Implementation opportunities and challenges identified by key stakeholders in scaling up HIV Treatment as Prevention in British Columbia, Canada: a qualitative study
Implementation opportunities and challenges identified by key stakeholders in scaling up HIV Treatment as Prevention in British Columbia, Canada: a qualitative study
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DOI：
10.1186/s43058-020-00044-2
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发表时间：
2020-06-16
影响因子：
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通讯作者：
Knight, Rod
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文献类型：
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作者：
Chayama, Koharu Loulou;McNeil, Ryan;Knight, Rod
背景 加拿大不列颠哥伦比亚省 (BC) 是首批将艾滋病毒治疗作为预防 (TasP) 扩大到人口水平的司法管辖区之一，包括提供资金和政策承诺，加强艾滋病毒检测工作（例如扩大常规、选择退出检测），同时向所有艾滋病毒感染者普遍提供抗逆转录病毒治疗。因此，BC 代表了一个关键背景，可以在其中确定影响 TasP 可扩展性的因素（例如可接受性、采用性、忠诚度、公平覆盖范围、可持续性），包括关键机遇和挑战。方法我们对 10 个主要利益相关者进行深入、半结构化的访谈，其中包括地方和省级的政策制定者以及社区组织的代表。使用实施研究综合框架（CFIR）来指导数据收集、编码和分析，我们确定了影响实践转型和扩大规模的关键因素。 结果 有助于 TasP 成功扩大规模的关键因素包括： (ii) 内部环境实施氛围，部分是由政府对 TasP 的大量且具有高度象征意义的投资塑造的； (iii) 外部环境的特征，例如外部政策（例如减少危害），为实施新的艾滋病毒干预“系统级”方法创造了机会； (iv) 一些“中层”影响者的个人属性，包括由一些积极性高、注重社会正义的个人组成的团队（例如，致力于服务边缘化人群的人）； (v) 开发各种实施流程的能力，这些流程可以在高度分散的服务提供系统中保持“灵活和循证”的适应，同时还创造机会根据“实时”计划数据调整 TasP 编程的特征。结论 CFIR 所有五个领域（干预特征、外部环境、内部环境、个人特征和流程）的结构被确定为影响 TasP 在 BC 的成功。我们的研究结果为 BC 如何成功实施和扩大已证明有效的其他系统级干预措施提供了重要见解，同时也为目前或计划扩大 TasP 的其他司法管辖区提供了见解。
Background The province of British Columbia (BC), Canada, was among the first jurisdictions to scale up HIV Treatment as Prevention (TasP) to the population level, including funding and policy commitments that enhanced HIV testing efforts (e.g., expansion of routine, opt-out testing), while also making antiretroviral therapy universally available to all people living with HIV. As such, BC represents a critical context within which to identify factors that influenced the scalability of TasP (e.g., acceptability, adoption, fidelity, equitable reach, sustainability), including key opportunities and challenges.Methods We draw on in-depth, semi-structured interviews with 10 key stakeholders, comprised policymakers at the local and provincial levels and representatives from community-based organizations. Using the Consolidated Framework for Implementation Research (CFIR) to guide data collection, coding, and analysis, we identified key factors that influenced practice transformation and scale up.Results Key factors that contributed to the successful scale up of TasP included: (i) opportunities that enhanced stakeholder buy-in based on features of the intervention characteristics, including with regard to assessments about the quality and strength of evidence supporting TasP; (ii) an inner setting implementation climate that was, in part, shaped by the large and highly symbolic government investments into TasP; (iii) features of the outer setting such as external policies (e.g., harm reduction) that cultivated opportunities to implement new "systems-level" approaches to HIV intervention; (iv) the personal attributes of some "middle-level" influencers, including a team that was comprised of some highly motivated and social justice-oriented individuals (e.g., folks who were deeply committed to serving marginalized populations); and (v) the capacity to develop various implementation processes that could maintain "nimble and evidence-informed" adaptations across a highly decentralized service delivery system, while also creating opportunities to adapt features of TasP programming based on "real time" program data.Conclusion Constructs across all five domains of CFIR (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified to influence the success of TasP in BC. Our findings provide important insights into how BC can successfully implement and scale up other systems-level interventions that have demonstrated efficacy, while also offering insights for other jurisdictions that are currently or planning to scale up TasP.