Impact of an enhanced patient care (EPC) intervention on viral suppression among patients living with HIV in Kenya

Abstract

Background: Effective patient-centered interventions are needed to promote patient engagement in HIV care. We assessed the impact of a patient-centered intervention referred to as Enhanced Patient Care (EPC) on viral suppression among unsuppressed patients living with HIV in Kenya. Setting: Two rural HIV clinics within the Academic Model Providing Access to Health care (AMPATH). Methods: This was a 6-month pilot randomized control trial. The EPC intervention incorporated continuity of clinician-patient relationships, enhanced treatment dialogue and improved patients' clinic appointment scheduling. Provider-patient communication training was offered to all clinicians in the intervention site. We targeted 360 virally unsuppressed patients: 1) 240 in the intervention site with 120 randomly assigned to PPC training + EPC and 120 to PPC training + standard of care (SOC), and 2) 120 in the control site receiving SOC. Logistic regression analysis was applied using R (version 3.6.3). Results: A total of 328 patients were enrolled: 110 (92%) PPC training + EPC, 110 (92%) PPC training + SOC, 108 (90%) SOC. Participants' mean age at baseline was 48 years (SD: 12.05). Viral suppression 6 months post-intervention was 84.4% among those in PPC training + EPC, 83.7% in PPC training + SOC, and 64.4% in SOC (p=<0.001). Compared to participants in PPC training + EPC, those in SOC had lower odds of being virally suppressed 6 months post-intervention (OR=0.36, 95% CI: 0.18-0.72). Conclusion: PPC training may have had the greatest impact on patient viral suppression. Hence adequate training and effective PPC implementation strategies are needed.