Cargando…
Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework
BACKGROUND: As the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, ‘engagement’ is a complex concept and ambiguous definitions limit its evaluation. To guid...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161576/ https://www.ncbi.nlm.nih.gov/pubmed/37143067 http://dx.doi.org/10.1186/s12913-023-09433-4 |
_version_ | 1785037522484592640 |
---|---|
author | Keene, Claire M. Euvrard, Jonathan Amico, K . Rivet Ragunathan, Ayesha English, Mike McKnight, Jacob Orrell, Catherine |
author_facet | Keene, Claire M. Euvrard, Jonathan Amico, K . Rivet Ragunathan, Ayesha English, Mike McKnight, Jacob Orrell, Catherine |
author_sort | Keene, Claire M. |
collection | PubMed |
description | BACKGROUND: As the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, ‘engagement’ is a complex concept and ambiguous definitions limit its evaluation. To guide engagement evaluation and development of interventions to improve HIV outcomes, we sought to identify critical, measurable dimensions of engagement with HIV care for people on treatment from a health service-delivery perspective. METHODS: We used a pragmatic, iterative approach to develop a framework, combining insights from researcher experience, a narrative literature review, framework mapping, expert stakeholder input and a formal scoping review of engagement measures. These inputs helped to refine the inclusion and definition of important elements of engagement behaviour that could be evaluated by the health system. RESULTS: The final framework presents engagement with HIV care as a dynamic behaviour that people practice rather than an individual characteristic or permanent state, so that people can be variably engaged at different points in their treatment journey. Engagement with HIV care for those on treatment is represented by three measurable dimensions: ‘retention’ (interaction with health services), ‘adherence’ (pill-taking behaviour), and ‘active self-management’ (ownership and self-management of care). Engagement is the product of wider contextual, health system and personal factors, and engagement in all dimensions facilitates successful treatment outcomes, such as virologic suppression and good health. While retention and adherence together may lead to treatment success at a particular point, this framework hypothesises that active self-management sustains treatment success over time. Thus, evaluation of all three core dimensions is crucial to realise the individual, societal and public health benefits of antiretroviral treatment programmes. CONCLUSIONS: This framework distils a complex concept into three core, measurable dimensions critical for the maintenance of engagement. It characterises elements that the system might assess to evaluate engagement more comprehensively at individual and programmatic levels, and suggests that active self-management is an important consideration to support lifelong optimal engagement. This framework could be helpful in practice to guide the development of more nuanced interventions that improve long-term treatment success and help maintain momentum in controlling a changing epidemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09433-4. |
format | Online Article Text |
id | pubmed-10161576 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-101615762023-05-06 Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework Keene, Claire M. Euvrard, Jonathan Amico, K . Rivet Ragunathan, Ayesha English, Mike McKnight, Jacob Orrell, Catherine BMC Health Serv Res Research Article BACKGROUND: As the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, ‘engagement’ is a complex concept and ambiguous definitions limit its evaluation. To guide engagement evaluation and development of interventions to improve HIV outcomes, we sought to identify critical, measurable dimensions of engagement with HIV care for people on treatment from a health service-delivery perspective. METHODS: We used a pragmatic, iterative approach to develop a framework, combining insights from researcher experience, a narrative literature review, framework mapping, expert stakeholder input and a formal scoping review of engagement measures. These inputs helped to refine the inclusion and definition of important elements of engagement behaviour that could be evaluated by the health system. RESULTS: The final framework presents engagement with HIV care as a dynamic behaviour that people practice rather than an individual characteristic or permanent state, so that people can be variably engaged at different points in their treatment journey. Engagement with HIV care for those on treatment is represented by three measurable dimensions: ‘retention’ (interaction with health services), ‘adherence’ (pill-taking behaviour), and ‘active self-management’ (ownership and self-management of care). Engagement is the product of wider contextual, health system and personal factors, and engagement in all dimensions facilitates successful treatment outcomes, such as virologic suppression and good health. While retention and adherence together may lead to treatment success at a particular point, this framework hypothesises that active self-management sustains treatment success over time. Thus, evaluation of all three core dimensions is crucial to realise the individual, societal and public health benefits of antiretroviral treatment programmes. CONCLUSIONS: This framework distils a complex concept into three core, measurable dimensions critical for the maintenance of engagement. It characterises elements that the system might assess to evaluate engagement more comprehensively at individual and programmatic levels, and suggests that active self-management is an important consideration to support lifelong optimal engagement. This framework could be helpful in practice to guide the development of more nuanced interventions that improve long-term treatment success and help maintain momentum in controlling a changing epidemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09433-4. BioMed Central 2023-05-04 /pmc/articles/PMC10161576/ /pubmed/37143067 http://dx.doi.org/10.1186/s12913-023-09433-4 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Keene, Claire M. Euvrard, Jonathan Amico, K . Rivet Ragunathan, Ayesha English, Mike McKnight, Jacob Orrell, Catherine Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework |
title | Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework |
title_full | Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework |
title_fullStr | Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework |
title_full_unstemmed | Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework |
title_short | Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework |
title_sort | conceptualising engagement with hiv care for people on treatment: the indicators of hiv care and antiretroviral engagement (incare) framework |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161576/ https://www.ncbi.nlm.nih.gov/pubmed/37143067 http://dx.doi.org/10.1186/s12913-023-09433-4 |
work_keys_str_mv | AT keeneclairem conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT euvrardjonathan conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT amicokrivet conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT ragunathanayesha conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT englishmike conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT mcknightjacob conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT orrellcatherine conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework |