Are patient outcomes improved by models of professionally-led community HIV management which aim to be person-centred? A systematic review of the evidence

ABSTRACT

UNAIDS advocates person-centred care (PCC) for people living with HIV/AIDS (PLWHA) to improve outcomes and wellbeing. We appraised the evidence of person-centred models of community HIV care delivered or led by trained healthcare professionals and its impact on care outcomes. A systematic review was conducted in line with PRISMA guidance. Six electronic databases (CINAHL, Embase, PubMed, Medline, PsycINFO and Web of Science) were searched from January 1980 to April 2019. We included primary studies of any design of PCC models; for adults aged ≥15 years; that were delivered or led by trained HCP. Data were extracted including study location, design, quality, outcomes measured and effectiveness. Five out of 1393 studies met the inclusion criteria, of which four were from a high-income country and one a lower-middle income country. Of the PCC components (physical, psychological, social and spiritual wellbeing) delivered alongside HIV clinical management, one study delivered 2, two studies delivered 3 and two studies delivered all 4 components. This review highlights the lack of outcome evidence for person-centred HIV care, and of concurrent focus on all domains of concern for PLWHA within interventions. Clear articulation of the meaning, practice of PCC and implementation strategies are needed to meet policy recommendations.

KEYWORDS:

• Person-centred care
• HIV/AIDS
• holistic care
• holistic assessment
• community-based care

Acknowledgements

This study was conceived and designed by MA-O, KB and RH. The first reviewer (MA-O) imported all search results to Endnote reference manager version X9, de-duplicated, then screened titles and abstracts of all identified studies. Retained studies were screened against inclusion/ exclusion criteria, any article for which inclusion was unclear were discussed with a second reviewer (KB) and if necessary adjudicated by a third reviewer (RH). All authors critically appraised and contributed to the manuscript. I am grateful to God for the wisdom and grace given me to complete this review.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Ghana Education Trust Fund.