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The Impact of Visual Aids and Enhanced Training on the Delivery of Positive Health, Dignity, and Prevention Messages to Adult Patients Living with HIV in Rural North Central Mozambique.

Audet CM, Gutin SA, Blevins M, Chiau E, Alvim F, Jose E, Vaz LM, Shepherd BE, Dawson Rose C - PLoS ONE (2015)

Bottom Line: Despite intensive training and support, PHDP message delivery remained unacceptably low in rural Mozambique.Patients at high risk for treatment abandonment were not more likely to be counselled about adherence and support measures, something that needs to be addressed.We need to develop novel strategies to motivate health care providers to deliver these messages more consistently to all patients and develop a system that assists counsellors and clinicians to quickly and effectively determine which messages should be delivered.

View Article: PubMed Central - PubMed

Affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Departments of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America.

ABSTRACT

Introduction: Positive health, dignity, and prevention (PHDP) interventions target people living with HIV and AIDS (PLHIV) to promote well-being and prevent onward transmission. Concern that increased life expectancy and improved well-being would lead to increased risky sexual behaviour and subsequent HIV transmission motivated researchers to test novel strategies to support treatment adherence, encourage safer sex, STI treatment and partner testing, prevention of mother to child transmission, and support uptake of family planning.

Methods: We assessed the number and type of PHDP messages delivered to PLHIV before and after the implementation of an educational intervention for health providers combined with the distribution of visual job aids and monthly technical assistance.

Results: From April 21, 2013 to March 20, 2014, we documented 54,731 clinical encounters at three rural health centres in Zambézia province, Mozambique from 9,248 unique patients. The percentage of patients who received all seven PHDP messages during their last three visits was 1.9% pre-intervention vs. 13.6% post- intervention (p=<0.001). Younger patients (25 years vs. 35) and those with a recent HIV diagnosis (two weeks vs. two years) had higher odds of receiving any PHDP message (Odds Ratio [OR]: 1.22 and 2.79, respectively). Patients >59 days late collecting medications were not more likely to receive adherence messages than adherent patients (p=0.17).

Discussion: Targeting HIV prevention efforts to PLHIV is an effective HIV prevention approach to eliminate HIV transmission. Despite intensive training and support, PHDP message delivery remained unacceptably low in rural Mozambique. Patients at high risk for treatment abandonment were not more likely to be counselled about adherence and support measures, something that needs to be addressed.

Conclusions: We need to develop novel strategies to motivate health care providers to deliver these messages more consistently to all patients and develop a system that assists counsellors and clinicians to quickly and effectively determine which messages should be delivered.

No MeSH data available.


Related in: MedlinePlus

Psychosocial Evaluation and Positive Prevention form.
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pone.0130676.g001: Psychosocial Evaluation and Positive Prevention form.

Mentions: Every patient receiving HIV care and treatment in Mozambique should be provided PHDP messages during clinical, counselling, and pharmacy visits [40]. These messages (part of the Positive Prevention Toolkit) were developed by researchers at University of California, San Francisco [41], from pilot studies in Maputo, Mozambique [37, 38, 42] and implemented as a national strategy by the Ministry of Health in April 2013. Concurrently, a new form, the Ficha de Avaliação Psicossocial e de Prevenção Positiva (Psychosocial Assessment and Positive Prevention Record) was introduced into patient records to allow providers to document delivery of PHDP messages during each clinical encounter (Fig 1). In November 2013, a four day short-course PHDP training session for all HIV care and treatment clinicians and counsellors was provided at the three study sites. The training focused on the importance of PHDP, how and when to deliver messages, how to address patient barriers to service uptake, and how to use new visual aids (a poster and flip-chart containing images of PHDP services and behaviours). These providers were also given a PHDP poster and flip-chart for their offices which provide visual images of PHDP messages to facilitate discussion with patients. Monthly technical assistance follow-up visits at the HCW’s clinical care site within four weeks of the training were provided to improve the implementation of the PHDP intervention in their day-to-day work and as a way to provide reinforcement for the skills taught in the enhanced PHDP training package. Providers were trained to ensure that each patient received all seven messages (including the most relevant PHDP 5 message) every three months (Table 1).


The Impact of Visual Aids and Enhanced Training on the Delivery of Positive Health, Dignity, and Prevention Messages to Adult Patients Living with HIV in Rural North Central Mozambique.

Audet CM, Gutin SA, Blevins M, Chiau E, Alvim F, Jose E, Vaz LM, Shepherd BE, Dawson Rose C - PLoS ONE (2015)

Psychosocial Evaluation and Positive Prevention form.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493138&req=5

pone.0130676.g001: Psychosocial Evaluation and Positive Prevention form.
Mentions: Every patient receiving HIV care and treatment in Mozambique should be provided PHDP messages during clinical, counselling, and pharmacy visits [40]. These messages (part of the Positive Prevention Toolkit) were developed by researchers at University of California, San Francisco [41], from pilot studies in Maputo, Mozambique [37, 38, 42] and implemented as a national strategy by the Ministry of Health in April 2013. Concurrently, a new form, the Ficha de Avaliação Psicossocial e de Prevenção Positiva (Psychosocial Assessment and Positive Prevention Record) was introduced into patient records to allow providers to document delivery of PHDP messages during each clinical encounter (Fig 1). In November 2013, a four day short-course PHDP training session for all HIV care and treatment clinicians and counsellors was provided at the three study sites. The training focused on the importance of PHDP, how and when to deliver messages, how to address patient barriers to service uptake, and how to use new visual aids (a poster and flip-chart containing images of PHDP services and behaviours). These providers were also given a PHDP poster and flip-chart for their offices which provide visual images of PHDP messages to facilitate discussion with patients. Monthly technical assistance follow-up visits at the HCW’s clinical care site within four weeks of the training were provided to improve the implementation of the PHDP intervention in their day-to-day work and as a way to provide reinforcement for the skills taught in the enhanced PHDP training package. Providers were trained to ensure that each patient received all seven messages (including the most relevant PHDP 5 message) every three months (Table 1).

Bottom Line: Despite intensive training and support, PHDP message delivery remained unacceptably low in rural Mozambique.Patients at high risk for treatment abandonment were not more likely to be counselled about adherence and support measures, something that needs to be addressed.We need to develop novel strategies to motivate health care providers to deliver these messages more consistently to all patients and develop a system that assists counsellors and clinicians to quickly and effectively determine which messages should be delivered.

View Article: PubMed Central - PubMed

Affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Departments of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America; Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America.

ABSTRACT

Introduction: Positive health, dignity, and prevention (PHDP) interventions target people living with HIV and AIDS (PLHIV) to promote well-being and prevent onward transmission. Concern that increased life expectancy and improved well-being would lead to increased risky sexual behaviour and subsequent HIV transmission motivated researchers to test novel strategies to support treatment adherence, encourage safer sex, STI treatment and partner testing, prevention of mother to child transmission, and support uptake of family planning.

Methods: We assessed the number and type of PHDP messages delivered to PLHIV before and after the implementation of an educational intervention for health providers combined with the distribution of visual job aids and monthly technical assistance.

Results: From April 21, 2013 to March 20, 2014, we documented 54,731 clinical encounters at three rural health centres in Zambézia province, Mozambique from 9,248 unique patients. The percentage of patients who received all seven PHDP messages during their last three visits was 1.9% pre-intervention vs. 13.6% post- intervention (p=<0.001). Younger patients (25 years vs. 35) and those with a recent HIV diagnosis (two weeks vs. two years) had higher odds of receiving any PHDP message (Odds Ratio [OR]: 1.22 and 2.79, respectively). Patients >59 days late collecting medications were not more likely to receive adherence messages than adherent patients (p=0.17).

Discussion: Targeting HIV prevention efforts to PLHIV is an effective HIV prevention approach to eliminate HIV transmission. Despite intensive training and support, PHDP message delivery remained unacceptably low in rural Mozambique. Patients at high risk for treatment abandonment were not more likely to be counselled about adherence and support measures, something that needs to be addressed.

Conclusions: We need to develop novel strategies to motivate health care providers to deliver these messages more consistently to all patients and develop a system that assists counsellors and clinicians to quickly and effectively determine which messages should be delivered.

No MeSH data available.


Related in: MedlinePlus