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研究生： 歐立德
OLETE, RODENIE
論文名稱： 評估菲律賓社區型診所中以人為本與差異化之HIV照護：一項採用 HIV 感染狀態中立框架之實施科學研究
Evaluating Person-Centered and Differentiated HIV Care in Community-Based Clinics in the Philippines: An Implementation Science Study using HIV Status-Neutral Framework
指導教授： 莊佳蓉
Strong, Carol
學位類別： 博士
Doctor
系所名稱： 醫學院 - 公共衛生學系
Department of Public Health
論文出版年： 2026
畢業學年度： 114
語文別： 英文
論文頁數： 219
中文關鍵詞： 社區型 HIV 科學 、以人為本照護 、HIV 感染狀態中立框架 、差異化服務提供 、實施科學
外文關鍵詞： Community-based HIV Science, Person-Centered Care, Status-Neutral Approach, Differentiated Service Delivery, Implementation Science
ORCID： https://orcid.org/0000-0003-0249-8706
相關次數： 點閱：4  下載：0 
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    • 本論文採用整合性實施科學方法，評估菲律賓社區主導診所中以人為本與差異化之 HIV 照護的實施情形、執行成效及長期結果。本研究以「感染狀態中立」框架為基礎，結合質性、量化與長期資料分析方法，探討 HIV 服務在四個 SAIL 診所中的提供方式、使用情形及其可持續性。
    本研究所回應的核心問題為：儘管已有有效的生物醫學與創新的服務管道，關鍵族群的服務覆蓋率、持續就醫率及公平性成果仍存在落差。本論文不將此現象視為介入措施的失敗，而是將其概念化為由組織、結構與政策條件所形塑的「實施落差」。
    本研究採用三種互補性方法。首先，透過正常化過程理論（Normalization Process Theory）進行質性分析，探討以人為本照護、差異化服務及感染狀態中立模式如何被整合至日常臨床實務中。研究結果顯示，第一線人員對上述照護模式具有高度認同，但其實施仍受到組織脆弱性的限制，包括資金不穩定、人力不足，以及高度依賴非正式的互動關係的工作方式。這些限制影響服務提供的一致性與可持續性。
    其次，本研究運用 RE-AIM 架構評估遠距 PrEP 計畫（SAIL-telePrEP）的實施成效。結果顯示該計畫具有高度接受度與使用持續性，但在不同關鍵族群之間的覆蓋率不均。污名與懲罰性政策等結構性因素限制了部分邊緣族群（如藥物使用者）的服務可近性。此結果顯示，計畫成效不僅取決於服務設計，也深受社會與政策環境影響。
    第三，本研究透過多狀態存活分析（multistate survival analysis）檢視 HIV 感染者的長期治療參與情形。結果指出，治療參與呈現動態變化，包含反覆的中斷與再進入治療，而非單一線性歷程。立即抗病毒藥物治療可降低中斷風險，但結構性與人口學因素仍為治療中斷的重要預測因子。此發現挑戰傳統靜態留存指標，並強調需採用持續且具調適性的照護策略。
    綜合上述研究結果，本論文提出「三層次實施診斷」架構。組織能力影響計畫覆蓋，計畫覆蓋進而影響個人層級的治療參與結果。個人層級的流失現象，實際上反映了上游計畫設計與制度支持的限制。此架構提供一個更完整的觀點，以理解實施條件如何轉化為族群與臨床層級的健康結果。
    此外，本研究將上述發現置於全球 HIV 融資與政策轉型的脈絡中進行討論。社區主導的 HIV 計畫長期依賴外部資助，而此類資金來源正逐漸不穩定。全球趨勢顯示，將 HIV 服務整合至初級健康照護系統，是促進永續性的可能方向。然而，本論文指出整合本身並非必然有效，其成功取決於是否能維持社區主導特性、提供無汙名的照護環境，以及確保足夠的資源與人力支持。若缺乏上述條件，整合反而可能削弱社區模式原有的優勢。
    作為潛在策略之一，本論文提出「社會契約機制」（social contracting），作為在國家健康體系中支持社區服務的可行途徑。此機制使政府得以資助社區組織，同時保留其運作自主性與以信任為基礎的服務模式。
    總體而言，本論文透過整合多種理論與方法，提供一套多層次的健康系統診斷，對實施科學領域有所貢獻。研究結果不僅提供東南亞地區社區主導 HIV 照護的實證資料，也為提升健康系統效能、促進公平性及強化長期治療成果提供具體政策建議。

    This dissertation evaluates the implementation, performance, and long-term outcomes of person-centered and differentiated HIV care in community-led clinics in the Philippines using an integrated implementation science approach. The study is grounded in a status-neutral framework and combines qualitative, quantitative, and longitudinal methods to examine how HIV services are delivered, accessed, and sustained across four Save And Improve Lives (SAIL) community-based clinics.
    The research addresses a central problem in HIV care: despite the availability of effective biomedical and service delivery innovations, gaps persist in reaching key populations, sustaining engagement, and achieving equitable outcomes. Rather than treating these gaps as failures of interventions, this dissertation conceptualizes them as manifestations of an implementation gap shaped by organizational, structural, and policy conditions.
    Three complementary approaches were used. First, a qualitative study guided by Normalization Process Theory examined how person-centered care, differentiated service delivery, and status-neutral approaches are integrated into routine clinical practice. Findings show that frontliner demonstrate strong commitment to these models, but their implementation is constrained by organizational fragility, including unstable funding, limited workforce capacity, and reliance on informal relational work. These constraints affect the consistency and sustainability of service delivery.
    Second, a quantitative evaluation using the RE-AIM framework assessed the implementation of a telehealth-based PrEP program (SAIL-telePrEP). The results indicate high acceptability and persistence among users, but uneven reach across key populations. Structural barriers, including stigma and punitive policies, limit access for marginalized groups such as people who use drugs. These findings suggest that program effectiveness depends not only on service design but also on the broader social and policy environment.
    Third, a multistate survival analysis examined long-term HIV treatment engagement among people living with HIV. The results demonstrate that engagement is dynamic, characterized by cycles of disengagement and re-engagement rather than linear retention. Rapid ART initiation reduces the risk of disengagement, but structural and demographic factors remain significant predictors of treatment interruption. These findings challenge static retention metrics and highlight the need for continuous, adaptive care strategies.
    Synthesizing these findings, the dissertation proposes a three-layer implementation diagnosis. Organizational capacity shapes program reach, and program reach shapes individual engagement outcomes. Failures at the client level reflect upstream constraints in program design and institutional support. This framework provides a more comprehensive understanding of how implementation conditions translate into population-level and clinical outcomes.
    The study also situates these findings within the broader global HIV financing and policy context. Community-led HIV programs remain heavily dependent on external donor funding, which is increasingly unstable. Global evidence suggests a shift toward integrating HIV services into primary health care systems to ensure sustainability. However, this dissertation argues that integration is not inherently beneficial. Its success depends on preserving community leadership, ensuring stigma-free care, and maintaining adequate financing and workforce capacity. Without these conditions, integration risks undermining the relational and contextual strengths that enable community-led models to reach marginalized populations.
    As a potential pathway, the dissertation highlights social contracting as a strategy to sustain community-led services within national health systems. This approach allows governments to finance community organizations while maintaining their operational autonomy and trust-based service delivery.
    Overall, this dissertation contributes to implementation science by demonstrating the value of combining theoretical frameworks and methodological approaches to generate a multi-level diagnosis of health system performance. It provides empirical evidence from Southeast Asia on how community-led HIV care functions under real-world conditions and offers actionable insights for strengthening health systems, improving equity, and sustaining long-term HIV outcomes.

    Title Page i Dissertation Summary iv Table of Contents ix List of Tables and Figures xii List of Abbreviated Terms xiv Part I: The Foundations 1 Chapter 1 3 1.1 Background and Rationale 3 1.2 Research Aims and Objectives 6 Aim 1 6 Aim 2 6 Aim 3 7 1.3 Significance of the Study 8 1.4 Organization of the Dissertation 10 Chapter 2 11 2.1 HIV Care and Universal Health Care in the Philippines 11 2.2 The Role of CBO in Advancing Equitable HIV Responses 14 2.3 The Punitive Drug Law and Its HIV Consequences 16 2.4 Person-Centered Care and Differentiated Service Delivery 17 2.5 The Status-Neutral Approach in HIV Care 20 2.6 Rethinking PrEP Delivery in the Philippines 22 2.7 Same-Day and Rapid ART Initiation and Long-Term HIV Care 24 2.8 Synthesis of the Literature 26 Chapter 3 28 3.1 Implementation Science: An Overview 28 3.2 Implementation Science, QI, and HSR 30 3.3 Normalization Process Theory 34 3.4 RE-AIM Framework 39 3.5 Multistate Modeling as an Implementation Science Tool 43 3.6 The Three Frameworks As a Complementary Toolkit 46 3.7. Ethical Considerations 50 Part II: The Three Studies 51 Chapter 4 53 Preface 53 Abstract 54 4.1 Study Background 55 4.2 Methods 57 4.2.1 Research Design and Theoretical Framework 57 4.2.2 Study Setting and Programs Implemented 57 4.2.3 Participants and Data Sources 60 4.2.4 Analysis 62 4.2.5 Positionality And Reflexivity 64 4.3 Results 67 Proposition 1 67 Proposition 2 69 Proposition 3 71 Proposition 4 73 Proposition 5 75 4.4 Discussion 78 4.4.1 Identity-Based Internalization as a Distinct Coherence Pathway 78 4.4.2 How Resource Constraints Undermine Normalization 79 4.4.3 Adaptive Execution and the Limits of Informal Sustainability 80 4.4.4 Structural Implications for Community-Based HIV Programs 81 4.4.5 Organizational Fragility as a Population-Level Implementation Problem 83 4.5 Limitations 84 4.6 Conclusion 85 Chapter 5 86 Preface 86 Abstract 87 5.1 Study Background 88 5.2 Methodology 90 5.2.1 Program Description: SAIL-TelePrEP as a DSD Model 90 5.2.2 Study Design and Data Sources 92 5.2.3 Study Population 92 5.2.4 Outcome Definitions by RE-AIM Dimension 93 5.2.5 Statistical Analysis 95 5.3 Results 96 5.3.1 Client Characteristics 96 5.3.2 Reach: Uptake Patterns and Associated Factors 97 5.3.3 Effectiveness: PrEP Persistence and Seroconversion 99 5.3.4 Adoption: Clinic-Level Uptake Variation 99 5.3.5 Implementation: Service Delivery and Logistics Patterns 101 5.3.6 Maintenance: Policy Integration as a Leading Indicator 103 5.4 Discussion 105 5.4.1 Who SAIL-TelePrEP Reached and Who It Missed 105 5.4.2 Effectiveness: Persistence as Evidence of Model Fit 106 5.4.3 Adoption and Implementation: Geography, Logistics, and the Cost Of Distance 107 5.4.4 Maintenance and the Path to Scale 108 5.4.5 Organizational Coherence as Determinant of Reach: NPT and RE-AIM 109 5.5 Limitations 112 5.6 Conclusion 113 Chapter 6 114 Preface 114 Abstract 115 6.1 Study Background 116 6.2 Methodology 118 6.2.1 Study Design and Study Setting 118 6.2.2 Data Sources and Cohort Construction 118 6.2.3 State Definitions and Multistate Framework 120 6.2.4 Covariates 121 6.2.5 Statistical Analysis 122 6.3 Results 124 6.3.1 Cohort Characteristics 124 6.3.2 Observed State Occupation Over Time 127 6.3.3 Aalen–Johansen State-Occupation Probabilities 128 6.3.4 Factors Associated with Disengagement And Re-Engagement 129 6.4 Discussion 132 6.4.1 Reframing Retention: HIV Care as a Cyclical Process 132 6.4.2 Start Initiation: Early Protection without Long-Term Immunity 132 6.4.3 Structural Over Behavioral Determinants of Engagement 133 6.4.4 Re-Engagement as a Programmatic Priority, Not a Failure Indicator 134 6.4.5 Connecting Aim 3 to the Dissertation Argument 135 6.5 Limitations 137 6.6 Conclusion 138 Part III: The Synthesis 139 Chapter 7 141 7.1 Triangulation: What the Three Frameworks Show 141 7.1.1 Cross-Study Integration and Interpretation 141 7.1.2 The Empirical Bridge: From the Strongest Connection to the Most Nuanced 141 7.1.3 Community-Based Care Works within Real Resource Constraints 144 7.1.4 What The Evidence Does Not Establish 145 7.1.5 A Methodological Bridge: Why Chapter 6's Follow-Up Data is Incomplete 146 7.2 The Productive Tension that this Study Found 149 7.3 Implementation Gaps as a Question of Obligation 150 7.4 Synthesis, Strengths, and Limitations of this Dissertation 152 7.4.1 Synthesis 152 7.4.2 Strengths 152 7.4.3 Limitations 153 7.5 A Personal Note 156 Chapter 8 157 8.1 What this Dissertation Set Out to Do 157 8.2 Summary of Key Findings 158 8.2.1 Study 1: Normalization is Real and Institutionally Thin 158 8.2.2 Study 2: TelePrEP Reached Some Populations and Missed Others 158 8.2.3 Study 3: HIV Care Engagement is Cyclical, Not Linear 159 8.2.4 What The Evidence Demands 160 8.3 Contributions of this Dissertation 161 8.3.1 Contribution to Implementation Science 161 8.3.2 Contribution to HIV Science 162 8.3.3 Contribution to the Philippine HIV Response 162 8.4 Future Research Directions 164 8.4.1 Client-Facing Implementation Research 164 8.4.2 Longitudinal Follow-Up of SAIL Organizational Transition 164 8.4.3 PWID-Specific HIV Prevention Research 164 8.4.4 Comparative Implementation Research Across Settings 165 8.4.5 Metrics Development for Dynamic HIV Care Engagement 165 8.5 The Claim and the Obligation 166 References 168 Appendix A. Ethical Clearances 181 Appendix B. DOH HIV Testing Standardized Form 187 Appendix C. DOH PrEP Initiation and Follow-Up Standardized Form 189 Appendix D. DOH ART Initiation and Follow-Up Standardized Form 192 Appendix E. Informed Consent Form – NPT Guided Interview with SAIL Personnel 193 Appendix F. Interview Guide – NPT Guided Interview With Sail Personnel 195 Appendix G. Coding Manual For Aim 1 (Adapted from May and Colleagues, 2022) 196 Appendix H. Reflexive Memo and Reflections of a Coder 204

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