Abstract
Evidence-based HIV interventions often fail to reach anticipated impact due to insufficient utilization in real-world health systems. Human-centered design (HCD) represents a novel approach in tailoring innovations to fit end-users, narrowing the gap between efficacious interventions and impact at scale. We combined a narrative literature review of HCD in HIV programs with our experience using HCD to redesign an intervention promoting patient-centered care (PCC) practices among health care workers (HCW) in Zambia. We summarize the use and results of HCD in the global HIV response and share case study insights to advance conceptualization of HCD applications. The literature review identified 13 articles (representing 7 studies) on the use of HCD in HIV. All studies featured HCD hallmarks including empathy development, user-driven inquiry, ideation, and iterative refinement. HCD was applied to mHealth design, a management intervention and pre-exposure prophylaxis delivery. Our HCD application addressed a behavioral service delivery target: changing HCW patient-centered beliefs, attitudes, and practices. Through in-depth developer-user interaction, our HCD approach revealed specific HCW support for and resistance to PCC, suggesting intervention revisions to improve feasibility and acceptability and PCC considerations that could inform implementation in transferable settings. As both a research and implementation tool, HCD has potential to improve effective implementation of the HIV response, particularly for product development; new intervention introduction; and complex system interventions. Further research on HCD application strengths and limitations is needed. Those promoting PCC may improve implementation success by seeking out resonance and anticipating the challenges our HCD process identified.
Highlights
Today’s public health response to HIV has a robust set of evidence-based tools with which to address the global epidemic [eg, antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), and voluntary medical male circumcision], implementation has failed to achieve the tools’ full preventive and therapeutic potential.[1]
Our review suggested that Human-centered design (HCD) offers an important and emerging tool for adapting strategies to enhance ART services
Successful HCD outcomes are no panacea and likely depend on relationships, time, and other resources required for authentic engagement and responsiveness, which may not always be available
Summary
Human-Centered Design Lessons for HIV IS morbidities, and mortality.[3] These gaps demand alternative and innovative treatment delivery models—drawing from interdisciplinary perspectives—for advancing the public health response.[4,5]. HCD brings end-users and developers together to cocreate health products, services, or delivery strategies that identify, prioritize, and address barriers to usability.[6,7,8] Traditionally, HCD focused on product development using participatory activities emphasizing researcher and user interaction to improve intervention utility, uptake, sustainability, and effectiveness.[7,8,9] no single definition of HCD in health exists,[6] there are hallmarks present across HCD applications[7,8,9] (Table 1). Human-centered design (HCD) represents a novel approach in tailoring innovations to fit end-users, narrowing the gap between efficacious interventions and impact at scale
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