Participant perspectives on a person-centred care model for mobile individuals in HIV care from the SEARCH Dynamic Choice Treatment trial in rural Kenya and Uganda

Abstract

Introduction Mobile populations experience difficulties maintaining antiretroviral therapy (ART) adherence and HIV care engagement. We sought to explore participant perceptions of a patient-centred model aimed at enhancing care engagement through ‘dynamic choice’ treatment services for mobile individuals. Methods We conducted 23 qualitative interviews with participants (N = 18) and healthcare providers (N = 5) from eight communities in southwest Uganda and western Kenya enrolled in a dynamic choice intervention that provided six-month and community ART refills; a “travel pack” with a travel checklist, discreetly packed ART, and an emergency supply of ART; phone access to a mobility coordinator; and facilitated transfers to distal clinics. Interviews explored participant life and mobility contexts, intervention experiences and preferences (as recipient or provider), and patient-provider relations. We employed a framework analysis of selected codes to identify emergent themes around intervention components and recommendations for improvement. Results Participants liked all options, the travel pack being most preferred. Longer times between refills allowed participants to concentrate on ART adherence, rather than on managing clinic appointments in the context of uncertain mobility. Viral load counselling was appreciated for explaining the relationship between medication adherence, viral load, and opportunistic infections. Poverty and food insecurity remain obstacles to ideal ART adherence. Recommendations Participants suggested scaling up these support services to the whole community, incorporating services to treat additional diseases, and food or employment support to help improve overall health outcomes. Care providers also recommended strengthening supply chains and deploying electronic medical records country-wide to facilitate care for mobile individuals.