IMPROVING TRACKING AND RETENTION IN CARE OF PLHIV IN SÃO PAOLO
Background
In Brazil, the Clinical Monitoring System (Sistema de Monitoramento Clinico [SIMC]) was developed in 2013 and made available by the Ministry of Health to all public healthcare services performing follow-up of PLHIV. SIMC helps identify 3 salient patient groups in outpatient settings: (a) patients with CD4/viral loads tests and not in treatment; (b) patients in treatment 6 months with a detectable viral load; and (c) patients lost to follow-up.
The São Paulo State STI/Aids Program Coordination has been promoting the implementation and use of SIMC but due to cultural and organizational barriers in the healthcare network, the implementation and scale up has been difficult.
Design
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.
Primary objective
- To evaluate the impact of an intervention to improve the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, and implement SIMC.
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%) centres 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.
Collaborators
Dr. Maria Ines Battistella Nemes
Dr Ana Paula Loch
Setting
Fundação Faculdade De Medicina
Location
Brazil
Duration
May 2019 – Jul 2020
Category
Retention in Care and Adherence
Key study materials
RELATED STUDIES
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NP-GBL-HVU-WCNT- 210051 | March 2022
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