HIV-Related Implementation Research for Key Populations: Designing for Individuals, Evaluating Across Populations, and Integrating Context
HIV-Related Implementation Research for Key Populations: Designing for Individuals, Evaluating Across Populations, and Integrating Context
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DOI：
10.1097/qai.0000000000002191
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发表时间：
2019-12-01
影响因子：
3.6
通讯作者：
Baral, Stefan
中科院分区：
文献类型：
--
作者：
Schwartz, Sheree R.;Rao, Amrita;Baral, Stefan
简介：关键人群，包括男男性行为者、变性人、性工作者、注射毒品者和被监禁人口，承受着艾滋病毒的沉重负担，迫切需要有效的干预措施。然而，关键人群实施研究（IR）的证据基础仍然薄弱，并对流行病学推断提出了具体的挑战。我们应用IR的综合框架来考虑IR与key population.Discussion的具体挑战和建议：在关键人群中的个人存在内部和外部设置，包括组织结构，法律的（如，刑事化），和资金环境，影响干预措施的设计，采用和保真度，以及干预规模的潜在可持续性。潜在的脆弱性和外部的压力，在个人层面上经历（如无家可归，暴力）进一步影响参与和保留在IR。因此，研究人员应占在研究过程中的代表性，开始与社区参与IR设计和考虑枚举/抽样方法的关键人群谁缺乏概率抽样框架。关键人群的干预措施需要大量的适应性和复杂性（例如，个性化，多成分），以确保适当性;然而，复杂性的需求与内部有效性（保真度）和外部有效性（可推广的规模）的挑战之间存在紧张关系。最后，整合上下文，抽样和实施元素到分析方法是至关重要的有效性evaluation.Conclusions：翻译有效的调查结果，在个人层面的有效性，在人口水平需要承认的风险异质性。认识到与关键人群合作的细微差别对于确保设计代表个人并因此实现人群健康方面的收益至关重要。
Introduction: Key populations, including men who have sex with men, transgender people, sex workers, people who inject drugs, and incarcerated populations, experience high burdens of HIV and urgently need effective interventions. Yet the evidence base for implementation research (IR) with key populations remains weak and poses specific challenges to epidemiologic inference. We apply the Consolidated Framework for IR to consider specific challenges and recommendations for IR with key populations.Discussion: Individuals within key populations exist within inner and outer settings-including organizational structures, legal (eg, criminalization), and funding environments-which influence the design, adoption and fidelity of interventions, and the potential sustainability of intervention scale-up. Underlying vulnerabilities and external stressors experienced at the individual level (eg, homelessness, violence) further impact participation and retention in IR. Thus, researchers should account for representation in the research process, beginning with community engagement in IR design and consideration of enumeration/sampling methods for key populations who lack probabilistic sampling frames. Interventions for key populations require substantial adaptation and complexity (eg, individually tailored, multicomponent) to ensure appropriateness; however, there is tension between the need for complexity and challenges to internal validity (fidelity) and external validity (generalizable scale-up). Finally, integrating contextual, sampling, and implementation elements into analytic approaches is critical for effectiveness evaluation.Conclusions: Translation of efficacious findings at the individual level to effectiveness at the population level requires recognition of risk heterogeneity. Recognizing the nuances of working with key populations is essential to ensure that individuals are represented by design and therefore gains in population health can be achieved.