The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial
The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial
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DOI：
10.1186/s12962-018-0107-x
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发表时间：
2018-10-23
影响因子：
2.3
通讯作者：
Aliyu, S. H.
中科院分区：
文献类型：
--
作者：
Bautista-Arredondo, S.;Nance, N.;Aliyu, S. H.
背景：虽然世界在减少新的艾滋病毒感染方面取得了很大的全球进展，但艾滋病毒仍然是一个重要的公共卫生问题。面对不断受到限制的资源，捐助者和受赠方都必须寻求优化资源，尽可能高效地提供艾滋病毒服务。虽然有证据表明，管理做法可以影响效率，但这还有待在艾滋病毒服务提供的背景下进行严格检验。方法：本方案描述了一组随机对照试验的设计，以估计管理实践对效率的影响。具体而言，我们将评估以改善社区组织（cbo）管理实践为重点的干预措施对尼日利亚女性性工作者（FSW）艾滋病毒预防服务成本的影响。为了设计干预措施，我们使用了一种定性的、基于设计思维的方法，使我们能够更好地理解组织背景下的管理，并开发出以用户为中心的解决方案。在设计了一套管理工具后，我们随机将16名cbo分配到干预组，15名cbo分配到对照组。干预措施包括全面的管理培训和管理“工具包”，以支持更好地规划和组织其工作，以及更好地在社区组织和社区志愿人员之间进行沟通。治疗组和对照组都接受了记录效率数据的培训——使用的投入和产生的产出。研究结束前，我们将对两组进行前瞻性跟踪，届时，我们将使用准实验的“差中差”（DiD）策略，比较两组服务的每个FSW的平均单位成本。这种方法通过检查干预前后治疗组和对照组之间的差异来确定干预的效果，从而解释组间的时间常数差异。尽管采用了严格的随机化程序，但该国的小样本量和多样性仍可能导致与效率相关的不可观察特征，以及治疗组和对照组在基线时的不平衡。考虑到这种可能性，使用准实验DiD方法可以在测量效果时将任何基线差异“区分出来”。讨论：本研究设计将通过建立管理技能和实践与服务提供效率之间关系的严格证据，独特地增加有关管理实践的文献。我们预计管理将对效率产生积极影响。这项研究将产生有价值的证据，我们将把这些证据传播给主要利益攸关方，包括那些参与尼日利亚艾滋病毒应对工作的人。
Background: While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery.Methods: The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management "toolkit" to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency-inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental "difference-in-differences" (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be "differenced out" when measuring the effect.Discussion: This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response.