Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study
Abstract Background Engagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), ret...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-023-10481-z |
| _version_ | 1797355916954173440 |
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| author | Lawrence Mbuagbaw Saranee Fernando Chloe Lee Maureen Owino Cynthia Youssef M. Elizabeth Snow |
| author_facet | Lawrence Mbuagbaw Saranee Fernando Chloe Lee Maureen Owino Cynthia Youssef M. Elizabeth Snow |
| author_sort | Lawrence Mbuagbaw |
| collection | DOAJ |
| description | Abstract Background Engagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), retention in care, and engagement in care. We have previously identified effective care cascade strategies in a systematic review. Initiation of ART could be improved by mobile health interventions, and changes in healthcare delivery. Adherence to ART could be improved by mobile health interventions, incentives, counselling, and psychotherapy. Retention in care could be improved by mobile health interventions, incentives, education, and electronic interventions. The aim of this study was to investigate barriers and facilitators to implementing these effective interventions in HIV clinics in Ontario, Canada. Methods We conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences. Results Twenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support. Conclusion Clinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH. |
| first_indexed | 2024-03-08T14:18:07Z |
| format | Article |
| id | doaj.art-593ac16d584248f78b4b93906e8742f6 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-08T14:18:07Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-593ac16d584248f78b4b93906e8742f62024-01-14T12:16:51ZengBMCBMC Health Services Research1472-69632024-01-0124111310.1186/s12913-023-10481-zBarriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method studyLawrence Mbuagbaw0Saranee Fernando1Chloe Lee2Maureen Owino3Cynthia Youssef4M. Elizabeth Snow5Department of Health Research Methods, Evidence and Impact, McMaster UniversityCentre for Advancing Health OutcomesMcMaster University, Bachelors of Health Sciences ProgramThe Canadian HIV Trials Network (CTN)McMaster University, Bachelors of Health Sciences ProgramCentre for Advancing Health OutcomesAbstract Background Engagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), retention in care, and engagement in care. We have previously identified effective care cascade strategies in a systematic review. Initiation of ART could be improved by mobile health interventions, and changes in healthcare delivery. Adherence to ART could be improved by mobile health interventions, incentives, counselling, and psychotherapy. Retention in care could be improved by mobile health interventions, incentives, education, and electronic interventions. The aim of this study was to investigate barriers and facilitators to implementing these effective interventions in HIV clinics in Ontario, Canada. Methods We conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences. Results Twenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support. Conclusion Clinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH.https://doi.org/10.1186/s12913-023-10481-zHIVTheoretical domains frameworkInitiationAdherenceRetentionCare Cascade |
| spellingShingle | Lawrence Mbuagbaw Saranee Fernando Chloe Lee Maureen Owino Cynthia Youssef M. Elizabeth Snow Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study BMC Health Services Research HIV Theoretical domains framework Initiation Adherence Retention Care Cascade |
| title | Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study |
| title_full | Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study |
| title_fullStr | Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study |
| title_full_unstemmed | Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study |
| title_short | Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study |
| title_sort | barriers and facilitators to improving the cascade of hiv care in ontario a mixed method study |
| topic | HIV Theoretical domains framework Initiation Adherence Retention Care Cascade |
| url | https://doi.org/10.1186/s12913-023-10481-z |
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