Results of a cluster randomized trial testing the systems analysis and improvement approach to increase HIV testing in family planning clinics.
Results of a cluster randomized trial testing the systems analysis and improvement approach to increase HIV testing in family planning clinics.
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DOI：
10.1097/qad.0000000000003099
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发表时间：
2022-02-01
期刊：
影响因子：
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通讯作者：
McClelland RS
中科院分区：
文献类型：
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作者：
Eastment MC;Wanje G;Richardson BA;Mwaringa E;Sherr K;Barnabas RV;Perla M;Mandaliya K;Jaoko W;McClelland RS
测试一项实施战略，即系统分析和改进方法（SAIA），以提高肯尼亚蒙巴萨计划生育诊所的艾滋病毒检测和咨询（HTC）率。集群随机试验24家计划生育诊所按1:1随机分组，分别实施SAIA和常规程序。研究人员每月与计划生育诊所的工作人员进行一次SAIA周期，为期12个月。SAIA有五个步骤。步骤1使用“级联分析”工具来量化完成流程每个步骤的个人数量。步骤2涉及到顺序流程映射，以识别系统中可修改的瓶颈。步骤3开发和实现工作流修改以解决瓶颈。步骤4通过重新计算级联分析来评估修改的影响。步骤5重复这个循环。主要结果是在试验的最后一个季度中，新的计划生育客户接受艾滋病毒检测的比例。在试验的最后三个月，85%（740/868）的计划生育新客户在干预诊所接受了艾滋病毒咨询，而在对照诊所为67%(1036/1542)（患病率比[PRR] 1.27, 95%可信区间[CI] 1.15-1.30）。42%（364/859）的计划生育患者在干预诊所接受艾滋病毒检测，而在对照诊所接受检测的比例为32% (485/1521)（PRR为1.33,95%CI为1.16-1.52）。SAIA导致蒙巴萨计划生育诊所的艾滋病毒检测显著增加。将常规的HTC纳入计划生育诊所是实现联合国艾滋病规划署目标的一项有希望的战略，即95%的艾滋病毒感染者了解自己的状况。
To test an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), to increase rates of HIV testing and counseling (HTC) in family planning (FP) clinics in Mombasa, Kenya. Cluster randomized trial Twenty-four FP clinics were randomized 1:1 to implementing SAIA versus usual procedures. Study staff implemented monthly SAIA cycles with FP clinic staff for 12 months. SAIA has five steps. Step 1 uses a “cascade analysis” tool to quantify the number of individuals who complete each step of a process. Step 2 involves sequential process flow mapping to identify modifiable bottlenecks in the system. Step 3 develops and implements workflow modifications to address bottlenecks. Step 4 assesses impact of the modification by recalculating the cascade analysis. Step 5 repeats the cycle. The primary outcome was the proportion of new FP clients tested for HIV during the last quarter of the trial. During the last three months of the trial, 85% (740/868) of new FP clients were counseled for HIV in intervention clinics compared to 67% (1036/1542) in control clinics (prevalence rate ratio [PRR] 1.27, 95% confidence interval [CI] 1.15-1.30). Forty-two percent (364/859) of FP clients were tested for HIV at intervention clinics compared to 32% (485/1521) at control clinics (PRR 1.33, 95%CI 1.16-1.52). SAIA led to a significant increase in HIV testing in FP clinics in Mombasa. Integrating routine HTC into FP clinics is a promising strategy to achieve the UNAIDS goal of 95% of people living with HIV being aware of their status.