Effect of a multicomponent, person-centred care intervention on client experience and HIV treatment outcomes in Zambia: a stepped-wedge, cluster-randomised trial

作者：Kombatende Sikombe, Aaloke Mody, Charles W. Goss, Sandra Simbeza, Laura K. Beres, Jake M. Pry, Ingrid Eshun‐Wilson, Anjali Sharma, Njekwa Mukamba, Lloyd Mulenga, Brian Rice, Jacob Mutale, Alida Zulu Dube, Musunge Mulabe, James Hargreaves, Carolyn Bolton‐Moore, Charles B. Holmes, Izukanji Sikazwe, Elvin Geng · 发表于：The Lancet HIV · 年份：2024 · DOI：10.1016/s2352-3018(24)00264-9 · 被引用次数：10 · 研究领域：HIV/AIDS Research and Interventions、Mental Health and Patient Involvement、Global Maternal and Child Health

BACKGROUND: Recipients of health services value not only convenience but also respectful, kind, and helpful providers. To date, research to improve person-centred HIV treatment has focused on making services easier to access (eg, differentiated service delivery) rather than the interpersonal experience of care. We developed and evaluated a person-centred care (PCC) intervention targeting practices of health-care workers. METHODS: Using a stepped-wedge, cluster-randomised design, we randomly allocated 24 HIV clinics stratified by size in Zambia into four groups and introduced a PCC intervention that targeted caring aspects of the behaviour of health-care workers in one group every 6 months. The intervention entailed training and coaching for health-care workers on PCC practices (to capacitate), client experience assessment with feedback to facilities (to create opportunities), and small performance-based incentives (to motivate). In a probability sample of clients who were pre-trained on a client experience exit survey and masked to facility intervention status, we evaluated effects on client experience by use of mean score change and also proportion with poor encounters (ie, score of ≤8 on a 12-point survey instrument). We examined effects on missed visits (ie, >30 days late for next scheduled encounter) in all groups and retention in care at 15 months in group 1 and group 4 by use of electronic health records. We assessed effects on treatment success at 15 months (ie, HIV RN...