Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
J Int AIDS Soc. 2024 May;27(5):e26258. doi: 10.1002/jia2.26258.
Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient-provider interactions and how these interventions have improved HIV care continuum outcomes and person-reported outcomes (PROs) among people living with HIV in low- and middle-income countries.
We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs.
We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs.
Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression.
Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
以人为中心的护理（PCC）已被公认为提供优质和响应性卫生服务的关键要素。在多个模型中，将患者与提供者的关系概念化为 PCC 的核心，但在艾滋病毒护理中，这种关系在很大程度上仍未得到检验。我们进行了一项系统评价，以更好地了解为改善医患互动而实施的 PCC 干预措施的类型，以及这些干预措施如何改善中低收入国家艾滋病毒感染者的艾滋病毒护理连续体结果和患者报告的结果（PROs）。
我们搜索了数据库、会议记录，并进行了有针对性的手动搜索，以确定截至 2023 年 1 月发表的随机试验和观察性研究。PCC 搜索术语由 Scholl 的患者为中心综合模型指导。我们纳入了旨在增强医患互动的以人为中心的干预措施。我们纳入了艾滋病毒护理连续体结果和 PROs。
我们纳入了 28 项独特的研究：18 项（64.3%）为定量研究，8 项（28.6%）为混合方法研究，2 项（7.1%）为定性研究。在 PCC 患者-提供者干预措施中，我们归纳出五类 PCC 干预措施：（1）提供友好和欢迎的服务；（2）赋予患者权力和提高沟通技巧（例如，支持患者主导的技能，如健康素养和与提供者沟通的方法）；（3）改善个性化咨询和以患者为中心的沟通（例如，支持提供者技能，如动机性访谈培训）；（4）审计和反馈；（5）使提供者对患者的体验和身份敏感。在纳入的具有报告对照臂和效应大小的研究中，62.5%的研究报告称干预对至少一项艾滋病毒护理连续体结果有显著的积极影响，100%的研究报告称干预对至少一项纳入的 PRO 有积极影响。
在已发表的艾滋病毒 PCC 干预措施中，所解决的 PCC 组成部分、所涉及的行为者和预期结果存在异质性。虽然临床和 PROs 的结果也存在异质性，但在 PROs 方面有更多的证据表明有显著的改善。需要进一步的研究来更好地了解 PCC 的临床意义，因为较少的研究测量联系或长期保留或病毒抑制。
更好地理解 PCC 领域、机制和测量的一致性将推进 PCC 研究和实施。
