Selecting implementation strategies to improve implementation of integrated PrEP for pregnant and postpartum populations in Kenya: a sequential explanatory mixed methods analysis.
Selecting implementation strategies to improve implementation of integrated PrEP for pregnant and postpartum populations in Kenya: a sequential explanatory mixed methods analysis.
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DOI：
10.1186/s43058-023-00481-9
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发表时间：
2023-08-14
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怀孕期间和产后感染艾滋病毒的风险更高。在此期间，建议对感染风险高的人进行暴露前预防（PrEP）;妇幼保健诊所的综合分娩是可行和可接受的，但需要优化实施。PrEP在怀孕，加速覆盖和效率研究（PrEPARE; NCT 04712994）参与利益相关者优先考虑PrEP交付的决定因素（使用Likert评分），并优先考虑PrEP交付实施策略。使用顺序解释混合方法设计，我们进行了定量调查，在肯尼亚西部的55个设施和利益相关者研讨会（包括护士，药剂师，顾问，县和国家的政策制定者）的医疗工作者，利益相关者的感知的可行性和有效性的战略产生的视觉图。一个逐步消除的过程中使用，以确定七个策略的实证检验。讲习班主持人的汇报报告被用来对决策过程进行定性评估。在146名医护人员中，报告的PrEP提供最大障碍是提供者不足，培训不足，空间不足和患者数量过多。对16种策略进行了评估，其中14种被纳入最终分析。在182名医疗工作者和44名PrEP政策制定者和实施者的排名中，有7项策略被淘汰，原因是研讨会后排名分数较低（最低50个百分点），或者被认为至少50%的研讨会组可行性低或有效性低。排名前七位的策略包括在妇幼保健诊所而不是药店提供PrEP，快速跟踪PrEP客户以减少等待时间，在等候区提供PrEP相关的健康讲座，任务转移PrEP咨询，任务转移PrEP风险评估，培训不同的提供者提供PrEP，以及对PrEP提供者进行再培训。所有排名前七的策略都被分组为捆绑包，用于后续测试。主持人汇报报告一般与排名一致，但指出当考虑到战略对设施工作人员和非PrEP客户的影响时，利益相关者的决策是如何变化的。在妇幼保健诊所提供综合PrEP的最大障碍是人员配备和空间不足。通过利益攸关方投入的多种方法确定实施战略的优先次序，重点放在服务的同地办公和提高诊所效率。今后将对这些以股东为优先事项的战略包进行测试，以评估其有效性和实施成果。在线版本包含补充材料，可通过10.1186/s43058-023-00481-9获得。
There is a higher risk for HIV acquisition during pregnancy and postpartum. Pre-exposure prophylaxis (PrEP) is recommended during this period for those at high risk of infection; integrated delivery in maternal and child health (MCH) clinics is feasible and acceptable but requires implementation optimization. The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged stakeholders to prioritize determinants of PrEP delivery (using Likert scores) and prioritize PrEP delivery implementation strategies. Using a sequential explanatory mixed methods design, we conducted quantitative surveys with healthcare workers at 55 facilities in Western Kenya and a stakeholder workshop (including nurses, pharmacists, counselors, and county and national policymakers), yielding visual plots of stakeholders’ perceived feasibility and effectiveness of the strategies. A stepwise elimination process was used to identify seven strategies for empirical testing. Facilitator debriefing reports from the workshop were used to qualitatively assess the decision-making process. Among 146 healthcare workers, the strongest reported barriers to PrEP delivery were insufficient providers and inadequate training, insufficient space, and high volume of patients. Sixteen strategies were assessed, 14 of which were included in the final analysis. Among rankings from 182 healthcare workers and 44 PrEP policymakers and implementers, seven strategies were eliminated based on low post-workshop ranking scores (bottom 50th percentile) or being perceived as low feasibility or low effectiveness for at least 50% of the workshop groups. The top seven strategies included delivering PrEP within MCH clinics instead of pharmacies, fast-tracking PrEP clients to reduce waiting time, delivering PrEP-related health talks in waiting bays, task shifting PrEP counseling, task shifting PrEP risk assessments, training different providers to deliver PrEP, and retraining providers on PrEP delivery. All top seven ranked strategies were grouped into bundles for subsequent testing. Facilitator debriefing reports generally aligned with rankings but noted how stakeholders’ decision-making changed when considering the impact of strategies on facility staff and non-PrEP clients. The most impactful barriers to integrated PrEP delivery in MCH clinics were insufficient staffing and space. Implementation strategies prioritized through multiple methods of stakeholder input focused on co-location of services and increasing clinic efficiency. Future testing of these stakeholder-prioritized strategy bundles will be conducted to assess the effectiveness and implementation outcomes. The online version contains supplementary material available at 10.1186/s43058-023-00481-9.