Assessing readiness to implement long-acting injectable HIV antiretroviral therapy: provider and staff perspectives.
Assessing readiness to implement long-acting injectable HIV antiretroviral therapy: provider and staff perspectives.
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DOI：
10.1186/s43058-023-00506-3
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发表时间：
2023-10-19
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长效注射抗逆转录病毒疗法（LAI-ART）代表了艾滋病毒疗法的下一个创新。需要进行实施前研究，以制定有效的战略，确保艾滋病毒感染者公平地获得LAI-ART。我们与旧金山弗朗西斯科、芝加哥和亚特兰大的艾滋病诊所的提供者和工作人员进行了焦点小组讨论（FGD），以了解LAI-ART实施的障碍和促进因素。与会者还完成了一项关于执行意图的简短调查。FGD通过视频会议举行，记录，转录，并使用与实施研究的综合框架（CFIR）相关的域进行主题分析。在2020年9月至2021年4月期间，我们领导了10个FDG，共有49名参与者，其中约60%是处方提供者。组织对实施变革的准备程度很高，85%的人同意致力于弄清楚如何实施LAI-ART。虽然回答受到每个环境中独特的内部和外部资源的影响，但几个共同的主题，包括实施机制，占主导地位：（1）对LAI-ART的乐观和热情取决于确保公平获得LAI-ART;（2）LAI-ART将ART依从性的主要责任从患者转移到诊所;（3）现有的诊所系统需要加强，以满足依从性挑战患者的需求。所有研究中心的当前系统都可以支持在有限数量的稳定患者中使用LAI-ART。如果不增加人员，扩大规模和公平使用将是一项挑战，甚至是不可能的。与会者概述了实现公平获取所需的计划要素，包括患者的集中跟踪、深入、动手外展的能力以及LAI-ART的移动的交付。研究中心进一步详细说明了与计费/付款人来源以及运输和药物储存相关的对实施的未知物流影响。在这些艾滋病毒护理站点中，向一部分患者提供LAI-ART的诊所准备程度很高。执行方面的主要挑战包括对不平等机会的关切以及认识到加强诊所系统至关重要。
Long-acting injectable antiretroviral therapy (LAI-ART) represents the next innovation in HIV therapy. Pre-implementation research is needed to develop effective strategies to ensure equitable access to LAI-ART to individuals living with HIV. We conducted focus group discussions (FGDs) with providers and staff affiliated with HIV clinics in San Francisco, Chicago, and Atlanta to understand barriers to and facilitators of LAI-ART implementation. Participants also completed a short survey about implementation intentions. FGDs were held via video conference, recorded, transcribed, and thematically analyzed using domains associated with the Consolidated Framework for Implementation Research (CFIR). Between September 2020 and April 2021, we led 10 FDGs with 49 participants, of whom ~60% were prescribing providers. Organizational readiness for implementing change was high, with 85% agreeing to being committed to figuring out how to implement LAI-ART. While responses were influenced by the unique inner and outer resources available in each setting, several common themes, including implementation mechanisms, dominated: (1) optimism and enthusiasm about LAI-ART was contingent on ensuring equitable access to LAI-ART; (2) LAI-ART shifts the primary responsibility of ART adherence from the patient to the clinic; and (3) existing clinic systems require strengthening to meet the needs of patients with adherence challenges. Current systems in all sites could support the use of LAI-ART in a limited number of stable patients. Scale-up and equitable use would be challenging or impossible without additional personnel. Participants outlined programmatic elements necessary to realize equitable access including centralized tracking of patients, capacity for in-depth, hands-on outreach, and mobile delivery of LAI-ART. Sites further specified unknown logistical impacts on implementation related to billing/payer source as well as shipping and drug storage. Among these HIV care sites, clinic readiness to offer LAI-ART to a subset of patients is high. The main challenges to implementation include concerns about unequal access and a recognition that strengthening the clinic system is critical.