Specific Aims: The goal of this study is to collect formative data that will provide a foundation for future interventions to improve patient engagement in antiretroviral therapy (ART) programs in Mali through targeted improvements in provider communication skills. Specifically, the study aims to (1) examine the nature and content of patient-provider communication (PPC) and how it influences patient engagement in ART programs and (2) measure patient preferences toward different styles of PPC. Significance: As access to ART in sub-Saharan Africa expands, optimizing patient engagement in ART programs becomes increasingly important. Mali's 12-month retention rate of ART patients is one of the lowest in the region at 64%. Recently, there has been growing attention to the role of PPC in patient retention and adherence in ART programs in sub-Saharan Africa. Positive effects of implementing pre- service PPC trainings have been documented in medical and nursing schools in high-income countries, yet similar trainings in sub-Saharan Africa are limited or non-existent. Integrating PPC training interventions in medical and nursing curricula is a potentially effective and sustainable opportunity to improve patient engagement in ART programs. Formative research for such efforts is needed. Approach: This study will build of the applicant's previous experience in Mali and partnership with the University of Bamako. It will be based at three major clinical ART sites. This mixed method study with a foundation in patient-centered care theory.
Aim 1 will be achieved with qualitative interviews and focus groups with people living with HIV and ART clinical providers. This qualitative data will be analyzed with thematic coding and conversation analysis.
Aim 2 will be achieved through a factorial survey that will test ART patient reactions to systematic variations of communication styles in video vignettes. Multiple regression analyses will be used to analyze the data. Fellowship Information: This study will serve as the doctoral dissertation for Ms. Emily Hurley, a current PhD student in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Ms. Hurley has chosen one primary sponsor and three co-sponsors who have complementary expertise in the methods and topics of this project. The training plan is designed with research, coursework and teaching opportunities to help Ms. Hurley achieve her long-term goal of becoming a leading researcher in the social, cultural, and behavioral aspects of primary health care and HIV in sub-Saharan Africa.

Public Health Relevance

Improving engagement of patients in antiretroviral therapy (ART) programs in sub-Saharan Africa is critical to the control of the HIV epidemic. There is increasing attention to the impact of patient-provider communication on ART adherence and patient retention, yet research that systematically examines the nature and substance of clinical interactions is limited. This mixed- methods study aims to better understand patient-provider communication in ART programs in Bamako, Mali and identify intervention opportunities to improve provider communication skills through pre-service training.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1)
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Stoff, David M
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Hurley, Emily A; Doumbia, Seydou; Kennedy, Caitlin E et al. (2018) Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study. BMJ Open 8:e019224
Hurley, Emily A; Harvey, Steven A; Keita, Mariam et al. (2017) Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences. SSM Popul Health 3:539-548