The patient-centered medical home: a reality for HIV care in Nigeria

Abstract

Objective: HIV care delivery in resource-limited settings (RLS) may serve as a paradigm for chronic disease care, but comprehensive measurement frameworks are lacking. Our objective was to adapt the patient-centered medical home (PCMH) framework for use in RLS, and evaluate the performance of HIV treatment programs within this framework. Design and setting: Cross-sectional survey administered within the AIDS Prevention Initiative in Nigeria (APIN) network. Participants: Medical directors at APIN clinics. Main outcome measures: We adapted the 2011 US National Committee on Quality Assurance’s PCMH standard to develop a survey measuring five domains of HIV care: (i) enhancing access and continuity, (ii) identifying and managing patient populations, (iii) planning and managing care, (iv) promoting self-care and support and (v) measuring and improving performance. Results: Thirty-three of 36 clinics completed the survey. Most were public (73%) and urban/semi-urban (64%); 52% had >500 patients in care. On a 0–100 scale, clinics scored highest in self-care and support, 91% (63–100%); managing patient populations, 80% (72–81%) and improving performance, 72% (44–78%). Clinics scored lowest with the most variability in planning/managing care, 65% (22–89%), and access and continuity, 61% (33–80%). Average score across all domains was 72% (58–81%). Conclusions: Our findings suggest that the modified PCMH tool is feasible, and likely has sufficient performance variation to discriminate among clinics. Consistent with extant literature, clinics showed greatest room for improvement on access and continuity, supporting the tool’s face validity. The modified PCMH tool may provide a powerful framework for evaluating chronic HIV care in RLS.