The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART
Abstract Background Offering antiretroviral therapy (ART) to patients directly following an HIV diagnosis (“Rapid ART”) improves clinical outcomes and is feasible and acceptable for patients and providers. Despite this, implementation of Rapid ART is not yet standard practice in the USA. Structural-...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-023-00464-w |
| _version_ | 1797778837728133120 |
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| author | Lissa Moran Kimberly A. Koester Noelle Le Tourneau Susa Coffey Kelvin Moore Janessa Broussard Pierre-Cedric Crouch Lyndon VanderZanden John Schneider Elizabeth Lynch Jorge Roman Katerina A. Christopoulos |
| author_facet | Lissa Moran Kimberly A. Koester Noelle Le Tourneau Susa Coffey Kelvin Moore Janessa Broussard Pierre-Cedric Crouch Lyndon VanderZanden John Schneider Elizabeth Lynch Jorge Roman Katerina A. Christopoulos |
| author_sort | Lissa Moran |
| collection | DOAJ |
| description | Abstract Background Offering antiretroviral therapy (ART) to patients directly following an HIV diagnosis (“Rapid ART”) improves clinical outcomes and is feasible and acceptable for patients and providers. Despite this, implementation of Rapid ART is not yet standard practice in the USA. Structural-level implementation guidance is available, but research at the individual provider level that explores the patient-provider interaction itself remains scarce. The Consolidated Framework for Implementation Research (CFIR) provides a nuanced guide to investigating the less visible, more social elements of implementation like the knowledge and feelings of people, and the influences of culture and resources on individual approaches. Methods We conducted a multi-site qualitative study, exploring intervention commonalities across three HIV clinic environments: an HIV primary care clinic; an HIV/STI testing, treatment, and prevention clinic; and a large federally qualified health center (FQHC). Qualitative data were gathered from 27 provider informants—Rapid ART program staff and clinicians—using an interview guide developed using the CFIR. An experienced qualitative team conducted a comprehensive thematic analysis and identified cross-cutting themes in how providers approach and engage in the Rapid interaction, as well as longer-form narratives from providers that describe more fully what this interaction looks like for them. Results Three main themes represent the range and content of individual provider approaches to the Rapid interaction: (1) patient-centeredness; (2) emotional support and partnership; and (3) correcting misperceptions about HIV. Each theme encompassed both conceptual approaches to offering Rapid ART and concrete examples of messaging to the patient that providers used in the Rapid interaction. We describe and show examples of these themes, offer key take-aways for implementation, and provide expanded narratives of providers’ personal approaches to the Rapid interaction. Conclusions Exploration of provider-level approaches to Rapid ART implementation, as carried out in the patient-provider Rapid interaction, contributes a critical layer of evidence for wider implementation. It is our hope that, together with existing research showing positive outcomes and core components of systems-level implementation, these findings add to an instructive body of findings that facilitates the implementation of Rapid ART as an enhanced model of HIV care. |
| first_indexed | 2024-03-12T23:23:18Z |
| format | Article |
| id | doaj.art-6881ef56c207451082c9c9f7d383755b |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-03-12T23:23:18Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-6881ef56c207451082c9c9f7d383755b2023-07-16T11:18:27ZengBMCImplementation Science Communications2662-22112023-07-014111110.1186/s43058-023-00464-wThe Rapid interaction: a qualitative study of provider approaches to implementing Rapid ARTLissa Moran0Kimberly A. Koester1Noelle Le Tourneau2Susa Coffey3Kelvin Moore4Janessa Broussard5Pierre-Cedric Crouch6Lyndon VanderZanden7John Schneider8Elizabeth Lynch9Jorge Roman10Katerina A. Christopoulos11Department of Medicine, University of CaliforniaDepartment of Medicine, University of CaliforniaDepartment of Medicine, University of CaliforniaDepartment of Medicine, Zuckerberg San Francisco General Hospital, University of CaliforniaDepartment of Medicine, University of CaliforniaDepartment of Community Health Systems, School of Nursing, University of CaliforniaDepartment of Medicine, Zuckerberg San Francisco General Hospital, University of CaliforniaHoward Brown Health CenterDepartment of Medicine, University of ChicagoDepartment of Medicine, Zuckerberg San Francisco General Hospital, University of CaliforniaSan Francisco AIDS FoundationDepartment of Medicine, Zuckerberg San Francisco General Hospital, University of CaliforniaAbstract Background Offering antiretroviral therapy (ART) to patients directly following an HIV diagnosis (“Rapid ART”) improves clinical outcomes and is feasible and acceptable for patients and providers. Despite this, implementation of Rapid ART is not yet standard practice in the USA. Structural-level implementation guidance is available, but research at the individual provider level that explores the patient-provider interaction itself remains scarce. The Consolidated Framework for Implementation Research (CFIR) provides a nuanced guide to investigating the less visible, more social elements of implementation like the knowledge and feelings of people, and the influences of culture and resources on individual approaches. Methods We conducted a multi-site qualitative study, exploring intervention commonalities across three HIV clinic environments: an HIV primary care clinic; an HIV/STI testing, treatment, and prevention clinic; and a large federally qualified health center (FQHC). Qualitative data were gathered from 27 provider informants—Rapid ART program staff and clinicians—using an interview guide developed using the CFIR. An experienced qualitative team conducted a comprehensive thematic analysis and identified cross-cutting themes in how providers approach and engage in the Rapid interaction, as well as longer-form narratives from providers that describe more fully what this interaction looks like for them. Results Three main themes represent the range and content of individual provider approaches to the Rapid interaction: (1) patient-centeredness; (2) emotional support and partnership; and (3) correcting misperceptions about HIV. Each theme encompassed both conceptual approaches to offering Rapid ART and concrete examples of messaging to the patient that providers used in the Rapid interaction. We describe and show examples of these themes, offer key take-aways for implementation, and provide expanded narratives of providers’ personal approaches to the Rapid interaction. Conclusions Exploration of provider-level approaches to Rapid ART implementation, as carried out in the patient-provider Rapid interaction, contributes a critical layer of evidence for wider implementation. It is our hope that, together with existing research showing positive outcomes and core components of systems-level implementation, these findings add to an instructive body of findings that facilitates the implementation of Rapid ART as an enhanced model of HIV care.https://doi.org/10.1186/s43058-023-00464-wRapid ARTSame-day startPatient-provider interactionProvider messagingProvider narrativesIndividual-level implementation |
| spellingShingle | Lissa Moran Kimberly A. Koester Noelle Le Tourneau Susa Coffey Kelvin Moore Janessa Broussard Pierre-Cedric Crouch Lyndon VanderZanden John Schneider Elizabeth Lynch Jorge Roman Katerina A. Christopoulos The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART Implementation Science Communications Rapid ART Same-day start Patient-provider interaction Provider messaging Provider narratives Individual-level implementation |
| title | The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART |
| title_full | The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART |
| title_fullStr | The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART |
| title_full_unstemmed | The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART |
| title_short | The Rapid interaction: a qualitative study of provider approaches to implementing Rapid ART |
| title_sort | rapid interaction a qualitative study of provider approaches to implementing rapid art |
| topic | Rapid ART Same-day start Patient-provider interaction Provider messaging Provider narratives Individual-level implementation |
| url | https://doi.org/10.1186/s43058-023-00464-w |
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