Centre for Infectious Disease Research in Zambia in Lusaka province between August 2019 and November 2021. Client-provider encounters were audio-recorded and coded using RIAS by trained research staff. We performed latent class analysis to identify interactions with distinctive patterns of provider PCC behaviours (i.e. rapport building, person-centred counselling, PCC micropractices [e.g. brief empathy statements], assessing barriers to care, shared decision-making and leveraging discretionary power) and compared their distribution across client, provider, interaction and facility characteristics.
We enrolled 478 people living with HIV and 139 providers (14% nurses, 73.6% clinical officers, 12.3% were medical officers). We identified four distinct profiles: (1) "Medically Oriented Interaction, Minimal PCC Behaviours" (47.6% of interactions) was characterized by medical discussion, minimal psychosocial/non-medical talk and low use of PCC behaviours; (2) "Balanced Medical/Non-medical Interaction, Low PCC Behaviours" (21.0%) was characterized by medical and non-medical discussion but limited use of other PCC behaviours; (3) "Medically Oriented Interaction, Good PCC Behaviours" (23.9%) was characterized by medically oriented discussion, more information-giving and increased use of PCC behaviours; and (4) "Highly person-centred Interaction" (7.5%) was characterized by both balanced medical/non-medical focus and the highest use of PCC behaviours. Nurse interactions were more likely to be characterized by more PCC behaviours (i.e. Class 3 or 4) (44.8%), followed by medical officers (33.9%) and clinical officers (27.3%) (p = 0.031). Longer interactions were also more likely to integrate more PCC behaviours (p < 0.001).
PCC behaviours are relatively uncommon in HIV care in Zambia, and often limited to brief rapport-building statements and PCC micropractices. Strengthening PCC, such as shared decision-making and leveraging discretionary power to better accommodate client needs and preferences, may be an important strategy for improving the quality in HIV treatment programmes.
医患沟通不畅是艾滋病毒感染者长期坚持护理的一个关键障碍。然而，在非洲，对这一关键指标的标准化评估是有限的。我们使用罗特互动分析系统（RIAS）来定量描述赞比亚的以患者为中心的沟通（PCC）行为模式。
我们招募了 2019 年 8 月至 2021 年 11 月在赞比亚卢萨卡省的 24 个卫生部支持的医疗机构中进行常规艾滋病毒随访的艾滋病毒感染者及其提供者，并对他们进行了配对。由经过培训的研究人员使用 RIAS 对患者-提供者的接触情况进行录音和编码。我们进行了潜在类别分析，以确定具有独特提供者 PCC 行为模式（即建立融洽关系、以患者为中心的咨询、PCC 微观实践[例如简短的同理心陈述]、评估护理障碍、共同决策和利用自由裁量权）的互动，并比较它们在患者、提供者、互动和设施特征方面的分布情况。
我们共招募了 478 名艾滋病毒感染者和 139 名提供者（14%的护士、73.6%的临床医生、12.3%的医生）。我们确定了四个不同的特征：（1）“以医学为导向的互动，以最低限度的 PCC 行为”（占 47.6%的互动）的特点是医学讨论、最低限度的心理社会/非医学谈话和低 PCC 行为使用；（2）“平衡的医学/非医学互动，低 PCC 行为”（21.0%）的特点是医学和非医学讨论，但其他 PCC 行为的使用有限；（3）“以医学为导向的互动，良好的 PCC 行为”（23.9%）的特点是医学导向的讨论，更多的信息提供和增加 PCC 行为的使用；（4）“高度以患者为中心的互动”（7.5%）的特点是兼顾平衡的医学/非医学焦点和最高的 PCC 行为使用。护士的互动更有可能以更多的 PCC 行为（即第 3 类或第 4 类）为特征（44.8%），其次是医生（33.9%）和临床医生（27.3%）（p = 0.031）。较长的互动也更有可能整合更多的 PCC 行为（p < 0.001）。
在赞比亚的艾滋病毒护理中，PCC 行为相对较少，通常仅限于简短的融洽关系建立陈述和 PCC 微观实践。加强 PCC，如共同决策和利用自由裁量权更好地满足患者的需求和偏好，可能是改善艾滋病毒治疗方案质量的一个重要策略。
