Qualitative evaluation of the Systems Analysis and Improvement Approach as a strategy to increase HIV testing in family planning clinics using the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework.
Qualitative evaluation of the Systems Analysis and Improvement Approach as a strategy to increase HIV testing in family planning clinics using the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework.
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DOI：
10.1186/s43058-022-00342-x
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发表时间：
2022-09-08
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计划生育诊所在艾滋病毒检测和咨询方面仍存在重大差距。为了解决这些差距，我们的团队测试了一种名为系统分析和改进方法（SAIA）的实施策略，这是一种基于证据的多组件实施策略，专注于改善整个护理级联。在肯尼亚蒙巴萨县24家FP诊所的一项随机分组试验中，与对照诊所相比，SAIA导致干预诊所的HTC显著增加。本文的目的是使用实施研究综合框架（CFIR）评估SAIA，并评估实施成果框架的可接受性，适当性和可行性。该定性评估嵌套在随机分组试验中。数据收集包括问卷调查，以评估可修改和不可修改的卫生系统因素相关的HTC和深入的访谈，以查询诊所规范，优先事项，沟通策略，并准备改变。关注的主要结果是SAIA的可行性、适当性和可接受性。收集了FP诊所内部设置和结构特征的数据，以了解背景如何影响结果。所有访谈都进行了记录，并使用快速评估方法进行分析。在12个干预诊所中，6个（50%）是公共设施。资源的可用性因诊所而异。大多数诊所都有积极的实施氛围，领导层参与，并能获得资源和信息。虽然并非所有诊所都将HTC确定为诊所的优先事项，但大多数诊所都报告说，FP诊所内存在着拥抱变革和认识到艾滋病毒检测重要性的强烈文化。访谈强调了SAIA的高度可接受性、适当性和可行性。实施策略并不复杂，并且非常适合现有的临床流程。特别是，工作人员赞赏SAIA允许诊所工作人员生成他们实施的上下文相关的解决方案。SAIA在不同规模、能力和管理支持的FP诊所中实施，被认为是可接受的、适当的和可行的。诊所工作人员在提出和实施自己的解决方案时所感受到的代理可能是SAIA成功的一部分。我们预计，当SAIA在未来的试验中扩大到更多的诊所时，这将继续成为SAIA成功的机制。ClinicalTrials.gov（NCT02994355）于2016年12月16日注册。
Significant gaps remain in HIV testing and counseling (HTC) in family planning (FP) clinics. To address these gaps, our group tested an implementation strategy called the Systems Analysis and Improvement Approach (SAIA), an evidenced-based multi-component implementation strategy focused on improving entire care cascades. In a cluster randomized trial of 24 FP clinics in Mombasa County, Kenya, SAIA led to a significant increase in HTC in intervention clinics compared to control clinics. The objective of this manuscript was to evaluate SAIA using the Consolidated Framework for Implementation Research (CFIR) and assess the Implementation Outcomes Framework outcomes of acceptability, appropriateness, and feasibility. This qualitative assessment was nested within the cluster-randomized trial. Data collection included questionnaires to assess modifiable and non-modifiable health system factors related to HTC and in-depth interviews to query clinic norms, priorities, communication strategies, and readiness for change. The primary outcomes of interest were feasibility, appropriateness, and acceptability of SAIA. Data on inner setting and structural characteristics of FP clinics were collected to inform how context may impact outcomes. All interviews were recorded and analyzed using a rapid assessment approach. Of the 12 intervention clinics, 6 (50%) were public facilities. Availability of resources varied by clinic. Most clinics had a positive implementation climate, engaged leadership, and access to resources and information. While not all clinics identified HTC as a clinic priority, most reported a strong culture of embracing change and recognition of the importance of HIV testing within FP clinics. Interviews highlighted very high acceptability, appropriateness, and feasibility of SAIA. The implementation strategy was not complicated and fit well into existing clinic processes. In particular, staff appreciated that SAIA allowed clinic staff to generate contextually relevant solutions that they implemented. SAIA was implemented in FP clinics of varying sizes, capacity, and management support and was found to be acceptable, appropriate, and feasible. The agency that clinic staff felt in proposing and implementing their own solutions was likely part of SAIA’s success. We anticipate this will continue to be a mechanism of SAIA’s success when it is scaled up to more clinics in future trials. ClinicalTrials.gov (NCT02994355) registered 16 December 2016.