Assessing the sustainability of the Systems Analysis and Improvement Approach to increase HIV testing in family planning clinics in Mombasa, Kenya: results of a cluster randomized trial.
Assessing the sustainability of the Systems Analysis and Improvement Approach to increase HIV testing in family planning clinics in Mombasa, Kenya: results of a cluster randomized trial.
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DOI：
10.1186/s13012-022-01242-3
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发表时间：
2022-10-04
影响因子：
7.2
通讯作者：
McClelland, R. Scott
中科院分区：
文献类型：
--
作者：
Long, Jessica E.;Eastment, McKenna C.;Wanje, George;Richardson, Barbra A.;Mwaringa, Emily;Mohamed, Mwanakarama Athman;Sherr, Kenneth;Barnabas, Ruanne, V;Mandaliya, Kishorchandra;Jaoko, Walter;McClelland, R. Scott
关键词：
在肯尼亚，育龄妇女的艾滋病毒感染率最高。一个关键的艾滋病毒缓解战略是将艾滋病毒检测和咨询纳入计划生育服务，但成功的整合仍然存在问题。我们进行了一项随机分组试验，使用系统分析和改进方法（SAIA），以确定和解决瓶颈HTC整合计划生育诊所在蒙巴萨县，肯尼亚。该试验（1）评估了这种方法的有效性，（2）检查了SAIA是否可以可持续地纳入卫生服务部（DOHS）的计划活动。在第1阶段，SAIA在增加HTC摄取方面是有效的。在此，我们介绍了第2阶段，该阶段评估了在蒙巴萨县DOHS实施时SAIA交付是否会持续，以及是否会继续观察到高HTC性能。蒙巴萨县的24个计划生育诊所被随机分配到SAIA实施战略或标准护理。在第1阶段，研究工作人员进行所有研究活动。在第2阶段，我们将SAIA实施过渡到DOHS工作人员，并在过渡后1年将干预诊所与对照诊所的HTC进行比较。研究人员为DOHS实施者提供培训和最低限度的支持，并收集季度HTC结果数据。与计划生育诊所的工作人员进行了访谈，以评估维持HTC交付的障碍和促进因素。计划中的SAIA访视仅完成39%（56/144），主要是由于COVID-19疫情和医护人员罢工持续。在研究的最后一个季度，干预机构81.6%（160/196）的新客户接受了艾滋病毒咨询，而对照机构为22.4%（55/245）（患病率比[PRR]=3.64，95%置信区间[CI]=2.68-4.94）。在干预诊所对60.5%（118/195）的计划生育新客户进行了艾滋病毒检测，而在对照诊所为18.8%（45/240）（PRR=3.23，95%CI =2.29-4.55）。与计划生育诊所工作人员的访谈表明，制度化有助于持续提供人道主义援助，这得益于实施战略的低复杂性和持续监督。尽管大规模的医疗中断和实施战略的不完整交付，但在SAIA过渡到DOHS领导后，干预诊所表现出HTC的持续改善。这些研究结果表明，系统干预措施可能会持续纳入DOHS方案活动。ClinicalTrials.gov（NCT 02994355）于2016年12月16日注册。
In Kenya, HIV incidence is highest among reproductive-age women. A key HIV mitigation strategy is the integration of HIV testing and counseling (HTC) into family planning services, but successful integration remains problematic. We conducted a cluster-randomized trial using the Systems Analysis and Improvement Approach (SAIA) to identify and address bottlenecks in HTC integration in family planning clinics in Mombasa County, Kenya. This trial (1) assessed the efficacy of this approach and (2) examined if SAIA could be sustainably incorporated into the Department of Health Services (DOHS) programmatic activities. In Stage 1, SAIA was effective at increasing HTC uptake. Here, we present Stage 2, which assessed if SAIA delivery would be sustained when implemented by the Mombasa County DOHS and if high HTC performance would continue to be observed. Twenty-four family planning clinics in Mombasa County were randomized to either the SAIA implementation strategy or standard care. In Stage 1, the study staff conducted all study activities. In Stage 2, we transitioned SAIA implementation to DOHS staff and compared HTC in the intervention versus control clinics 1-year post-transition. Study staff provided training and minimal support to DOHS implementers and collected quarterly HTC outcome data. Interviews were conducted with family planning clinic staff to assess barriers and facilitators to sustaining HTC delivery. Only 39% (56/144) of planned SAIA visits were completed, largely due to the COVID-19 pandemic and a prolonged healthcare worker strike. In the final study quarter, 81.6% (160/196) of new clients at intervention facilities received HIV counseling, compared to 22.4% (55/245) in control facilities (prevalence rate ratio [PRR]=3.64, 95% confidence interval [CI]=2.68–4.94). HIV testing was conducted with 60.5% (118/195) of new family planning clients in intervention clinics, compared to 18.8% (45/240) in control clinics (PRR=3.23, 95% CI=2.29–4.55). Interviews with family planning clinic staff suggested institutionalization contributed to sustained HTC delivery, facilitated by low implementation strategy complexity and continued oversight. Intervention clinics demonstrated sustained improvement in HTC after SAIA was transitioned to DOHS leadership despite wide-scale healthcare disruptions and incomplete delivery of the implementation strategy. These findings suggest that system interventions may be sustained when integrated into DOHS programmatic activities. ClinicalTrials.gov (NCT02994355) registered on 16 December 2016.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1097/qad.0000000000003099
发表时间：
2022-02-01
期刊：
AIDS (London, England)
影响因子：
--
作者：
Eastment MC;Wanje G;Richardson BA;Mwaringa E;Sherr K;Barnabas RV;Perla M;Mandaliya K;Jaoko W;McClelland RS
通讯作者：
McClelland RS
影响因子：
3.2
作者：
Fabian, Katrin E.;Muanido, Alberto;Wagenaar, Bradley H.
通讯作者：
Wagenaar, Bradley H.
影响因子：
7.2
作者：
Cumbe, Vasco F. J.;Muanido, Alberto Gabriel;Turner, Morgan;Ramiro, Isaias;Sherr, Kenneth;Weiner, Bryan J.;Flaherty, Brian P.;Sharma, Monisha;Faduque, Flavia;Xerinda, Ernesto Rodrigo;Wagenaar, Bradley H.
通讯作者：
Wagenaar, Bradley H.
DOI：
10.1016/s2352-3018(20)30359-3
发表时间：
2021-03
期刊：
The lancet. HIV
影响因子：
--
作者：
Dorward J;Khubone T;Gate K;Ngobese H;Sookrajh Y;Mkhize S;Jeewa A;Bottomley C;Lewis L;Baisley K;Butler CC;Gxagxisa N;Garrett N
通讯作者：
Garrett N