Patient-centred approaches to providing care at HIV diagnosis: perspectives from healthcare and peer-support workers
Nathanael Wells
A * , Garrett Prestage A , Dean Murphy A , Nicholas Medland A , Limin Mao B , Chris Howard C , Christopher Fairley D E , Graham Brown F and Steven P. Philpot on behalf of the RISE Study Team A
+ Author Affiliations
- Author Affiliations
A Kirby Institute, University of NSW, Sydney, NSW, Australia.
B Centre for Social Research in Health, University of NSW, Sydney, NSW, Australia.
C Queensland Positive People (QPP), Brisbane, Qld, Australia.
D Alfred Health, Melbourne Sexual Health Centre, Melbourne, Vic., Australia.
E Central Clinical School, Monash University, Melbourne, Vic., Australia.
F Centre for Social Impact, University of NSW, Sydney, NSW, Australia.
Sexual Health 19(5) 448-455 https://doi.org/10.1071/SH22052
Submitted: 1 April 2022 Accepted: 21 June 2022 Published: 22 July 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Early uptake of HIV treatment among those newly diagnosed with HIV can improve individual health and prevent onward transmission. Patient-centred care is considered an important aspect in health care, the management of HIV, and can improve uptake of and adherence to HIV treatments.
Methods: Semi-structured interviews were conducted with sexual health clinicians (n, 10) and HIV support workers (n, 4) to understand how they approached HIV diagnosis delivery and care immediately thereafter.
Results: Our thematic analysis identified three themes: (1) centring patient needs at diagnosis; (2) assessing patients’ readiness to begin treatment; and (3) referrals to psychosocial support services. Our findings highlight centring patients was an important aspect of how participants delivered HIV diagnoses. By taking this approach, clinicians were best able to consider patient readiness to initiate treatment and referrals to social support services.
Conclusions: Given HIV diagnoses are increasingly occurring in generalist health services, our findings offer an important opportunity to learn from the experiences of specialist sexual health clinicians and HIV support workers.
Keywords: clinician perspectives, HIV, HIV diagnosis, patient-centred care, peer support, sexual health, treatment initiation, qualitative.
References
[1] Department of Health. Eighth national HIV strategy: 2018–2022. Canberra: Australian Government; 2018. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-1/$File/HIV-Eight-Nat-Strategy-2018-22.pdf[2] Newman CE, de Wit JBF, Kippax SC, Reynolds RH, Canavan PG, Kidd MR. The role of the general practitioner in the Australian approach to HIV care: interviews with ‘key informants’ from government, non-government and professional organisations. Sex Transm Infect 2012; 88 132–5.
| The role of the general practitioner in the Australian approach to HIV care: interviews with ‘key informants’ from government, non-government and professional organisations.Crossref | GoogleScholarGoogle Scholar |
[3] Bavinton BR, Pinto AN, Phanaphak N, Grinsztejn B, Prestage GP, Zablotska-Manos IB, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV 2018; 5 e438–47.
| Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study.Crossref | GoogleScholarGoogle Scholar |
[4] Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. J Am Med Assoc 2016; 316 171–81.
| Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[5] Vernazza PL. The debate continues: does ‘undetectable’ mean ‘uninfectious’? HIV Ther 2009; 3 113–6.
| The debate continues: does ‘undetectable’ mean ‘uninfectious’?Crossref | GoogleScholarGoogle Scholar |
[6] World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2016. Available at https://www.deslibris.ca/ID/10089566
[7] Byrd KK, Hou JG, Bush T, Hazen R, Kirkham H, Delpino A, et al. Adherence and viral suppression among participants of the patient-centered human immunodeficiency virus (HIV) care model project: a collaboration between community-based pharmacists and HIV clinical providers. Clin Infect Dis 2020; 70 789–97.
| Adherence and viral suppression among participants of the patient-centered human immunodeficiency virus (HIV) care model project: a collaboration between community-based pharmacists and HIV clinical providers.Crossref | GoogleScholarGoogle Scholar |
[8] Grimsrud A, Bygrave H, Doherty M, Ehrenkranz P, Ellman T, Ferris R, et al. Reimagining HIV service delivery: the role of differentiated care from prevention to suppression. J Int AIDS Soc 2016; 19 21484
| Reimagining HIV service delivery: the role of differentiated care from prevention to suppression.Crossref | GoogleScholarGoogle Scholar |
[9] Grimsrud A, Barnabas RV, Ehrenkranz P, Ford N. Evidence for scale up: the differentiated care research agenda. J Int AIDS Soc 2017; 20 22024
| Evidence for scale up: the differentiated care research agenda.Crossref | GoogleScholarGoogle Scholar |
[10] Laws RA, Kemp LA, Harris MF, Davies GP, Williams AM, Eames-Brown R. An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study. Implement Sci 2009; 4 66
| An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study.Crossref | GoogleScholarGoogle Scholar |
[11] Dang BN, Westbrook RA, Njue SM, Giordano TP. Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC Med Educ 2017; 17 32
| Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study.Crossref | GoogleScholarGoogle Scholar |
[12] Balint M. The doctor, his patient, the illness. New York: International Universities Press; 1957.
[13] Balint E. The possibilities of patient-centered medicine. J R Coll Gen Pract 1969; 17 269–76.
[14] Stewart M, Brown JB, Weston W, McWhinney IR, McWilliam CL, Freeman T. Patient-centered medicine: transforming the clinical method, 3rd edn. Boca Raton: Taylor & Francis Group; 2013.
[15] Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med 2000; 51 1087–110.
| Patient-centredness: a conceptual framework and review of the empirical literature.Crossref | GoogleScholarGoogle Scholar |
[16] World Health Organization. WHO global strategy on people-centred and integrated health services interim report. Geneva: World Health Organization; 2015. pp. 1–49.
[17] Stewart M. Towards a global definition of patient centred care: the patient should be the judge of patient centred care. BMJ: Br Med J 2001; 322 444–5.
| Towards a global definition of patient centred care: the patient should be the judge of patient centred care.Crossref | GoogleScholarGoogle Scholar |
[18] Byrne A-L, Baldwin A, Harvey C. Whose centre is it anyway? Defining person-centred care in nursing: an integrative review. PLoS One 2020; 15 e0229923
| Whose centre is it anyway? Defining person-centred care in nursing: an integrative review.Crossref | GoogleScholarGoogle Scholar |
[19] Ahmed S, Siad FM, Manalili K, Lorenzetti DL, Barbosa T, Lantion V, Lu M, Quan H, Santana M-J. How to measure cultural competence when evaluating patient-centred care: a scoping review. BMJ Open 2018; 8 e021525
| How to measure cultural competence when evaluating patient-centred care: a scoping review.Crossref | GoogleScholarGoogle Scholar |
[20] Epstein RM, Street RL. The values and value of patient-centered care. Ann Fam Med 2011; 9 100–3.
| The values and value of patient-centered care.Crossref | GoogleScholarGoogle Scholar |
[21] McWhinney IR. Patient-centred and Doctor-centred models of clinical decision-making. In: Sheldon M, Brooke J, Rector A, editors. Decision-making in general practice. London: Palgrave; 1985.
[22] Greene SM, Tuzzio L, Cherkin D. A framework for making patient-centered care front and center. Perm J 2012; 16 49–53.
| A framework for making patient-centered care front and center.Crossref | GoogleScholarGoogle Scholar |
[23] Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs 2013; 69 4–15.
| What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing.Crossref | GoogleScholarGoogle Scholar |
[24] Miles A, Asbridge JE. Increasing the person-centered care of people living with HIV (PLHIV). An analysis and commentary on ‘Treatment challenges, priorities, and relationship with healthcare providers in HIV care: a cross-sectional survey of Portuguese adults living with HIV”. Antunes, A., Augusto, I., Parada, P., Okoli, C., Appiah, A. & de los Rios, P. Eur J Pers Cent Healthc 2020; 8 282–93.
| Increasing the person-centered care of people living with HIV (PLHIV). An analysis and commentary on ‘Treatment challenges, priorities, and relationship with healthcare providers in HIV care: a cross-sectional survey of Portuguese adults living with HIV”. Antunes, A., Augusto, I., Parada, P., Okoli, C., Appiah, A. & de los Rios, P.Crossref | GoogleScholarGoogle Scholar |
[25] Lewin S, Skea Z, Entwistle M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev 2001; CD003267
| Interventions for providers to promote a patient-centred approach in clinical consultations.Crossref | GoogleScholarGoogle Scholar |
[26] Mol A. The logic of care: health and the problem of patient choice. London; New York: Routledge; 2008.
[27] Pantelic M, Stegling C, Shackleton S, Restoy E. Power to participants: a call for person-centred HIV prevention services and research. J Int AIDS Soc 2018; 21 e25167
| Power to participants: a call for person-centred HIV prevention services and research.Crossref | GoogleScholarGoogle Scholar |
[28] Hoang T, Goetz MB, Yano EM, Rossman B, Anaya HD, Knapp H, et al. The impact of integrated HIV care on patient health outcomes. Med Care 2009; 47 560–7.
| The impact of integrated HIV care on patient health outcomes.Crossref | GoogleScholarGoogle Scholar |
[29] Duncombe C, Rosenblum S, Hellmann N, Holmes C, Wilkinson L, Biot M, Bygrave H, Hoos D, Garnett G. Reframing HIV care: putting people at the centre of antiretroviral delivery. Trop Med Int Health 2015; 20 430–47.
| Reframing HIV care: putting people at the centre of antiretroviral delivery.Crossref | GoogleScholarGoogle Scholar |
[30] Perazzo JD. Transitioning newly diagnosed patients with HIV into care. Nurse Pract 2017; 42 44–9.
| Transitioning newly diagnosed patients with HIV into care.Crossref | GoogleScholarGoogle Scholar |
[31] Gianacas C, Down I, Ellard J, Kidd P, Brown G, Triffitt K, Persson A, Prestage G. Experiences of HIV: the seroconversion study: final report 2007–2015. Sydney: The Kirby Institute, UNSW Australia; 2015.
[32] Murphy D, Down I, Prestage G. Mapping referral pathways after HIV diagnosis. Sydney: The Kirby Institute, UNSW; 2017.
[33] Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: Pranee L, editor. Handbook of research methods in health social sciences. Singapore: Springer; 2019. pp. 843–60.
[34] Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
[35] Spaan P, van Luenen S, Garnefski N, Kraaij V. Psychosocial interventions enhance HIV medication adherence: a systematic review and meta-analysis. J Health Psychol 2020; 25 1326–40.
| Psychosocial interventions enhance HIV medication adherence: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[36] Giordano TP. Retention in HIV care: what the clinician needs to know. Top Antivir Med 2016; 19 12–6.
[37] Bulsara SM, Wainberg ML, Audet CM, Newton-John TRO. Retention in HIV care in Australia: the perspectives of clinicians and clients, and the impact of medical and psychosocial comorbidity. AIDS Patient Care STDs 2019; 33 415–24.
| Retention in HIV care in Australia: the perspectives of clinicians and clients, and the impact of medical and psychosocial comorbidity.Crossref | GoogleScholarGoogle Scholar |
[38] McDonald K, Slavin S, Pitts MK, Elliott JH. Chronic disease self-management by people with HIV. Qual Health Res 2016; 26 863–70.
| Chronic disease self-management by people with HIV.Crossref | GoogleScholarGoogle Scholar |
[39] Hardon A, Moyer E. Anthropology of AIDS: modes of engagement. Med Anthropol 2014; 33 255–62.
| Anthropology of AIDS: modes of engagement.Crossref | GoogleScholarGoogle Scholar |
[40] Moyer E. The anthropology of life after AIDS: epistemological continuities in the age of antiretroviral treatment. Ann Rev Anthropol 2015; 44 259–75.
| The anthropology of life after AIDS: epistemological continuities in the age of antiretroviral treatment.Crossref | GoogleScholarGoogle Scholar |
[41] Moyer E, Hardon A. A disease unlike any other? Why HIV remains exceptional in the age of treatment. Med Anthropol 2014; 33 263–9.
| A disease unlike any other? Why HIV remains exceptional in the age of treatment.Crossref | GoogleScholarGoogle Scholar |
[42] Khalpey Z, Fitzgerald L, Howard C, Istiko SN, Dean J, Mutch A. Peer navigators’ role in supporting people living with human immunodeficiency virus in Australia: qualitative exploration of general practitioners’ perspectives. Health Soc Care Community 2022; 30 1353–62.
| Peer navigators’ role in supporting people living with human immunodeficiency virus in Australia: qualitative exploration of general practitioners’ perspectives.Crossref | GoogleScholarGoogle Scholar |
[43] Prestage G, Brown G, Allan B, Ellard J, Down I. Impact of peer support on behavior change among newly diagnosed Australian gay men. J Acquir Immune Defic Syndr 2016; 72 565–71.
| Impact of peer support on behavior change among newly diagnosed Australian gay men.Crossref | GoogleScholarGoogle Scholar |
[44] Westergaard RP, Genz A, Panico K, Surkan PJ, Keruly J, Hutton HE, Chang LW, Kirk GD. Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders. Addict Sci Clin Pract 2017; 12 11
| Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders.Crossref | GoogleScholarGoogle Scholar |
[45] Waldrop-Valverde D, Guo Y, Ownby RL, Rodriguez A, Jones DL. Risk and protective factors for retention in HIV care. AIDS Behav 2014; 18 1483–91.
| Risk and protective factors for retention in HIV care.Crossref | GoogleScholarGoogle Scholar |
[46] Power J, Amir S, Brown G, Rule J, Johnson J, Lyons A, Bourne A, Carman M. HIV futures 9: quality of life among people living with HIV in Australia. Report No.: 116. Melbourne: The Australian Research Centre in Sex, Health and Society, La Trobe University; 2019.
[47] Wells N, Philpot S, Murphy D, Ellard J, Howard C, Rule J, Fairley C, Prestage G. Belonging, social connection and non-clinical care: experiences of HIV peer support among recently diagnosed people living with HIV in Australia. Health Soc Care Community 2022;
| Belonging, social connection and non-clinical care: experiences of HIV peer support among recently diagnosed people living with HIV in Australia.Crossref | GoogleScholarGoogle Scholar |
[48] Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2018. Sydney: Kirby Institute, UNSW; 2018. Available at https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-and-stis-australia-2017
[49] Sulzer SH, Muenchow E, Potvin A, Harris J, Gigot G. Improving patient-centered communication of the borderline personality disorder diagnosis. J Mental Health 2016; 25 5–9.
| Improving patient-centered communication of the borderline personality disorder diagnosis.Crossref | GoogleScholarGoogle Scholar |
