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Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF's Welcome Service.
Arendse, Kirsten D; Walker, Caroline; Pfaff, Colin; Lebelo, Keitumetse; Cassidy, Tali; Isaakidis, Petros; von der Heyden, Erin; Abdullah, Fareed; Ellman, Tom; Katz, Ingrid T; Euvrard, Jonathan; Keene, Claire M.
Afiliação
  • Arendse KD; Médecins Sans Frontières, Cape Town, South Africa.
  • Walker C; Médecins Sans Frontières, Cape Town, South Africa.
  • Pfaff C; Médecins Sans Frontières, Cape Town, South Africa.
  • Lebelo K; Médecins Sans Frontières, Cape Town, South Africa.
  • Cassidy T; Médecins Sans Frontières, Cape Town, South Africa.
  • Isaakidis P; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
  • von der Heyden E; Médecins Sans Frontières, Cape Town, South Africa. petros.isaakidis@joburg.msf.org.
  • Abdullah F; Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. petros.isaakidis@joburg.msf.org.
  • Ellman T; Western Cape Department of Health, Cape Town, South Africa.
  • Katz IT; Office of AIDS and TB Research, South African Medical Research Council, Cape Town, South Africa.
  • Euvrard J; Department of Public Health Medicine, School of Public Health and Health Systems, University of Pretoria, Pretoria, South Africa.
  • Keene CM; Division of Infectious Diseases, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Sci Rep ; 14(1): 7317, 2024 03 27.
Article em En | MEDLINE | ID: mdl-38538754
ABSTRACT
Psychosocial challenges impact patients' ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs' understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Tuberculose / Infecções por HIV Limite: Humans País como assunto: Africa Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Tuberculose / Infecções por HIV Limite: Humans País como assunto: Africa Idioma: En Ano de publicação: 2024 Tipo de documento: Article