Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Jan 10;18(1):27.
doi: 10.1186/s12879-017-2900-0.

Active ingredients of a person-centred intervention for people on HIV treatment: analysis of mixed methods trial data

Keira Lowther  1   2 , Richard Harding  3 , Victoria Simms  4 , Aabid Ahmed  5 , Zipporah Ali  6 , Nancy Gikaara  6 , Lorraine Sherr  7 , Hellen Kariuki  8 , Irene J Higginson  3 , Lucy Ellen Selman  9
Affiliations
Randomized Controlled Trial

Active ingredients of a person-centred intervention for people on HIV treatment: analysis of mixed methods trial data

Keira Lowther et al. BMC Infect Dis. .

Abstract

Background: A new model of care is required to meet the changing needs of people living with HIV (PLWH), particularly in low and middle-income countries, where prevalence is highest. We evaluated a palliative care intervention for PLWH in Mombasa, Kenya. Although we found no effect on pain (primary outcome), there was a positive effect on mental health (secondary outcome) in the intervention group. To inform replication and implementation, we have determined the active ingredients of the intervention and their mechanisms of action.

Methods: We conducted a randomised controlled trial (RCT) with qualitative exit interviews in HIV clinic attenders. The intervention was delivered over 5 months, with a minimum of 7 clinical contacts. Longitudinal quantitative data on components of care received were analysed using area under the curve and logistic regression. Qualitative data were analysed using inductive and deductive thematic analysis.

Results: Quantitative data analysis identified that intervention patients received more weak opioid, laxatives, discussion about spiritual worries, emotional support from staff for themselves and their families, time to talk about worries, discussion about future and planning ahead. Qualitative data analysis found that patients reported that having time to talk, appropriate pain medication and effective health education was of therapeutic value for their psychological well-being. Integration of mixed method findings suggest that positive effect in quantitative measures of mental health and well-being are attributable to the active ingredients of: appropriate medication, effective health education and counselling, and having time to talk in clinical encounters. Mechanisms of action include symptom relief, improved understanding of illness and treatment, and support focused on articulated concerns.

Conclusions: Routine care must provide opportunities and means for existing clinical staff to make routine appointments more person-centred. This approach enabled staff to identify and manage multidimensional problems and provide tailored health education and counselling.

Trial registration: ClinicalTrials.gov ( NCT01608802 ). Registered 12th May 2012.

Keywords: HIV; Mixed methods; Palliative care; Psychosocial; RCT.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval has been sought and secured from Kings College London Research Ethics Committee (BDM/10/11–31), and Kenyan Medical Research Institute (KEMRI/RES/7/3/1). All participants provided written informed consent to participate in the study, through a signature or thumbprint.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests. All authors were funded by their respective institutions for the manuscript preparation.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Comparison of components of care received by participants allocated to the intervention and control study arms
See this image and copyright information in PMC

References

    1. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382:1525–1533. doi: 10.1016/S0140-6736(13)61809-7. - DOI - PMC - PubMed
    1. Atun R, Bataringaya J. Building a durable response to HIV/AIDS: implications for health systems. J Acquir Immune Defic Syndr. 2011;57:S91–S95. doi: 10.1097/QAI.0b013e3182218441. - DOI - PubMed
    1. Unge C, Södergård B, Ekström AM, Carter J, Waweru M, Ilako F, et al. Challenges for scaling up ART in a resource-limited setting: a retrospective study in Kibera, Kenya. J Acquir Immune Defic Syndr. 2009;50:397–402. doi: 10.1097/QAI.0b013e318194618e. - DOI - PubMed
    1. UNAIDS . 90–90-90 an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
    1. Harding R, Simms V, Penfold S, Downing J, Namisango E, Powell RA, et al. Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study. BMC Infect Dis. 2014;14:613. doi: 10.1186/s12879-014-0613-1. - DOI - PMC - PubMed

Publication types

Associated data