Multisectoral, Combination HIV Prevention for Adolescent Girls and Young Women: A Qualitative Study of the DREAMS Implementation Trajectory in Zambia.
Multisectoral, Combination HIV Prevention for Adolescent Girls and Young Women: A Qualitative Study of the DREAMS Implementation Trajectory in Zambia.
复制标题
DOI：
10.9745/ghsp-d-22-00089
复制
发表时间：
2022-10-31
期刊：
影响因子：
--
通讯作者：
Mathur S
中科院分区：
文献类型：
--
作者：
Rosen JG;Musheke M;Mulenga D;Namukonda ES;Jani N;Mbizvo MT;Pulerwitz J;Mathur S
我们对赞比亚 DREAMS 实施的研究确定了实施合作伙伴和项目参与者从项目推出到整个发展过程中所经历的关键实施成功和挑战。 DREAMS 伙伴关系是撒哈拉以南非洲地区的一项艾滋病毒预防组合方法，旨在降低少女和年轻女性 (AGYW) 的风险，但其多部门方法给执行伙伴带来了挑战。多部门规划需要实施伙伴组织之间的全面协调系统，以建立有效实施所需的基础设施。确保针对 AGYW 的主要干预措施和针对其男性伴侣和父母的二级干预措施的财务承诺，对于吸引这些利益相关者并解决 AGYW 中艾滋病毒风险的结构性驱动因素非常重要。实施策略的实时调整有助于解决招募风险最高的 AGYW 并将 AGYW 保留在计划中的挑战。为了可持续、有效地管理 DREAMS，实施伙伴必须投资于强大的实施基础设施，包括统一的电子数据采集系统和灵活的工作计划，这是多部门艾滋病毒预防规划所必需的。为了确定赞比亚“梦想”（坚定、有弹性、赋权、无艾滋病、指导和安全妇女）伙伴关系实施挑战的解决方案，本研究考察了“梦想”伙伴关系实施的推出和演变。 2018 年 9 月至 10 月，参与 DREAMS 计划的执行伙伴 (IP) 工作人员 (n=15) 和少女和年轻女性 (AGYW) (n=32) 完成了深入访谈，探讨了 DREAMS 的早期推出和扩大、计划参与的经验以及为应对新出现的实施挑战而转变的服务提供方法。对 47 次访谈的归纳和演绎主题分析揭示了 DREAMS 实施头两年中显着的服务交付促进因素和障碍，随后将其映射到以下领域：覆盖范围、有效性、采用、实施和维护。 IP 工作人员确定的关键实施成功包括在 IP 组织中使用标准化招聘和风险评估工具、使用导师模型向 AGYW 提供计划内容，以及在 AGYW 可访问的场所提供集中服务交付。通过适应性服务交付策略纠正了 DREAMS Partnership 生命周期早期发现的实施挑战。每月召开一次面对面协调会议，以解决知识产权工作人员在招聘和目标设定方面的管辖权争议。为了解决参与者高流失的问题，IP 工作人员采用了一种队列方法，依次招募 AGYW，他们一起报名并互相提供社会支持，以维持对 DREAMS 计划的参与。实施保真度的突出障碍包括招募风险最高的 AGYW（例如失学的女性）的挑战、激励年轻女性参与的资源有限，以及在项目结束时促进公共部门吸收个人梦想干预措施的规划不足。忠实地提供像 DREAMS 这样的多部门艾滋病毒预防计划需要强大的实施基础设施（例如，适应性强的工作计划和统一的记录管理系统）、知识产权组织之间的早期协调以及捐助者的持续财政承诺。
Our study of DREAMS implementation in Zambia identified key implementation successes and challenges experienced by implementing partners and program participants, from program rollout and throughout its evolution. The DREAMS Partnership is a combination HIV prevention approach in sub-Saharan Africa to reduce risk in adolescent girls and young women (AGYW), but its multisectoral approach poses challenges for implementing partners. Comprehensive coordination systems between implementing partner organizations are needed in multisectoral programming to build the necessary infrastructure for effective implementation. Securing financial commitments, for both primary interventions directed toward AGYW and secondary interventions directed toward their male partners and parents, is important for engaging these stakeholders and addressing structural drivers of HIV risk among AGYW. Real-time adaptation of implementation strategies helped address challenges with recruiting AGYW with the highest risk and retaining AGYW in the program. To administer DREAMS sustainably and effectively, implementing partners must invest in robust implementation infrastructure, including harmonized electronic data capture systems and flexible workplans, requisite for multisectoral HIV prevention programming. To identify solutions to the implementation challenges with the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women) Partnership in Zambia, this study examines the rollout and evolution of the DREAMS Partnership’s implementation. In September–October 2018, implementing partner (IP) staff (n=15) and adolescent girls and young women (AGYW) participating in DREAMS programming (n=32) completed in-depth interviews exploring early rollout and scale-up of DREAMS, experiences with program participation, and shifting service delivery approaches in response to emerging implementation challenges. Inductive and deductive thematic analysis of 47 interviews uncovered salient service delivery facilitators and barriers in the first 2 years of DREAMS implementation, which were subsequently mapped onto the following domains: reach, effectiveness, adoption, implementation, and maintenance. Key implementation successes identified by IP staff included using standardized recruitment and risk assessment tools across IP organizations, using a mentor model for delivering program content to AGYW, and offering centralized service delivery at venues accessible to AGYW. Implementation challenges identified early in the DREAMS Partnership’s lifecycle were rectified through adaptive service delivery strategies. Monthly in-person coordination meetings were established to resolve IP staff jurisdictional disputes over recruitment and target setting. To address high participant attrition, IP staff adopted a cohort approach to sequentially recruit AGYW who enrolled together and provided social support to one another to sustain involvement in DREAMS programming. Prominent barriers to implementation fidelity included challenges recruiting the highest-risk AGYW (e.g., those out of school), limited resources to incentivize participation by young women, and inadequate planning to facilitate absorption of individual DREAMS interventions by the public sector upon project conclusion. Delivering multisectoral HIV prevention programs like DREAMS with fidelity requires a robust implementation infrastructure (e.g., adaptable workplans and harmonized record management systems), early coordination between IP organizations, and sustained financial commitments from donors.
影响因子：
3.7
作者：
Doyle AM;Floyd S;Baisley K;Orindi B;Kwaro D;Mthiyane TN;Muuo S;Shahmanesh M;Ziraba A;Birdthistle I
通讯作者：
Birdthistle I
影响因子：
4.5
作者：
Manda WC;Pilgrim N;Kamndaya M;Mathur S;Sikweyiya Y
通讯作者：
Sikweyiya Y