Impact of a Person-Centered Care Intervention on HIV Treatment Reengagement in Zambia

Background

Treatment interruptions (TIs) are significant challenges in sustaining effective HIV care and can result in adverse health outcomes. Poor interactions between clients and healthcare providers often exacerbate these interruptions, leading to a reluctance to return to care. Previous research indicated that implementing a person-centered care (PCC) intervention could enhance client experiences and retention in HIV care settings by improving healthcare worker behavior. This study aims to further evaluate the specific impacts of the PCC intervention on rates of return and sustained engagement in care after clients experience TIs.

Methods and Findings

This study was conducted across 24 clinics in Zambia through a stepped-wedge, cluster randomized trial framework from August 2019 to November 2021. Clinics were divided into four groups and transitioned from standard care to the PCC intervention every six months. The standard care provided routine HIV treatment without enhanced support from healthcare providers.

The PCC intervention included several components designed to enhance healthcare interactions:

1. Training and coaching for healthcare workers on PCC practices.
2. Systematic measurement and feedback concerning client experiences, collected through exit interviews.
3. Small facility-level incentives aimed at encouraging improvements in care quality.

We focused on individuals living with HIV who were more than 30 days late for their scheduled visits, categorizing their exposure to the intervention depending on their last appointment prior to the TI. An analysis of electronic health records was conducted to measure how the PCC intervention affected the following:

• The return rate to HIV care after experiencing a TI.
• The incidence of repeat TIs among those who returned to care.

During the study, a total of 128,910 clients (with 69,671 in the control group and 59,239 in the intervention group) experienced a TI. Key findings include:

• The PCC intervention increased the incidence of return after TIs after 12 months from 67.7% in the control group to 72.3% in the intervention group, representing a 4.6% increase with strong statistical significance (adjusted hazard ratio aHR of 1.16).
• Among those who returned to care, the intervention led to a significant reduction in repeat TIs, with 44.3% in the intervention group as opposed to 55.6% in the control group.
• In terms of ongoing care engagement, 82.7% of individuals in the PCC group remained in care (with or without repeat TIs), compared to 73.4% in the control group. Overall, the proportion of individuals in care 12 months after a TI rose from 51.5% in the control to 60.1% in the intervention group, further supporting the effectiveness of the PCC model.

Conclusions

Enhanced person-centered care interventions significantly improved the likelihood of clients returning to care after treatment interruptions and their ongoing engagement post-return. Focused strategies that emphasize caring interactions between healthcare workers and clients can greatly diminish barriers to reengagement, a vital aspect in addressing the challenges faced by individuals with a history of TIs. This study highlights the importance of investing in client-centered care environments to facilitate better health outcomes across various healthcare settings, particularly in low- and middle-income countries.

Author Summary

• TIs in HIV care are a persistent problem, often influenced by poor client-provider interactions.
• This study implements and evaluates a person-centered care (PCC) intervention, encompassing training for healthcare workers, feedback mechanisms for client experiences, and modest incentives at facility levels.
• Findings illustrate that the PCC intervention markedly increases both return rates after TIs and sustained engagement in care, underlining the importance of supportive healthcare environments which encourage client participation.
• These results are crucial in informing public health strategies aimed at reducing barriers to care and enhancing treatment continuity, applicable not only to HIV service delivery but broader health contexts as well.