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.

Abstract

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

Professor Proochista Ariana elected to University Council

The IHTM family and friends would like to congratulate IHTM Course Director, Professor Proochista Ariana who has been elected to University Council.

Ethics and Governance PBL

IHTM students spent last week studying ethics and governance in public health programming (PHP) and global health research (GHR).

Studying the MSc IHTM 2022/23

MSc IHTM sets out to attract individuals from low resource contexts who are looking to gain the skills and experience to help shape global health in the future. This year 23 students make up the cohort bringing the running total over the eight years of the course to 175 students from 56 countries, the majority of which are LMICs.

A scoping review of antibiotic use practices and drivers of inappropriate antibiotic use in animal farms in WHO Southeast Asia region

Greco Mark Malijan (cohort 2020-21) co-authored this article on a scoping review of antibiotic use practices and drivers of inappropriate antibiotic use in animal farms in WHO Southeast Asia region.

Malaria PBL Presentations

Students gave interesting and engaging presentations on malaria as part of the first problem-based learning activity, PBL, of this term.

Malaria PBL Presentations

Students gave interesting and engaging presentations on malaria as part of the first problem-based learning activity, PBL, of this term.