Measures of retention in HIV care: A protocol for a mixed methods study

Retention in HIV care is necessary to achieve adherence to antiretroviral therapy, viral load suppression, and optimal health outcomes. There is no standard definition for retention in HIV care, which compromises consistent and reliable reporting and comparison of retention across facilities, jurisdictions, and studies. The objective of this study is to explore how stakeholders involved in HIV care define retention in HIV care and their preferences on measuring retention.We will use an exploratory sequential mixed methods design involving HIV stakeholder groups such as people living with HIV, people involved in providing care for PLHIV, and people involved in decision-making about PLHIV. In the qualitative phase of the study, we will conduct 20–25 in-depth interviews to collect the perspectives of HIV stakeholders on using their preferred retention measures. The findings from the qualitative phase will inform the development of survey items for the quantitative phase. Survey participants (n = 385) will be invited to rate the importance of each approach to measuring retention on a seven-point Likert scale. We will merge the qualitative and quantitative findings phase findings to inform a consensus-building framework for a standard definition of retention in care.This study has received ethics approval from the Hamilton Integrated Research Ethics Board. The findings will be disseminated through peer-reviewed publications, conference presentations, and among stakeholder groups. This study has limitations; we won’t be able to arrive at a standard definition; a Delphi technique amongst the stakeholders will be utilized using the framework to reach a consensus globally accepted definition.<br><br>人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）护理留存是实现抗逆转录病毒治疗（Antiretroviral Therapy）依从性、病毒载量（Viral Load）抑制以及最优健康结局的必要前提。目前尚无统一的HIV护理留存定义，这妨碍了不同医疗机构、辖区及研究间对留存情况的一致性、可靠报告与对比分析。本研究旨在探究参与HIV护理工作的利益相关方如何界定HIV护理留存，以及他们对留存情况衡量方式的偏好。本研究将采用探索性顺序混合研究设计（Exploratory Sequential Mixed Methods Design），纳入的HIV相关利益相关方群体包括：艾滋病毒感染者（People Living with HIV, PLHIV）、为PLHIV提供护理服务的人员，以及参与PLHIV相关决策的人员。在本研究的定性阶段，我们将开展20至25次深度访谈（In-depth Interview），以收集HIV利益相关方对其偏好的留存情况衡量方式的观点。定性阶段的研究结果将为定量阶段的调查问卷条目开发提供依据。我们将邀请385名调查参与者，采用7点李克特量表（Likert Scale）对每种留存情况衡量方式的重要性进行评分。我们将整合定性与定量阶段的研究结果，以此构建用于形成统一护理留存定义的共识框架。 本研究已获得汉密尔顿综合研究伦理委员会（Hamilton Integrated Research Ethics Board）的伦理审查批准。研究结果将通过同行评议（Peer-reviewed）期刊发表、学术会议汇报以及向利益相关方群体通报的方式进行传播。本研究存在一定局限性：我们无法直接得出统一的留存定义；后续将依托该框架，通过在利益相关方中开展德尔菲法（Delphi Technique）调研，以达成全球公认的HIV护理留存定义。