Between empathy and anger: healthcare workers’ perspectives on patient disengagement from antiretroviral treatment in Khayelitsha, South Africa - a qualitative study

Nhemachena, Tsephiso; Späth, Carmen; Arendse, Kirsten D; Lebelo, Keitumetse; Keene, Claire; Zokufa, Nompumelelo; Cassidy, Tali; Swartz, Alison

doi:10.21203/rs.3.rs-1658234/v1

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…Clinic appointment attendance has emerged as a strong predictor for longer term retention of ART clients since missed appointments can lead to a reluctance to return to care and ultimately result in disengagement from HIV treatment (7)(8)(9). Beyond the risk of disengagement from ART, when care recipients are late for, or miss their scheduled appointments, this may place additional pressure on already constrained clinic staff to trace and bring clients back to care, negatively affecting the quality-of-service delivery (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Effect of Behaviourally Informed Text Messages to Promote Retention in HIV Care: A Randomized Trial in Ekurhuleni District, South Africa

Govathson,

Pascoe,

Chetty-Makkan

et al. 2023

Preprint

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IntroductionSustained engagement in care among people living with HIV is vital for realising the individual and public health benefits of antiretroviral therapy (ART). We examined whether mobile phone-based text messages that leveraged behavioural science principles promoted timely clinic attendance among ART recipients.MethodsWe conducted a randomized controlled trial in three primary health clinics in Gauteng Province, South Africa between July 2021 and December 2021. ART recipients with an upcoming clinic appointment were randomised to standard of care appointment reminders or three enhanced reminders that leveraged behavioural science principles of loss aversion, social norms, and altruism. The primary outcome was a timely clinic visit, on or before the scheduled appointment day. Poisson regression with clinic fixed effects and controls for age, sex, and ART duration was used to examine the effect of the enhanced reminders on the primary outcome.ResultsAmong 1539 participants, 690 (44.8%) were male and median time on ART was 11 months (IQR, 3.7-51.9). The primary outcome of timely clinic visit was 50.3% in the standard of care arm, and similar in the loss aversion arm (53.5%; adjusted risk ratio, ARR 1.1; 95% CI: 0.9-1.2), social norms arm (48.0%; ARR 1.1; 95% CI: 0.8-1.1), and altruism arm (50.9% ARR 1.0; 95% CI: 0.9-1.5). In subgroup analyses, messages framed with loss aversion increased the timely clinic visits among participants with ART duration <90 days (ARR=1.37; 95% CI: 1.08-1.74).ConclusionsThe use of behavioural science principles to frame reminder messages did not increase timely clinic visits among HIV care recipients. Among those who recently initiated ART, however, loss aversion framing increased timely clinic visits. Future research should explore alternative behavioural science principles to revise health communication with HIV care recipients.Clinical Trials NumberNCT05010291

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Section: Introductionmentioning

confidence: 99%

Effect of Behaviourally Informed Text Messages to Promote Retention in HIV Care: A Randomized Trial in Ekurhuleni District, South Africa

Govathson,

Pascoe,

Chetty-Makkan

et al. 2023

Preprint

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Developing a male-specific counselling curriculum for HIV treatment in Malawi

Mphande¹,

Robson

Hubbard

et al. 2023

Preprint

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Men living with HIV in sub-Saharan Africa have sub-optimal engagement in antiretroviral therapy (ART) Programs. Generic ART counselling curriculum in Malawi does not meet men’s needs and should be tailored to men.We developed a male-specific ART counselling curriculum, adapted from the Malawi Ministry of Health (MOH) curriculum based on literature review of men’s needs and motivations for treatment. The curriculum was piloted through group counselling with men in 6 communities in Malawi, with focus group discussion (FGD) conducted immediately afterward (n=85 men) to assess knowledge of ART, motivators and barriers to care, and perceptions of the male-specific curriculum. Data were analysed in Atlas.ti using grounded theory. We conducted a half-day meeting with MOH and partner stakeholders to finalize the curriculum (n=5).The male-specific curriculum adapted three existing topics from generic counselling curriculum (status disclosure, treatment as prevention, and ART side effects) and added four new topics (how treatment contributes to men’s goals, feeling healthy on treatment, navigating health systems, and self-compassion for the cyclical nature of lifelong treatment. Key motivators for men were embedded throughout the curriculum and included: family wellbeing, having additional children, financially stability, and earning/keeping respect. During the pilot, men reported having little understanding of how ART contributed to their personal goals prior to the male-specific counselling. Men were most interested in additional information about treatment as prevention, benefits of disclosure/social support beyond their sexual partner, how to navigate health systems, and side effects with new regimens. Respondents stated that the male-specific counselling challenged the idea that men were incapable of overcoming treatment barriers and lifelong medication.Male-specific ART counselling curriculum is needed to address men’s specific needs. In Malawi context, topics should include: how treatment contributes to men’s goals, navigating health systems, self-compassion/patience for lifelong treatment, and taking treatment while healthy.

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Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi

Hubbard,

Mphande,

Robson

et al. 2024

bmjph

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IntroductionPerson-centred care (PCC) improves clinical outcomes for people living with HIV. Heterosexual men in sub-Saharan Africa are under-represented in HIV care, yet PCC interventions for men are lacking. We identified core components of a PCC intervention for men living with HIV (MLHIV) in Malawi from both client and healthcare worker (HCW) perspectives, as well as strategies for implementation in routine settings.MethodsMLHIV≥15 years and not in care were enrolled in parent randomised trials to test the impact of male-tailored HIV services on 6-month treatment outcomes (n=1303). Clients received a PCC package including male-specific counselling+facility ART distribution or outside-facility ART distribution. 50 male clients were recruited for qualitative in-depth interviews using stratified random sampling to assess perceptions of the PCC packages. Focus group discussions were conducted with HCWs who delivered the intervention to understand implementation strategies and potential considerations for scale-up in routine settings. Interviews were audio recorded, translated into English, transcribed and coded in Atlas.ti V.9 and analysed using thematic analysis.Results36 MLHIV and 20 HCWs (10 lay cadre and 10 nurses) were interviewed between February and July 2022. Positive interactions with HCWs—characterised by kindness, reciprocity, privacy and focused conversations—and compelling, relevant counselling were considered the most important components of male PCC. While outside-facility ART dispensing was considered helpful, it was not as critical as these other components. HCWs outlined five steps to implementing male PCC: begin with kindness, apologise for past negative interactions, understand men’s holistic story, provide tailored counselling and support development of strategies for adherence. HCWs believed that male PCC enhanced their ability to support male clients but emphasised the need to be integrated into routine services.DiscussionPCC strategies that foster positive HCW relationships and addresses men’s unique experiences are highly valued by MLHIV. HCWs identified several strategies for delivering PCC to MLHIV that may help close gaps in HIV care for men.Trial registration numbersNCT04858243;NCT05137210.

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Between empathy and anger: healthcare workers’ perspectives on patient disengagement from antiretroviral treatment in Khayelitsha, South Africa - a qualitative study

Cited by 3 publications

References 23 publications

Effect of Behaviourally Informed Text Messages to Promote Retention in HIV Care: A Randomized Trial in Ekurhuleni District, South Africa

Effect of Behaviourally Informed Text Messages to Promote Retention in HIV Care: A Randomized Trial in Ekurhuleni District, South Africa

Developing a male-specific counselling curriculum for HIV treatment in Malawi

Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi

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