Systematic review: Development of a person-centered care framework within the context of HIV treatment settings in sub-Saharan Africa.

OBJECTIVES: Person-centred care (PCC) meets the needs of individuals by increasing convenience, providing supportive and culturally appropriate services to diverse populations, and engaging families, communities, and stakeholders in planning and provision of care. While the evidence demonstrates that PCC approaches can lead to clinical improvements across the HIV care continuum, it is not yet well defined in the context of HIV service delivery. METHODS: A systematic review was conducted to define PCC practices for HIV treatment services in health facilities in sub-Saharan Africa. Data synthesis led to the development of a PCC framework including domain and sub-domain development. The study team used the Effective Public Health Project Practice tool for quantitative studies to assess the quality of the included studies. RESULTS: Thirty-one studies from 12 countries met the inclusion criteria, including 56,586 study participants (females 42%-100% and males 0%-58%), resulting in three major domains and 11 sub-domains. These include staffing (sub-domains of composition, availability, and competency); service delivery standards (sub-domains of client feedback mechanisms; service efficiency and integration; convenience and access; and digital health worker support tools); and direct client support services (sub-domains of psychosocial services, logistics support, client-agency, and digital client support tools). Twenty-five of the person-centred interventions within these domains resulted in improvements in linkage to care, treatment retention, and/or viral suppression. CONCLUSIONS: The PCC framework can help to provide a more consistent classification of HIV treatment interventions and will support improved assessment of these interventions to ensure that people receive personalised care.

'The person cutting the path does not know his trail is crooked'. Drawing lessons learned from people accessing antiretroviral treatment services to propose a person-centered care (PCC) minimum practice standard.

Introduction: Person-centered care (PCC) in HIV services aims to improve client experiences, advance service accessibility and treatment outcomes and accelerate progress towards epidemic control. For PCC to be responsive, providers and clients must work together to identify clients' priorities. However, providers often neglect to identify non-clinical client concerns and clients may feel inhibited due to language or unequal power dynamics.Methods: While evaluating results from a mixed-methods study on implementation of a Person-Centered Care Assessment Tool (PCC-AT) in Ghana, our study team identified contrasting perspectives from people on antiretroviral treatment (ART) and providers that elucidated the need for a PCC minimum practice standard. Our team examined qualitative data to propose a five step PCC minimum practice standard.Discussion: Because PCC is a broad concept, with scarce practical implementable information to support a framework for its operationalization, its consistent and accurate implementation is unlikely without the presence and utilization of a Minimum Practice Standard. Future research should identify aims and further elucidate quality standards within each component of the minimum PCC practice standard.

Do HIV provider and client perspectives align on person-centered care? Lessons learned from implementation of the Person-Centered Care Assessment Tool (PCC-AT) in HIV treatment settings in Ghana.

Person-centered care (PCC) is foundational to improve client's experiences in care while advancing HIV-related outcomes. However, information is scarce on how to assess PCC in HIV treatment settings. This study team developed the PCC assessment tool (PCC-AT) to assess the performance in HIV clinics in Ghana. The objectives of this study were to: (1) pilot the PCC-AT and assess scoring consistency and reliability among clients and providers; and (2) assess content validity of the PCC-AT through client key informant perspectives and experiences. An analysis of similarities and differences in PCC-AT domain scores between ART providers and clients was conducted to assess score reliability. Axial and open coding of transcripts using NVivo identified key themes. Findings indicate that the PCC framework aligns with client's priorities, additionally two out of the three PCC domain scores demonstrated consistency between ART providers and clients. Emerging differences in ART provider and client perspectives highlighted opportunities for growth and underscored the importance of continually gathering client feedback as an integral component of a PCC assessment to continually strengthen ART services.

Assessing the person-centered care framework and assessment tool (PCC-AT) in HIV treatment settings in Ghana: A pilot study protocol.

INTRODUCTION: Evidence suggests that person-centered care (PCC) has the potential to overcome inequities in access to HIV services, support quality care that is responsive to diverse needs while increasing efficiencies and resilience of the health system. Despite emerging evidence on the effectiveness of PCC, there is limited information available on how to assess it in diverse clinical settings. This work builds upon a systematic literature review published elsewhere by this study team to develop a PCC framework for HIV treatment service delivery. OBJECTIVES: The PCC framework informed the development of the PCC assessment tool (PCC-AT) to assess the degree to which PCC activities are operationalized in diverse HIV treatment settings. The study objectives are to assess: (1) content validity of the PCC framework; (2) PCC-AT score consistency and reliability between health facility staff and clients; and (3) PCC-AT feasibility in HIV treatment settings. METHODS: The study team will pilot the PCC-AT among staff in five health facilities and conduct subsequent focus group discussions (FGDs) to determine PCC-AT feasibility. Key informant interviews (KIIs) with clients will explore content validity among PLHIV relative to each subdomain of the PCC-AT and provide a basis to compare score concordance. Quantitative data among health facility staff will examine how many and which cadres participated in the PCC-AT pilot and FGD, years of experience, gender, and the time required to complete the PCC-AT. Information on clients will include total time accessing treatment at the study health facility, years since diagnosis, age and gender. Qualitative data analysis, using descriptive coding with NVivo or a similar software, will be drawn from transcripts from the PCC-AT pilots, FGDs and KIIs. DISCUSSION: PCC assessment is a novel approach that aims to help health facilities assess and strengthen their ability to deliver PCC services to improve client outcomes.

Staff perspectives on the feasibility of the person-centered care assessment tool (PCC-at) in HIV treatment settings in Ghana: a mixed-methods study.

Person-centered care (PCC) aims to improve client's experiences in HIV care while advancing outcomes. This study team developed the PCC assessment tool (PCC-AT) to assess PCC service performance in HIV treatment settings in Ghana. Study objectives aimed to describe the range of PCC-AT scores within and across study facilities and examine the feasibility of PCC-AT implementation in diverse HIV treatment settings. The PCC-AT was piloted at five health facilities providing HIV services among 37 staff. Immediately following each pilot, focus group discussions (FGDs) were conducted to gather feasibility data. Thematic qualitative analysis was conducted on translated FGD transcripts. Across facilities, providers scored highest in the staffing domain, followed by service provision, and direct client support. Time required to implement the PCC-AT averaged 62 minutes. Providers described the tool as well-structured, user-friendly, relevant, reflective of the core PCC delivery elements, and useful in elucidating actions to improve PCC service delivery across domains. The PCC-AT holds potential to strengthen activities that support clients' broader clinical, mental and psychosocial wellbeing by offering friendly services that attend to each client's holistic needs while contributing progress towards epidemic control.

Strengthening person-centered care through quality improvement: a mixed-methods study examining implementation of the Person-Centered Care Assessment Tool in Zambian health facilities.

INTRODUCTION: Person-centered care (PCC) is considered a fundamental approach to address clients' needs. There is a dearth of data on specific actions that HIV treatment providers identify as priorities to strengthen PCC. OBJECTIVE: This study team developed the Person-Centered Care Assessment Tool (PCC-AT), which measures PCC service delivery within HIV treatment settings. The PCC-AT, including subsequent group action planning, was implemented across 29 facilities in Zambia among 173 HIV treatment providers. Mixed-methods study objectives included: (1) identify types of PCC-strengthening activities prioritized based upon low and high PCC-AT scores; (2) identify common themes in PCC implementation challenges and action plan activities by low and high PCC-AT score; and (3) determine differences in priority actions by facility ART clinic volume or geographic type. METHODS: The study team conducted thematic analysis of action plan data and cross-tabulation queries to observe patterns across themes, PCC-AT scores, and key study variables. RESULTS: The qualitative analysis identified 39 themes across 29 action plans. A higher proportion of rural compared to urban facilities identified actions related to stigma and clients' rights training; accessibility of educational materials and gender-based violence training. A higher proportion of urban and peri-urban compared to rural facilities identified actions related to community-led monitoring. DISCUSSION: Findings provide a basis to understand common PCC weaknesses and activities providers perceive as opportunities to strengthen experiences in care. CONCLUSION: To effectively support clients across the care continuum, systematic assessment of PCC services, action planning, continuous quality improvement interventions and re-measurements may be an important approach.