Multi-level considerations for optimal implementation of long-acting injectable antiretroviral therapy to treat people living with HIV: perspectives of health care providers participating in phase 3 trials.
Multi-level considerations for optimal implementation of long-acting injectable antiretroviral therapy to treat people living with HIV: perspectives of health care providers participating in phase 3 trials.
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DOI：
10.1186/s12913-021-06214-9
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发表时间：
2021-03-20
影响因子：
2.8
通讯作者：
Kerrigan D
中科院分区：
文献类型：
--
作者：
Mantsios A;Murray M;Karver TS;Davis W;Galai N;Kumar P;Swindells S;Bredeek UF;García RR;Antela A;Gomis SC;Bernáldez MP;Czarnogorski M;Hudson K;Walters N;Kerrigan D
长效注射抗逆转录病毒疗法（LA ART）已被证明不逊色于每日口服抗逆转录病毒疗法，迄今为止的研究表明，患者满意度高，更倾向于口服标准护理，最近已被批准在美国和欧洲使用。本研究考察了参与LA ART临床试验的卫生保健提供者对LA ART在现实世界中推广的潜在障碍和解决方案的看法。该分析利用了两个数据来源：(1)在13个国家参加ATLAS-2 M试验的329名卫生保健提供者的结构化在线调查中嵌入开放式问题；(2)对在美国和西班牙参与FLAIR/ ATLAS/ATLAS-2 M试验的14名提供者进行深入访谈。两项评估都探讨了与引入LA ART相关的提供者观点和诊所动态，并使用主题内容分析进行了分析。实施研究综合框架（CFIR）作为概念框架，支撑了描述研究结果的模型的发展。在个人、诊所和卫生系统层面确定了LA ART实施的障碍和建议的解决方案。提供者对患者层面障碍的认知包括坚持频繁注射预约和注射耐受性的挑战。提出的解决方案包括患者教育、指定工作人员保留门诊访问以及门诊预约安排的灵活性。提供者关心的主要问题是确定合适的LA ART候选人；提出的解决方案侧重于患者与供应商的沟通和决策。诊所层面的障碍包括需要更多的熟练人员来管理注射，工作流程随着需求的增加而变化，以及冷链储存的物流。提出的解决方案包括员工招聘和培训，围绕工作流程和物流的战略规划，以及在其他环境（包括家庭）提供注射的可能性。卫生系统层面的障碍包括成本和国家监管机构的批准。可能的解决办法包括政府补贴治疗，确保费用与口服抗逆转录病毒药物具有竞争力，并提供共同支付援助。结果提示多层次支持系统对优化医患沟通和治疗决策具有重要意义；诊所人员配置、工作流程、后勤协议和基础设施；以及特定卫生系统内与成本相关的因素。在线版本包含补充材料，可在10.1186/s12913-021-06214-9获得。
Long-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings. This analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M trial across 13 countries; and (2) in-depth interviews with 14 providers participating in FLAIR/ ATLAS/ATLAS-2 M trials in the United States and Spain. Both assessments explored provider views and clinic dynamics related to the introduction of LA ART and were analyzed using thematic content analysis. The Consolidated Framework for Implementation Research (CFIR) was drawn on as the conceptual framework underpinning development of a model depicting study findings. Barriers and proposed solutions to LA ART implementation were identified at the individual, clinic and health system levels. Provider perceptions of patient level barriers included challenges with adhering to frequent injection appointments and injection tolerability. Proposed solutions included patient education, having designated staff for clinic visit retention, and clinic flexibility with appointment scheduling. The main provider concern was identifying appropriate candidates for LA ART; proposed solutions focused on patient provider communication and decision making. Clinic level barriers included the need for additional skilled individuals to administer injections, shifts in workflow as demand increases and the logistics of cold-chain storage. Proposed solutions included staff hiring and training, strategic planning around workflow and logistics, and the possibility of offering injections in other settings, including the home. Health system level barriers included cost and approvals from national regulatory bodies. Potential solutions included governments subsidizing treatment, ensuring cost is competitive with oral ART, and offering co-pay assistance. Results suggest the importance of multi-level support systems to optimize patient-provider communication and treatment decision-making; clinic staffing, workflow, logistics protocols and infrastructure; and cost-related factors within a given health system. The online version contains supplementary material available at 10.1186/s12913-021-06214-9.
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DOI：
10.1097/qad.0000000000000697
发表时间：
2015-06-19
期刊：
AIDS (London, England)
影响因子：
--
作者：
Kacanek D;Angelidou K;Williams PL;Chernoff M;Gadow KD;Nachman S;International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1055 Study Team
通讯作者：
International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1055 Study Team
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
影响因子：
4.4
作者：
Mantsios, Andrea;Murray, Miranda;Kerrigan, Deanna
通讯作者：
Kerrigan, Deanna
影响因子：
3.7
作者：
Kerrigan, Deanna;Mantsios, Andrea;Murray, Miranda
通讯作者：
Murray, Miranda
影响因子：
2.2
作者：
Mantsios, Andrea;Murray, Miranda;Kerrigan, Deanna
通讯作者：
Kerrigan, Deanna