Advertisement

AIDS and Behavior

, Volume 23, Issue 4, pp 947–956 | Cite as

HIV Standard of Care for ART Adherence and Retention in Care Among HIV Medical Care Providers Across Four CNICS Clinics in the US

  • Sarah Shaw
  • Riddhi Modi
  • Michael Mugavero
  • Carol Golin
  • Evelyn Byrd Quinlivan
  • Laramie R. Smith
  • Katya Roytburd
  • Heidi Crane
  • Jeanne Keruly
  • Anne Zinski
  • K. Rivet AmicoEmail author
Original Paper

Abstract

Despite the issuance of evidence-based and evidence—informed guidelines to improve engagement in HIV care and adherence-related outcomes, few studies have assessed contemporary adherence or engagement support practices of HIV care providers in US clinics. As a result, the standard of HIV care in the US and globally remains poorly understood. This programmatic assessment approach aimed to identify the strengths and gaps in the current standard of HIV care from the perspective of HIV care providers. A self-administered Standard of Care measure was developed and delivered through Qualtrics to HIV care providers at four different HIV care sites as a part of a multisite intervention study to improve engagement in HIV care and ART adherence. Providers were asked to provide demographic and clinic specific information, identify practices/strategies applied during typical initial visits with HIV-positive patients and visits prior to and at ART initiation, as well as their perceptions of patient behaviors and adequacy of HIV care services at their clinics. Of the 75 surveys which were completed, the majority of respondents were physicians, and on average, providers have worked in HIV care for 13.5 years. Across the sites, 91% of the providers’ patient panels consist of HIV-positive patients, the majority of whom are virally suppressed and 1/5 are considered “out of care.” Few resources were routinely available to providers by other staff related to monitoring patient adherence and engagement in care. During typical initial visits with HIV positive patients, the majority of providers report discussing topics focused on behavioral/life contexts such as sexual partnerships, sexual orientation, disclosure, and other sources of social support. Nearly all providers emphasize the importance of adherence to treatment recommendations and nearly 90% discuss outcomes of good adherence and managing common side effects during ART start visits. Overall, providers do not report often implementing practices to improve retention in care. Survey results point to opportunities to enhance engagement in HIV care and improve ART adherence through systematic data monitoring and increased collaboration across providers and other clinic staff, specifically when identifying patients defined as “in need” or “out of care.” Trial Registration: Clinicaltrials.gov NCT01900236.

Keywords

HIV Standard of care Engagement in care ART adherence Retention 

Resumen

A pesar de la publicación de pautas basadas en la evidencia y basadas en la evidencia para mejorar la participación en la atención del VIH y los resultados relacionados con la adherencia, pocos estudios han evaluado la adherencia contemporánea o las prácticas de apoyo a la participación de los proveedores de atención del VIH en las clínicas de los Estados Unidos. Como resultado, el nivel de atención del VIH en los Estados Unidos y en todo el mundo sigue siendo poco conocido. Métodos: se desarrolló una medida estándar de cuidado autoadministrada a través de Qualtrics a proveedores de atención del VIH en cuatro sitios diferentes de atención del VIH como parte de un estudio de intervención multisitio para mejorar la participación en la atención del VIH y la adherencia al tratamiento antirretroviral. Se solicitó a los proveedores que proporcionen información demográfica y clínica específica, identifiquen las prácticas/estrategias aplicadas durante las visitas iniciales típicas con pacientes con VIH y las visitas antes y durante el inicio del tratamiento antirretroviral, así como sus percepciones de los comportamientos de los pacientes y la adecuación de los servicios de atención del VIH en su clinicas. de las 75 encuestas que se completaron, la mayoría de los encuestados eran médicos y, en promedio, los proveedores han trabajado en la atención del VIH durante 13.5 años. En todos los sitios, el 91% de los paneles de pacientes de los proveedores están conformados por pacientes VIH positivos, la mayoría de los cuales se suprimen de forma viral y 1/5 se consideran “fuera de la atención”. Pocos recursos estaban rutinariamente disponibles para los proveedores por otro personal relacionado con Monitorear la adherencia del paciente y el compromiso en la atención. Durante las visitas iniciales típicas con pacientes VIH positivos, la mayoría de los proveedores informan sobre temas relacionados con el comportamiento/contextos de vida, como las relaciones sexuales, la orientación sexual, la divulgación y otras fuentes de apoyo social. Casi todos los proveedores enfatizan la importancia de la adhesión a las recomendaciones de tratamiento y casi el 90% discute los resultados de una buena adherencia y el manejo de los efectos secundarios comunes durante las visitas iniciales de ART. En general, los proveedores no informan a menudo la implementación de prácticas para mejorar la retención en la atención. los resultados de la encuesta apuntan a oportunidades para mejorar la participación en la atención del VIH y mejorar la adherencia al tratamiento antirretroviral mediante el monitoreo sistemático de los datos y una mayor colaboración entre los proveedores y otro personal clínico, específicamente al identificar a los pacientes definidos como “necesitados” o “fuera de la atención”.

Notes

Funding

NIAID R01-AI-103661 (PI: Mugavero); K01 DA039767 (Laramie Smith).

Compliance with Ethical Standards

Conflict of interest

Authors had no conflicts of interest with the work presented.

Ethical Approval

All procedures were in accordance with the ethical standards of the UAB and participating site IRBs and with the 1964 Helsinki declaration and its later amendments and comparable ethical standards. All participants provided consent prior to completing the survey questions.

Supplementary material

10461_2018_2320_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 20 kb)

References

  1. 1.
    UNAIDS. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. 2014. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Accessed 2 Dec 2015.
  2. 2.
    Organization WH. 20162021 Global Health Sector Strategies for HIV, Viral Hepatitis and Sexually Transmitted Infections. 2015.Google Scholar
  3. 3.
    Mugavero MJ, Norton WE, Saag MS. Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care delivery system. Clin Infect Dis. 2011;52(Suppl 2):S238–46.CrossRefGoogle Scholar
  4. 4.
    Control CfD. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV. 2014.Google Scholar
  5. 5.
    Holtzman CW, Brady KA, Yehia BR. Retention in care and medication adherence: current challenges to antiretroviral therapy success. Drugs. 2015;75(5):445–54.CrossRefGoogle Scholar
  6. 6.
    U.S. Department of Health and Human Services HRaSA. Guide for HIV/AIDS Clinical Care. 2014. http://hab.hrsa.gov/deliverhivaidscare/2014guide.pdf. Accessed 23 Nov 2015.
  7. 7.
    Organization WH. Standards for quality HIV care: a tool for quality assessment, improvement, and accreditation. 2014.Google Scholar
  8. 8.
    Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817–33.CrossRefGoogle Scholar
  9. 9.
    Lippman SA, Koester KA, Amico KR, et al. Client and provider perspectives on new HIV prevention tools for MSM in the Americas. PLoS ONE. 2015;10(3):e0121044.CrossRefGoogle Scholar
  10. 10.
    Harman JJ, Amico KR, Johnson BT. Standard of care: promoting antiretroviral adherence in clinical care. AIDS Care. 2005;17(2):237–51.CrossRefGoogle Scholar
  11. 11.
    Amico KR. Standard of care for antiretroviral therapy adherence and retention in care from the perspective of care providers attending the 5th International Conference on HIV Treatment Adherence. J Int Assoc Phys AIDS Care. 2011;10(5):291–6.CrossRefGoogle Scholar
  12. 12.
    de Bruin M, Viechtbauer W, Hospers HJ, Schaalma HP, Kok G. Standard care quality determines treatment outcomes in control groups of HAART-adherence intervention studies: implications for the interpretation and comparison of intervention effects. Health Psychol: Off J Div Health Psychol, Am Psychol Assoc. 2009;28(6):668–74.CrossRefGoogle Scholar
  13. 13.
    Erlen JA, Tamres LK, Reynolds N, et al. Assessing usual care in clinical trials. Western J Nurs Res. 2015;37(3):288–98.CrossRefGoogle Scholar
  14. 14.
    Hu YW, Kinsler JJ, Sheng Z, Kang T, Bingham T, Frye DM. Using laboratory surveillance data to estimate engagement in care among persons living with HIV in Los Angeles County, 2009. AIDS Patient Care STDs. 2012;26(8):471–8.CrossRefGoogle Scholar
  15. 15.
    Herrmann S, McKinnon E, John M, et al. Evidence-based, multifactorial approach to addressing non-adherence to antiretroviral therapy and improving standards of care. Intern Med J. 2008;38(1):8–15.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sarah Shaw
    • 1
  • Riddhi Modi
    • 2
  • Michael Mugavero
    • 2
  • Carol Golin
    • 3
  • Evelyn Byrd Quinlivan
    • 3
    • 4
  • Laramie R. Smith
    • 5
  • Katya Roytburd
    • 3
  • Heidi Crane
    • 6
  • Jeanne Keruly
    • 7
  • Anne Zinski
    • 2
  • K. Rivet Amico
    • 1
    Email author
  1. 1.School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Division of Infectious Diseases, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.University of North Carolina at Chapel HillChapel HillUSA
  4. 4.AIDS Healthcare FoundationLithoniaUSA
  5. 5.School of MedicineUniversity of California San DiegoLa JollaUSA
  6. 6.Division of Allergy and Infectious Diseases, School of MedicineUniversity of WashingtonSeattleUSA
  7. 7.Johns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations