Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework
<p><strong>Background</strong> 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 defi...
| Main Authors: | , , , , , , |
|---|---|
| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
BioMed Central
2023
|
| _version_ | 1797111057710317568 |
|---|---|
| author | Keene, CM Euvrard, J Amico, KR Ragunathan, A English, M McKnight, J Orrell, C |
| author2 | InCARE Stakeholder Group |
| author_facet | InCARE Stakeholder Group Keene, CM Euvrard, J Amico, KR Ragunathan, A English, M McKnight, J Orrell, C |
| author_sort | Keene, CM |
| collection | OXFORD |
| description | <p><strong>Background</strong> 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.</p>
<p><strong>Methods</strong> 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.</p>
<p><strong>Results</strong> 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.</p>
<p><strong>Conclusions</strong> 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.</p> |
| first_indexed | 2024-03-07T08:04:54Z |
| format | Journal article |
| id | oxford-uuid:49d753e9-7c2d-4e81-b174-52923deab3f7 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:04:54Z |
| publishDate | 2023 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:49d753e9-7c2d-4e81-b174-52923deab3f72023-10-24T09:49:01ZConceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) FrameworkJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:49d753e9-7c2d-4e81-b174-52923deab3f7EnglishSymplectic ElementsBioMed Central2023Keene, CMEuvrard, JAmico, KRRagunathan, AEnglish, MMcKnight, JOrrell, CInCARE Stakeholder Group<p><strong>Background</strong> 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.</p> <p><strong>Methods</strong> 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.</p> <p><strong>Results</strong> 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.</p> <p><strong>Conclusions</strong> 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.</p> |
| spellingShingle | Keene, CM Euvrard, J Amico, KR Ragunathan, A English, M McKnight, J Orrell, C 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 |
| work_keys_str_mv | AT keenecm conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT euvrardj conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT amicokr conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT ragunathana conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT englishm conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT mcknightj conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework AT orrellc conceptualisingengagementwithhivcareforpeopleontreatmenttheindicatorsofhivcareandantiretroviralengagementincareframework |