Development and feasibility testing of a novel community-based enhanced care intervention to improve person-centred outcomes for people living with HIV/AIDS in Ghana

Mary Abboah-Offei

Research output: ThesisDoctoral Thesis


Background: Although person-centred care (PCC) has been identified as necessary to achieve the 90-90-90 HIV treatment targets, limited research has considered the meaning and practice of PCC in low- and middle-income settings.
Aim: To develop a community-based enhanced care intervention to improve person-centred outcomes for people living with HIV/AIDS, and to test the feasibility of a cluster randomised controlled trial in terms of participant recruitment and retention, and intervention delivery.
Methods: The Medical Research Councils’ (MRC) guidance for developing and evaluating complex interventions was used to conduct a sequential mixed methods design. This comprised an initial systematic review to identify and appraise the evidence for models of person-centred HIV care delivered in community care settings; systematic review findings then informed a topic guide for qualitative interviews. People living with HIV/AIDS (PLWHA) and healthcare professionals (HCP) were interviewed regarding HIV care, what PCC means in the African (Ghanaian) context and what person-centred outcomes matter to PLWHA. Interview findings were mapped onto a PCC theory in an expert intervention development workshop. A “community-based enhanced care intervention” (CECI) was developed and tested in a parallel mixed-methods feasibility cluster (2 clusters) randomised controlled trial (cRCT). Qualitative and quantitative data were analysed using NVivo version 12 and the SPSS version 25 respectively. Primary outcome was trial recruitment and retention.
Results: The systematic review revealed limited research on person-centred models of care in community settings, as the 5 studies retained in the final analysis only 2 delivered all four PCC components (physical, psychological, social and spiritual wellbeing). N= 24 PLWHA and 15 HCP were interviewed about HIV care delivery and their perspectives on PCC. The qualitative interviews revealed that PLWHA are not involved in their care and care does not address what mattered to them. HCP also lack skills to undertake holistic assessment and to practice PCC. These findings were integrated to form the key components of the CECI intervention. Of the 83 PLWHA screened for the feasibility cRCT, 60 were enrolled (30 participants assigned to each cluster). Recruitment and retention rates were 87% and 97% respectively. Potential effect size estimated at final timepoint for all measures using Partial Eta Squared statistics as a measure for effect size and 95% confidence interval were: APCA POS [0.7 (95% CI 0.17 to 1.23) p<0.001]; MOS-HIV [0.7 (95% CI 0.17 to 1.23) p<0.001]; Picker Patient Experience Questionnaire (PPE-15) [0.8 (95% CI 0.27 to 1.31) p<0.001; CARE Measure [1.0 (95% CI 0.45 to 1.55) p<0.001], POSITIVE OUTCOMES [0.7 (95% CI 0.17 to 1.23) p<0.001]. Post-trial interviews revealed a general acceptability of the intervention including PLWHA feeling satisfied about their involvement in making decisions about their own care and their symptoms and concerns being assessed and addressed holistically using PCC. Training on the CECI was well received by HCP who felt equipped with skills to carry out holistic assessment and to practice PCC.
Conclusion: These findings indicate that PCC care is context-specific and contextual meaning of PCC should guide PCC intervention development to address what matters to PLWHA. The CECI was successfully implemented, it was feasible to recruit and retain participants in the trial and CECI was acceptable for both PLWHA and HCP. Results confirm the feasibility and justify a definitive cRCT of CECI to improve person-centred outcomes for PLWHA.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Kings College London
Award date1 Jul 2020
Publication statusPublished - 31 Jul 2020


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