Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi
Introduction Person-centred care (PCC) improves clinical outcomes for people living with HIV. Heterosexual men in sub-Saharan Africa are under-represented in HIV care, yet PCC interventions for men are lacking. We identified core components of a PCC intervention for men living with HIV (MLHIV) in Ma...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/2/e001100.full |
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| author | Sam Phiri Khumbo Phiri Julie Hubbard Kathryn Dovel Kelvin Balakasi Elijah Chikuse Augustine T Choko Morna Cornell Misheck Mphande Isabella Robson Marguerite Thorp Thomas Coates |
| author_facet | Sam Phiri Khumbo Phiri Julie Hubbard Kathryn Dovel Kelvin Balakasi Elijah Chikuse Augustine T Choko Morna Cornell Misheck Mphande Isabella Robson Marguerite Thorp Thomas Coates |
| author_sort | Sam Phiri |
| collection | DOAJ |
| description | Introduction Person-centred care (PCC) improves clinical outcomes for people living with HIV. Heterosexual men in sub-Saharan Africa are under-represented in HIV care, yet PCC interventions for men are lacking. We identified core components of a PCC intervention for men living with HIV (MLHIV) in Malawi from both client and healthcare worker (HCW) perspectives, as well as strategies for implementation in routine settings.Methods MLHIV≥15 years and not in care were enrolled in parent randomised trials to test the impact of male-tailored HIV services on 6-month treatment outcomes (n=1303). Clients received a PCC package including male-specific counselling+facility ART distribution or outside-facility ART distribution. 50 male clients were recruited for qualitative in-depth interviews using stratified random sampling to assess perceptions of the PCC packages. Focus group discussions were conducted with HCWs who delivered the intervention to understand implementation strategies and potential considerations for scale-up in routine settings. Interviews were audio recorded, translated into English, transcribed and coded in Atlas.ti V.9 and analysed using thematic analysis.Results 36 MLHIV and 20 HCWs (10 lay cadre and 10 nurses) were interviewed between February and July 2022. Positive interactions with HCWs—characterised by kindness, reciprocity, privacy and focused conversations—and compelling, relevant counselling were considered the most important components of male PCC. While outside-facility ART dispensing was considered helpful, it was not as critical as these other components. HCWs outlined five steps to implementing male PCC: begin with kindness, apologise for past negative interactions, understand men’s holistic story, provide tailored counselling and support development of strategies for adherence. HCWs believed that male PCC enhanced their ability to support male clients but emphasised the need to be integrated into routine services.Discussion PCC strategies that foster positive HCW relationships and addresses men’s unique experiences are highly valued by MLHIV. HCWs identified several strategies for delivering PCC to MLHIV that may help close gaps in HIV care for men.Trial registration numbers NCT04858243; NCT05137210. |
| format | Article |
| id | doaj-art-f132961a22b64e4b9190cd1f16879dbc |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Public Health |
| spelling | doaj-art-f132961a22b64e4b9190cd1f16879dbc2024-12-22T13:35:09ZengBMJ Publishing GroupBMJ Public Health2753-42942024-12-012210.1136/bmjph-2024-001100Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in MalawiSam Phiri0Khumbo Phiri1Julie Hubbard2Kathryn Dovel3Kelvin Balakasi4Elijah Chikuse5Augustine T Choko6Morna Cornell7Misheck Mphande8Isabella Robson9Marguerite Thorp10Thomas Coates11Department of Implementation Science, Partners in Hope, Lilongwe, MalawiDepartment of Implementation Science, Partners in Hope, Lilongwe, MalawiDivision of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USAImplementation Science Department, Partners in Hope Medical Center, Lilongwe, Central Region, MalawiDepartment of Implementation Science, Partners in Hope, Lilongwe, MalawiDepartment of Implementation Science, Partners in Hope, Lilongwe, MalawiClinical Research Programme, Malawi Liverpool Wellcome Programme, Blantyre, MalawiCentre for Infectious Disease Epidemiology & Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South AfricaImplementation Science Department, Partners in Hope Medical Center, Lilongwe, Central Region, MalawiDivision of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USADivision of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USAUniversity of California Global Health Institute, San Francisco, California, USAIntroduction Person-centred care (PCC) improves clinical outcomes for people living with HIV. Heterosexual men in sub-Saharan Africa are under-represented in HIV care, yet PCC interventions for men are lacking. We identified core components of a PCC intervention for men living with HIV (MLHIV) in Malawi from both client and healthcare worker (HCW) perspectives, as well as strategies for implementation in routine settings.Methods MLHIV≥15 years and not in care were enrolled in parent randomised trials to test the impact of male-tailored HIV services on 6-month treatment outcomes (n=1303). Clients received a PCC package including male-specific counselling+facility ART distribution or outside-facility ART distribution. 50 male clients were recruited for qualitative in-depth interviews using stratified random sampling to assess perceptions of the PCC packages. Focus group discussions were conducted with HCWs who delivered the intervention to understand implementation strategies and potential considerations for scale-up in routine settings. Interviews were audio recorded, translated into English, transcribed and coded in Atlas.ti V.9 and analysed using thematic analysis.Results 36 MLHIV and 20 HCWs (10 lay cadre and 10 nurses) were interviewed between February and July 2022. Positive interactions with HCWs—characterised by kindness, reciprocity, privacy and focused conversations—and compelling, relevant counselling were considered the most important components of male PCC. While outside-facility ART dispensing was considered helpful, it was not as critical as these other components. HCWs outlined five steps to implementing male PCC: begin with kindness, apologise for past negative interactions, understand men’s holistic story, provide tailored counselling and support development of strategies for adherence. HCWs believed that male PCC enhanced their ability to support male clients but emphasised the need to be integrated into routine services.Discussion PCC strategies that foster positive HCW relationships and addresses men’s unique experiences are highly valued by MLHIV. HCWs identified several strategies for delivering PCC to MLHIV that may help close gaps in HIV care for men.Trial registration numbers NCT04858243; NCT05137210.https://bmjpublichealth.bmj.com/content/2/2/e001100.full |
| spellingShingle | Sam Phiri Khumbo Phiri Julie Hubbard Kathryn Dovel Kelvin Balakasi Elijah Chikuse Augustine T Choko Morna Cornell Misheck Mphande Isabella Robson Marguerite Thorp Thomas Coates Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi BMJ Public Health |
| title | Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi |
| title_full | Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi |
| title_fullStr | Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi |
| title_full_unstemmed | Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi |
| title_short | Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi |
| title_sort | core components of male specific person centred hiv care a qualitative analysis from client and healthcare worker perspectives in malawi |
| url | https://bmjpublichealth.bmj.com/content/2/2/e001100.full |
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