Abstract:
Background: Patient engagement is effective in promoting adherence to HIV care. In an effort to promote patient centered care, we implemented an enhanced patient care (EPC) intervention that addresses a combination of
system-level barriers including provider training, continuity of clinician-patient relationship, enhanced treatment
dialogue and better clinic scheduling. We describe the initial implementation of the EPC intervention in a rural HIV
clinic in Kenya, and the factors that facilitated its implementation.
Methods: The intervention occurred in one of the rural Academic Model Providing Healthcare (AMPATHplus) health
facilities in Busia County in the western region of Kenya. Both qualitative and quantitative data were collected
through training and meeting proceedings/minutes, a patient tracking tool, treatment dialogue and a peer
confirmation tool. Qualitative data were coded and emerging themes on the implementation and adaptation of
the intervention were developed. Descriptive analysis including percentages and means were performed on the
quantitative data.
Results: Our analysis identified four key factors that facilitated the implementation of this intervention. (1) The
smooth integration of the intervention as part of care that was facilitated by provider training, biweekly meetings
between the research and clinical team and having an intervention that promotes the health facility agenda. (2)
Commitment of stakeholders including providers and patients to the intervention. (3) The adaptability of the
intervention to the existing context while still maintaining fidelity to the intervention. (4) Embedding the
intervention in a facility with adequate infrastructure to support its implementation.
Conclusions: This analysis demonstrates the value of using mixed methods approaches to study the
implementation of an intervention. Our findings emphasize how critical local support, local infrastructure, and
effective communication are to adapting a new intervention in a clinical care program.