Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa.
Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa.
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DOI：
10.1016/j.drugalcdep.2020.108206
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发表时间：
2020-10-01
影响因子：
4.2
通讯作者：
Zule WA
中科院分区：
文献类型：
--
作者：
Gichane MW;Wechsberg WM;Ndirangu J;Browne FA;Bonner CP;Grimwood A;Shaikh N;Howard B;Zule WA
南非是全球艾滋病毒感染率最高的国家，对妇女的影响尤为严重。危险的酒精使用会减少抗逆转录病毒药物的坚持，从而可能导致不良健康状况。在现实世界中，很少有针对危险饮酒和艾滋病毒的循证干预措施得到实施。这项研究的目的是评估妇女健康合作社（WHC）的实施成果-一个以证据为基础的性别为重点的艾滋病毒干预措施-这是在开普敦实施。我们使用改进的阶梯楔形设计进行了这项实施科学试验。四个健康诊所与四个物质使用康复计划配对，并随机分为四个周期。每个周期招募感染艾滋病毒和使用酒精或其他药物的妇女（每个周期n=120）。我们使用混合方法评估了采用、可接受性、适当性、成本和保真度。采用：100%接受过世界卫生中心培训并被指定为干预人员的工作人员举办了一个或多个讲习班。可接受性：干预者发现WHC内容对他们的患者有益，WHC改善了设施中临床单位之间的联系。拨款：世界卫生中心与设施的目标保持一致，以提高抗逆转录病毒治疗的依从性和减少酒精使用;然而，在实施方面存在挑战，包括工作人员短缺、污名化以及很少有地方为妇女提供支持服务。费用：实施WHC的费用为每位与会者20.59南非兰特（1.40美元）。保真度：干预者以高度的保真度和质量实施了WHC。研究结果表明，它是可行的，将西隧纳入日常护理设置。今后扩大干预措施的努力将需要解决社会和结构性执行挑战。NCT 02733003于2016年1月21日批准
South Africa has the highest HIV prevalence globally, which disproportionately affects women. Hazardous alcohol use reduces antiretroviral adherence which can lead to adverse health. Few evidence-based interventions addressing hazardous alcohol use and HIV have been implemented in real-world settings. This study aimed to evaluate implementation outcomes from the Women’s Health CoOp (WHC)—an evidence-based gender-focused HIV intervention—which was implemented in Cape Town. We conducted this implementation science trial using a modified stepped-wedge design. Four health clinics were paired with four substance use rehabilitation programs and randomized into four cycles. Women living with HIV and who use alcohol or other drugs were recruited into each cycle (n=120 each cycle). We assessed adoption, acceptability, appropriateness, cost, and fidelity using a mixed methods approach. Adoption: 100% of staff trained in the WHC and designated as interventionists delivered one or more workshops. Acceptability: Interventionists found the WHC content beneficial to their patients and the WHC improved connections between clinical units in facilities. Appropriateness: The WHC aligned with facility goals to improve antiretroviral adherence and reduce alcohol use; however, there were implementation challenges, including staff shortages, stigma, and few places to refer women for supportive services. Cost: The cost of implementing the WHC was 20.59 ZAR (1.40 USD) per attendee. Fidelity: Interventionists implemented the WHC with high fidelity and quality. The findings suggest it is feasible to integrate the WHC into usual-care settings. Future efforts to scale up the intervention will need to address social and structural implementation challenges. NCT02733003 approved 1/21/2016
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DOI：
10.1186/s13012-015-0242-0
发表时间：
2015-04-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Nilsen P
通讯作者：
Nilsen P
影响因子：
3.2
作者：
Brooke-Sumner, Carrie;Petersen-Williams, Petal;Myers, Bronwyn
通讯作者：
Myers, Bronwyn
影响因子：
10.5
作者：
DEWEY, ME
通讯作者：
DEWEY, ME
影响因子：
1.7
作者：
Bogart LM;Chetty S;Giddy J;Sypek A;Sticklor L;Walensky RP;Losina E;Katz JN;Bassett IV
通讯作者：
Bassett IV
影响因子：
2.8
作者：
Howard BN;Van Dorn R;Myers BJ;Zule WA;Browne FA;Carney T;Wechsberg WM
通讯作者：
Wechsberg WM