In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 5 ( 2021-5-10), p. e0250060-
Abstract:
To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for 〉 6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU). Methods The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann–Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM. Results In the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p 〈 0.0001, and 3.9 vs. 4.1, p 〈 0.05); 27 (90%) centers developed plans to sustain routine CCM. Conclusion Implementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers’ perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0250060
DOI:
10.1371/journal.pone.0250060.g001
DOI:
10.1371/journal.pone.0250060.g002
DOI:
10.1371/journal.pone.0250060.g003
DOI:
10.1371/journal.pone.0250060.g004
DOI:
10.1371/journal.pone.0250060.g005
DOI:
10.1371/journal.pone.0250060.t001
DOI:
10.1371/journal.pone.0250060.t002
DOI:
10.1371/journal.pone.0250060.t003
DOI:
10.1371/journal.pone.0250060.t004
DOI:
10.1371/journal.pone.0250060.t005
DOI:
10.1371/journal.pone.0250060.t006
DOI:
10.1371/journal.pone.0250060.t007
DOI:
10.1371/journal.pone.0250060.t008
DOI:
10.1371/journal.pone.0250060.s001
DOI:
10.1371/journal.pone.0250060.s002
DOI:
10.1371/journal.pone.0250060.r001
DOI:
10.1371/journal.pone.0250060.r002
DOI:
10.1371/journal.pone.0250060.r003
DOI:
10.1371/journal.pone.0250060.r004
DOI:
10.1371/journal.pone.0250060.r005
DOI:
10.1371/journal.pone.0250060.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2267670-3
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