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. 2021 May 10;16(5):e0250060.
doi: 10.1371/journal.pone.0250060. eCollection 2021.

Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach

Ana Paula Loch  1 , Simone Queiroz Rocha  1 , Mylva Fonsi  1 , Joselita Maria de Magalhães Caraciolo  1 , Artur Olhovetchi Kalichman  1 , Rosa de Alencar Souza  1 , Maria Clara Gianna  1 , Alexandre Gonçalves  1 , Duncan Short  2 , Shenia Liane Pimenta  3 , Lea Bagnola  4 , Carolina Wonhnrath Menuzzo  5 , Zulmira da Rocha Meireles  6 , Eunice Natividade Diz  7 , Roberto Zajdenverg  8 , Isidoro Prudente  9 , Maria Ines Battistella Nemes  10
Affiliations

Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach

Ana Paula Loch et al. PLoS One. .

Abstract

Objective: 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.

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Conflict of interest statement

The commercial affiliation from authors DS, RZ and IP does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Pragmatic model with contextual factors considered in the conducting continuum of care interventions and measurements.
Fig 2
Fig 2. General structure of the intervention according to the steps of pre-implementation, implementation, and post-implementation of CCM.
Fig 3
Fig 3. The regular assistance flow and lost to follow-up flow of PLHIV in the continuum of care identified by the SIMC.
Fig 4
Fig 4. Health regions and services included in the intervention and number of patients with treatment gap, virologic failure, or who were lost to follow-up.
a. Clinical Monitoring System, May 2019.
Fig 5
Fig 5. Flow diagram of patients with virologic failure during the intervention.
See this image and copyright information in PMC

References

    1. International Advisory Panel on HIV Care Continuum Optimization. IAPAC guidelines for optimizing the HIV care continuum for adults and adolescents. J Int Assoc Providers AIDS Care. 2015;14: S3–S34. 10.1177/2325957415613442 . - DOI - PubMed
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    1. Brazilian Ministry of Health. Clinical HIV monitoring report. Department of chronic conditions and sexually transmitted infections. Available from: http://www.aids.gov.br/pt-br/pub/2019/relatorio-de-monitoramento-clinico....

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