Implementation Science Scholar Award

There will be an expected 30 million people on ART worldwide by 2020 and developing strategies to promoted sustained retention and engagement in HIV care is urgently needed. Furthering our understanding of delivering patient-centered care—well-established in more developed settings—in the public setting of HIV care in sub-Saharan Africa holds significant promise to improve overall care delivery for millions of HIV-infected individuals. 

As we enter a new phase of ART scale-up, increasing our understanding of patient barriers to care will be necessary enhance sustained retention and engagement in care, crucial to long-term HIV treatment success. Prior studies, including our own work from Zambia, details the high prevalence of clinic-based barriers to care, including rude behavior, short return intervals, and long wait times. Adapting current public health HIV care models in sub-Saharan Africa to incorporate patient-centered cared holds promise in this regard, but little is known about how to evaluate and best implement patient-centered care in this public health setting. To that end, we are proposing the following study to utilize a multimodal approach to evaluate the overall patient experience for HIV-infected individuals in public ART clinics in Zambia. First, we will evaluate patient-provider communication via coding of audio-recorded encounters using the Roter Interaction Analysis System (RIAS), a validated coding schema to objectively evaluate patient-provider communication. Second, we will evaluate patient perspectives on the clinic experience through the use of tablet-based exit surveys as well as in-depth qualitative interviews in a subset of patients. Lastly, we will utilize standardized patients trained to enact archetypal patient scenarios as “secret shoppers” to evaluate the quality of care and the use of patient-centered practices in ART clinics. Through this multimodal approach, we aim to develop a scalable platform to systematically evaluate the overall patient experience. The knowledge and tools gained from this study will enhance our understanding of the important drivers of patients’ clinical experience and lay important foundations for evaluating and implementing the delivery of patient-centered care in this setting in future studies.