Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach
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) individual...
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| Veröffentlicht in: | PloS one 2021-05, Vol.16 (5), p.e0250060-e0250060 |
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| creator | Loch, Ana Paula Rocha, Simone Queiroz Fonsi, Mylva de Magalhães Caraciolo, Joselita Maria Kalichman, Artur Olhovetchi de Alencar Souza, Rosa Gianna, Maria Clara Gonçalves, Alexandre Short, Duncan Pimenta, Shenia Liane Bagnola, Lea Wonhnrath Menuzzo, Carolina da Rocha Meireles, Zulmira Natividade Diz, Eunice Zajdenverg, Roberto Prudente, Isidoro Battistella Nemes, Maria Ines |
| description | 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).
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.
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 |
| doi_str_mv | 10.1371/journal.pone.0250060 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0250060</identifier><identifier>PMID: 33970914</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; AIDS ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Care and treatment ; CD4 antigen ; Continuum of care ; Diagnosis ; Epidemiology ; Funding ; Health care ; Health services ; HIV ; HIV infection ; Human immunodeficiency virus ; Load tests ; Management ; Medicine and Health Sciences ; Methods ; Monitoring ; Patient monitoring ; Patients ; People and places ; Public health ; Quality of service architectures ; Research and Analysis Methods ; Retention ; Service enhancement ; Supervision ; Telemedicine</subject><ispartof>PloS one, 2021-05, Vol.16 (5), p.e0250060-e0250060</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Loch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Loch et al 2021 Loch et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-281587f62b2ebb2dced03b6de03d546597eaf230c2e8427d52e1919642aad73a3</citedby><cites>FETCH-LOGICAL-c692t-281587f62b2ebb2dced03b6de03d546597eaf230c2e8427d52e1919642aad73a3</cites><orcidid>0000-0002-1725-4213</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109816/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109816/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33970914$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Isaakidis, Petros</contributor><creatorcontrib>Loch, Ana Paula</creatorcontrib><creatorcontrib>Rocha, Simone Queiroz</creatorcontrib><creatorcontrib>Fonsi, Mylva</creatorcontrib><creatorcontrib>de Magalhães Caraciolo, Joselita Maria</creatorcontrib><creatorcontrib>Kalichman, Artur Olhovetchi</creatorcontrib><creatorcontrib>de Alencar Souza, Rosa</creatorcontrib><creatorcontrib>Gianna, Maria Clara</creatorcontrib><creatorcontrib>Gonçalves, Alexandre</creatorcontrib><creatorcontrib>Short, Duncan</creatorcontrib><creatorcontrib>Pimenta, Shenia Liane</creatorcontrib><creatorcontrib>Bagnola, Lea</creatorcontrib><creatorcontrib>Wonhnrath Menuzzo, Carolina</creatorcontrib><creatorcontrib>da Rocha Meireles, Zulmira</creatorcontrib><creatorcontrib>Natividade Diz, Eunice</creatorcontrib><creatorcontrib>Zajdenverg, Roberto</creatorcontrib><creatorcontrib>Prudente, Isidoro</creatorcontrib><creatorcontrib>Battistella Nemes, Maria Ines</creatorcontrib><title>Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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).
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.
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.
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.</description><subject>Acquired immune deficiency syndrome</subject><subject>AIDS</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>CD4 antigen</subject><subject>Continuum of care</subject><subject>Diagnosis</subject><subject>Epidemiology</subject><subject>Funding</subject><subject>Health care</subject><subject>Health services</subject><subject>HIV</subject><subject>HIV infection</subject><subject>Human immunodeficiency virus</subject><subject>Load tests</subject><subject>Management</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Monitoring</subject><subject>Patient monitoring</subject><subject>Patients</subject><subject>People and places</subject><subject>Public health</subject><subject>Quality of service architectures</subject><subject>Research and Analysis Methods</subject><subject>Retention</subject><subject>Service 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Petros</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-05-10</date><risdate>2021</risdate><volume>16</volume><issue>5</issue><spage>e0250060</spage><epage>e0250060</epage><pages>e0250060-e0250060</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><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).
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33970914</pmid><doi>10.1371/journal.pone.0250060</doi><orcidid>https://orcid.org/0000-0002-1725-4213</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-05, Vol.16 (5), p.e0250060-e0250060 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2524841387 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome AIDS Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Care and treatment CD4 antigen Continuum of care Diagnosis Epidemiology Funding Health care Health services HIV HIV infection Human immunodeficiency virus Load tests Management Medicine and Health Sciences Methods Monitoring Patient monitoring Patients People and places Public health Quality of service architectures Research and Analysis Methods Retention Service enhancement Supervision Telemedicine |
| title | Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T14%3A53%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Improving%20the%20continuum%20of%20care%20monitoring%20in%20Brazilian%20HIV%20healthcare%20services:%20An%20implementation%20science%20approach&rft.jtitle=PloS%20one&rft.au=Loch,%20Ana%20Paula&rft.date=2021-05-10&rft.volume=16&rft.issue=5&rft.spage=e0250060&rft.epage=e0250060&rft.pages=e0250060-e0250060&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0250060&rft_dat=%3Cgale_plos_%3EA661372229%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2524841387&rft_id=info:pmid/33970914&rft_galeid=A661372229&rft_doaj_id=oai_doaj_org_article_45f5bc825dd0426a97161b04fc616031&rfr_iscdi=true |