Implementation and uptake of the Conexiones y Opciones en la Argentina intervention: feasibility and acceptability.

Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban health-care settings.

Improving Adherence to Care Among "Hard to Reach" HIV-Infected Patients in Argentina.

Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3-6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in "patient intervention only" improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among "hard to reach" patients.

Motivational Interviewing among HIV Health Care Providers: Challenges and Opportunities to Enhance Engagement and Retention in Care in Buenos Aires, Argentina.

In Argentina, providers' response to motivational interviewing (MI) to improve engagement and retention in care among challenging patients with HIV was evaluated. Twelve HIV care physicians participated, and their video recordings pre- and post-MI training were also obtained. One week post-training, 11 of the 12 participants were committed to using MI strategies during consult session. Of the 12 participants, 9 demonstrated appropriate utilization of MI techniques and change in HIV education provided during consultation (Z = -2.375, P = .018). Motivational interviewing appears to be a viable strategy to enhance engagement and retention in challenging HIV-positive patients.

Patient-provider perceptions on engagement in HIV care in Argentina.

Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient-provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.

Programa de Capacitación para Profesionales y Familias para Mejorar la Adherencia en Niños con Infección HIV / Training programme for professionals and families in order to improve compliance in children with HIV infection

Para que un programa de adherencia sea exitoso se requiere el trabajo conjunto del equipo de salud con los padres y los niños. El objetivo de este proyecto fue desarrollar un programa de capacitación dirigido a profesionales y familias para mejorar la adherencia al tratamiento en niños con infección HIV. Material y métodos: las actividades realizadas con los profesionales incluyeron talleres, cursos presenciales y a distancia; con las familias se realizaron talleres y reuniones con elaboración conjunta de materiales de capacitación. Los resultados esperados fueron la intensificación del trabajo interdisciplinario para profundizar los conocimientos y promover los cambios de actitudes y prácticas de los profesionales y las familias que participaban del programa. Resultados: se incorporaron 20 centros asistenciales de la Ciudad de Buenos Aires, Gran Buenos Aires y el resto del país. El 81% de los profesionales consideró que los talleres significaron un aporte importante para su aprendizaje y la atención de los pacientes. se trabajo con contenidos comunes en los módulos y se definieron factores protectores y de riesgo de las familias y los niños. Se analizaron percepciones y prácticas de las familias, lo que permitió pensar como impacta la prescripción del tratamiento en el proceso de autoatención de los pacientes, sus hipótesis y creencias y la presencia de las redes de sosten y acompañamiento. Conclusión: se pudo concretar la capacitación docente asistencial con efectos prácticos en el lugar de trabajo. es de remarcar la importancia de la recuperación de las prácticas que las familias realizan para poder sostener la adherencia al tratamiento