Evaluation of a Psychosocial Health Education Strategy for HIV Patients

Evaluation of a Psychosocial Health Education Strategy for HIV Patients for the Improvement of Viral Suppression at Beraca Medical Center 

Summary 

Human immunodeficiency virus (HIV) infection, treated with antiretroviral therapy, is currently considered a chronic disease. At Centre Medical Beraca, one of the leading establishments for the care of HIV patients in the North-West department of Haiti, a psychosocial educational strategy aimed at improving patient adherence to treatment was implemented in 2021. This strategy supports patients with detectable viral loads to improve viral suppression, a key performance indicator in HIV care, which remains low. This strategy was evaluated through a qualitative study, considering implementation, execution, and results from document consultations and semi-structured interviews with key stakeholders. The analysis assessed the innovative adaptation of the strategy given the available resources and identified shortcomings, particularly regarding the target population’s primary objective of viral suppression.

Introduction

 The World Health Organization (WHO) estimates that 50% of patients with chronic diseases do not adhere to their treatment. HIV infection, a chronic disease requiring daily medication, is also affected by this issue. Therefore, healthcare professionals have developed numerous approaches and strategies to optimize medication adherence, aiming to significantly reduce viral load and ensure a minimal risk of transmission within the population. These strategies are adapted to different countries, communities, and environments.

The primary goal of any HIV patient care program is to improve “viral suppression,” a key indicator according to the global consensus of the Joint United Nations Programme on HIV/AIDS (UNAIDS), aiming to end the AIDS epidemic by 2030. This consensus specifies that 95% of people living with HIV should know their status (goal 1), 95% of those who know their status should receive treatment (goal 2), and 95% of those on treatment should achieve viral suppression (goal 3).

At Centre Medical Beraca (CMB), one of the leading healthcare facilities in the North-West department, a psychosocial, educational strategy was implemented in 2021 to support HIV patients with detectable viral loads (less than 1000 copies of the virus per milliliter of blood, according to the national viral load algorithm). This strategy aimed to improve these patients’ treatment adherence over three months. It involved three approaches: telephone support, home visits, and adherence classes.

The evaluation of its implementation, deployment, and qualitative results is the objective of our study, which will provide recommendations for its improvement.

Methodology

This qualitative study involved reviewing documents on implementing the psychosocial educational strategy at CMB, examining the description of its implementation steps and components, and conducting semi-structured interviews with stakeholders.

Telephone Support 

The distribution of the 334 patients among the eight team members was based on patients’ residences, aligning with the field agents’ work zones. The goal was to make at least three calls per week. However, this quota was not met for the majority of patients. One hundred ninety-eight patients received at least one call per week over the three months, with about ten interactions.

Analysis of the Theoretical Approach to the Psychosocial Educational Strategy at CMB: 

Executing any project follows a structured approach to achieve set objectives. In health promotion, an intervention is organized into coherent steps, including situation analysis (diagnosis), problem prioritization, objective formulation, action planning, implementation, and finally, intervention evaluation and communication.

Conclusion

Adherence to treatment for chronic disease patients remains a significant challenge. Many policies, programs, and strategies will continue to be developed to address this reality. However, if these actions are not considered and adapted to the context and reality of the target patients, they will not produce the expected results. At Centre Medical Beraca, numerous activities have been implemented to improve viral suppression.

Conflict of Interest Statement

Paul Marc Hansley Joachim reports that the University of Lorraine, CHRU de Nancy, Department of Anesthesiology, Intensive Care, and Emergency Medicine provided assistance with report writing. Catholic Medical Mission Board Inc. provided administrative support and writing assistance. David Zéphirin declares no conflicts of interest.

References:

1. Sabaté, E. (2003). Adherence to long-term therapies: evidence for action.
2. Belche, J. L., et al. (2015). HIV infection: a chronic disease redefining collaboration between general practitioners and specialists. Obstacles and opportunities. Santé Publique.
3. HIV and AIDS [Internet] (2021).
4. Undetectable = Untransmittable: Public Health and Viral Load Suppression [Internet] (2018).
5. National Multisectoral Strategic Plan for HIV/AIDS Response 2018–2023 (2019).
6. Global AIDS Strategy 2021–2026: Ending Inequalities. Ending AIDS (2020).

This communication was presented on Tuesday, 04/06/2024, in the National Academy of Medicine session. © 2024 National Academy of Medicine.