The Role of Patient–Provider Communication in Engagement and Re-engagement in HIV Treatment in Bamako, Mali: A Qualitative Study

Abstract

Mounting evidence in sub-Saharan Africa suggests poor patient-provider communication (PPC) negatively impacts patient engagement (retention in care and adherence to medication) in antiretroviral therapy (ART) programs. In Bamako, Mali, where 36% of ART patients are lost to follow-up within 12 months of initiating treatment, we aimed to define features of positive PPC according to patient values and explore the mechanisms by which these features may sustain engagement and re-engagement according to patient and provider experiences. We conducted 33 in-depth interviews and 7 focus groups with 69 patients and 17 providers in five ART clinics. Regarding sustaining engagement, participants highlighted “establishing rapport” as a foundational feature of effective PPC, but also described how “responding to emotional needs”, “eliciting patient conflicts and perspective” and “partnering to mitigate conflicts” functioned to address barriers to engagement and increase connectedness to care. Patients who had disengaged felt that “communicating reacceptance” may have prompted them re-engage sooner and that tailored “partnering to mitigate conflicts” would be more effective in sustaining re-engagement than the standard adherence education providers typically offer. Optimizing provider skills related to these key PPC features may help maximize ART patient engagement, ultimately improving health outcomes and decreasing HIV transmission in sub-Saharan Africa.

Keywords:

• adherence
• antiretroviral therapy
• retention
• sub-Saharan Africa
• patient–provider communication

Acknowledgments

This work was supported by the National Institute of Mental Health through the Ruth L. Kirchstein National Research Service Award (#1F31MH106398) and the U.S. Department of Education through the Fulbright-Hays Doctoral Dissertation Research Abroad Fellowship (P022A140064). The authors would like to thank Kwame Sakyi, Madeleine Beebe, and Dr. Nicole Warren for comments on early versions of the manuscript as well as Mordibo Kané, Dr. Fodi Diallo, Dr. Issiaka Dembele, and Dr. Sounkalo Dao for support in field logistics.

Additional information

Funding

This work was supported by the National Institute of Mental Health [#1F31MH106398] and Office of Postsecondary Education [P022A140064].