The use of patient choice in public health interventions for HIV treatment and prevention. A  systematic review

Kanganga, Desire

The use of patient choice in public health interventions for HIV treatment and prevention. A systematic review

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Introduction: Africa has the highest burden of HIV globally. A growing number of evidencebased HIV intervention are being scaled up to eliminate HIV transmission and minimise morbidity and mortality. We reviewed the published HIV literature to describe interventions in which patients are given a choice in their HIV care, and examine the impact of patient choice on reported health outcomes among studies including a non-choice comparison group. Methods: We searched PubMed and reference lists, from 1 January 2010 to 8 December 2023. Included studies were HIV related interventions where patients were making a choice in some aspect of their care and carried out in Africa. The choice components and related results were described, and grouped by HIV continuum focus area. Measures of association were summarised for studies reporting comparison of health outcomes between choice and non-choice groups. Results: Eleven out of 593 studies were included. Six focused on HIV prevention, four on HIV treatment and one on HIV care and support. Five studies described choices offered in routine care; six were research interventions. Choices provided included product choice, location of services, duration of dispensing and choice treatment support. Limited details were provided on the implementation of the choice intervention in most studies. In two prevention studies comparing a choice and non-choice group, pre-exposure prophylaxis coverage was significantly higher in the choice arm compared to the control. In one HIV treatment study, there was no difference in viral suppression but retention in care was significantly higher in the choice arm compared to the non-choice arm. Conclusions: This review shows that patient choice is being offered in HIV preventative and treatment services and is allowing people to select what they need when needed. More research is required to understand how patient choice can be sustainably implemented in HIV services in high-burden and low-resource settings.

Keywords

Public Health

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