Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Claire Keene (cohort 2016-17) co-authored this article on measuring patient engagement with HIV care in sub-Saharan Africa: a scoping study. The article was published in the Journal of the International AIDS Society October 2022.

A graphic showing influential factors, engagement behaviour, treatment outcomes and antiretroviral programme benefits.


Introduction: Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programme-level decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation.

Methods: We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders.

Results and discussion: We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions (“retention,” “adherence” and “active self-management”), a combination category (“multi-dimensional engagement”) and “treatment outcomes” category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients.

Conclusions: Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on “gold-standard” indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.

Access the whole article

Similar stories

IHTM placement preparations get underway

This week, the focus shifted to this year’s IHTM placements. Following the exam period, placements begin at the end of April and finish at the end of June with a 10,000-word dissertation based on the student's research completed by mid-August.

Evaluating the Impact of a Digital Hospital Information Management System on the Operational and Financial Performance of Health Facilities in Kenya

Christabel Ngwashi, IHTM 2021, co-authored this article, which was published in the International Journal of Health Sciences and Research Vol.13; Issue: 3; March 2023 Original Research Article ISSN: 2249-9571

IHTM alumna Yasangra Rabo-Adeniji discusses her work in Nigeria

Eight years since the MSc in IHTM began, our alumni are having a tangible global impact.

International Day of Women and Girls in Science 2023

For this year’s International Day of Women and Girls in Science on 11 February, we asked a few of the IHTM teaching team to reflect on their science careers and in particular their experience of working in global health.

IHTM 2023 Oxford Union Debate – Climate Change

The IHTM Oxford Union Debate has been a key fixture in the course’s calendar for many years. This year's debate on climate change proved lively and engaging.