Making Implementation Science Work for Children and Adolescents Living With HIV
Making Implementation Science Work for Children and Adolescents Living With HIV
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DOI：
10.1097/qai.0000000000001750
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发表时间：
2018-08-15
影响因子：
3.6
通讯作者：
Ross, David A.
中科院分区：
文献类型：
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作者：
Mark, Daniella;Geng, Elvin;Ross, David A.
全球艾滋病毒防治工作正在把儿童和青少年抛在后面。由于缺乏对这些年龄组的治疗和护理模式的研究，我们对如何最好地实施服务以改善其健康结果的理解存在差距。如果没有这些证据，政策制定者就只能从成人研究中进行推断，这可能是不合适的，并可能导致服务提供效率低下、吸收受阻以及支持最佳结果的机制无效。实施科学研究旨在调查在研究环境中已知有效的干预措施如何在现实世界的项目中常规实施。有效的实施科学研究必须是政府、资助机构、调查人员和实施者之间的合作努力，每个人都发挥着关键作用。在儿童和青少年中成功地开展科学研究，需要制定更明确的政策，规定服务和研究的同意年龄，这些政策符合道德标准，但允许合理修改。在这些年龄组的实施研究还需要与年龄相适应的咨询和儿童，青少年及其照顾者的参与。最后，必须优先考虑资源、系统、技术和培训，以改善按年龄/性别分列的数据的提供和质量。实施科学在促进了解儿童和青少年艾滋病毒服务的多重复杂障碍如何阻碍有效干预措施惠及更多感染艾滋病毒的儿童和青少年方面发挥着明确的作用，并完全能够弥补这些年龄组艾滋病毒应对工作中的差距。现在比以往任何时候都更是如此，2020年全球目标紧迫而雄心勃勃，而迄今为止这些年龄组的进展不足。
The global HIV response is leaving children and adolescents behind. Because of a paucity of studies on treatment and care models for these age groups, there are gaps in our understanding of how best to implement services to improve their health outcomes. Without this evidence, policymakers are left to extrapolate from adult studies, which may not be appropriate, and can lead to inefficiencies in service delivery, hampered uptake, and ineffective mechanisms to support optimal outcomes. Implementation science research seeks to investigate how interventions known to be efficacious in study settings are, or are not, routinely implemented within real-world programmes. Effective implementation science research must be a collaborative effort between government, funding agencies, investigators, and implementers, each playing a key role. Successful implementation science research in children and adolescents requires clearer policies about age of consent for services and research that conform to ethical standards but allow for rational modifications. Implementation research in these age groups also necessitates age-appropriate consultation and engagement of children, adolescents, and their caregivers. Finally, resource, systems, technology, and training must be prioritized to improve the availability and quality of age-/sex-disaggregated data. Implementation science has a clear role to play in facilitating understanding of how the multiple complex barriers to HIV services for children and adolescents prevent effective interventions from reaching more children and adolescents living with HIV, and is well positioned to redress gaps in the HIV response for these age groups. This is truer now more than ever, with urgent and ambitious 2020 global targets on the horizon and insufficient progress in these age groups to date.