Implementation and evaluation of a large-scale postpartum family planning program in Rwanda

卢旺达大规模产后计划生育方案的实施和评估

• 批准号: 10211298
• 负责人: Kristin Marie Wall
• 金额: $ 59.27万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10211298
• 关键词: Academic advising; Address; Adoption; Africa; Area; Birth Intervals; Breast Feeding; Capital; Chicago; Child; Cities; Client; Client satisfaction; Clinic; Communities; Community Health Aides; Consolidated Framework for Implementation Research; Contraceptive Usage; Contraceptive methods; Cost Savings; Cost utility; Counseling; Country; Couples; Data; Decision Making; Diffusion; Effectiveness; Evaluation; Family Planning; Family Planning Programs; Goals; Government; Health; Health care facility; Implant; Intervention; Interview; Intrauterine Devices; Maintenance; Maternal Health; Maternal Mortality; Measures; Methods; Modeling; Morbidity - disease rate; National Institute of Child Health and Human Development; Neonatal Mortality; Newborn Infant; Nurses; Outcome; Patients; Play; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevention; Professional counselor; Provider; Randomized; Research; Rwanda; Savings; Services; Testing; Woman; Women' s Health; Work; World Health Organization; Zambia; abortion; acceptability and feasibility; base; comparison intervention; cost; cost effective; cost effectiveness; cost estimate; design; effectiveness evaluation; effectiveness implementation study; experience; implementation cost; implementation framework; implementation process; improved; incremental cost-effectiveness; innovation; low and middle-income countries; mortality; neonatal health; novel; organizational readiness; programs; promoter; randomized trial; reversible contraceptive; side effect; social; standard of care; theories; tool; unintended pregnancy; uptake

PROJECT SUMMARY In 2017-2018, we worked closely with the Rwanda Ministry of Health (MOH) to develop and pilot test a theory- based, multi-level intervention targeting postpartum family planning (PPFP) supply and demand in 5 government health facilities in Kigali, the capital. This innovative PPFP intervention is known as `C4' because it is informed by Clients, Clinic providers, Champions, and Community Health Workers. Long-acting reversible contraceptives (LARC), the intrauterine device (PPIUD) and implant, are fundamental to PPFP programs. LARCs are highly effective and are the only reversible methods that may be safely used in early postpartum period by breastfeeding women. During our pilot, LARC uptake among postpartum women increased significantly (172% for PP implant, 2,687% for PPIUD), PPFP feasibility and acceptability were high among providers and clients, and side-effects were rare. We now propose to use an implementation science framework to evaluate the effectiveness of different PPFP demand creation strategies and test the hypothesis that C4 is adaptable to large-scale implementation, cost-effective, and sustainable. In a Type 2 effectiveness- implementation hybrid study, we will evaluate facility organizational readiness prior to implementing C4 in a clinic randomized trial in 12 high-volume health facilities in Kigali, Rwanda (Aim 1). Adaptability and sustainability within government facilities is a critical aspect of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver C4 PPFP counseling to over 21,000 women/couples during the project period. We will then evaluate C4 effectiveness and implementation processes using RE-AIM (Aim 2). We hypothesize that C4 will significantly increase the number of stakeholders engaged, PPFP providers and promoters, couples/clients receiving information about PPFP (reach), and LARC uptake (effectiveness) comparing intervention versus standard of care. We expect PPFP client satisfaction will be high and side-effects will be rare. The independent effectiveness of each demand creation strategy on LARC uptake will be estimated. We assess measures of C4 adoption, implementation, and maintenance at the patient-, provider- and stakeholder-level to assess C4 sustainability. Finally, we will evaluate C4 cost-effectiveness and develop a national costed implementation plan to guide Rwandan MOH decision-making for nationwide roll-out of PPFP services (Aim 3). We hypothesize that C4 will be cost-saving relative to standard of care. C4 represents an important contribution to the Rwanda Family Planning 2020 goals and the MOH are enthusiastic to see our successful pilot efforts expanded to a larger number of facilities for greater and sustained impact. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have high unmet need for PPFP.

项目摘要 在2017 - 2018年，我们与卢旺达卫生部（MOH）密切合作开发和试点测试理论 - 针对产后计划生育（PPFP）的基于多层干预措施5 首都基加利的政府卫生设施。这种创新的PPFP干预被称为“ C4”，因为它 由客户，诊所提供者，冠军和社区卫生工作者告知。长效可逆 避孕药（LARC），宫内装置（PPIUD）和植入物是PPFP程序的基础。 LARC非常有效，是唯一可以在产后早期可以安全使用的可逆方法 母乳喂养的妇女时期。在我们的飞行员期间，产后妇女的LARC吸收增加 显着（PP植入物为172％，PPIUD为2,687％），PPFP的可行性和可接受性很高 提供者和客户以及副作用很少。我们现在建议使用实施科学框架 评估不同PPFP需求创建策略的有效性，并检验C4是 适用于大规模实施，具有成本效益和可持续性。在2型有效性中 实施混合研究，我们将在实施C4之前评估设施的组织准备 卢旺达基加利市的12个大批量保健设施的诊所随机试验（AIM 1）。适应性和 政府设施内的可持续性是我们提案的关键方面，以及卫生部和其他地方 利益相关者将从一开始就会订婚。我们希望将C4 PPFP咨询提供给21,000多个 在项目期间的妇女/夫妇。然后，我们将评估C4的有效性和实施 使用re-aim的过程（AIM 2）。我们假设C4将显着增加 利益相关者参与，PPFP提供商和发起人，夫妻/客户接收有关PPFP的信息 （覆盖范围）和LARC吸收（有效性）将干预与护理标准进行比较。我们期望PPFP 客户满意度将很高，副作用将很少见。每个需求的独立有效性 将估计有关LARC吸收的创建策略。我们评估C4采用，实施和 在患者，提供商和利益相关者级别的患者维护评估C4可持续性。最后，我们会的 评估C4成本效益并制定全国成本的实施计划，以指导卢旺达MOH 全国范围内PPFP服务的决策（AIM 3）。我们假设C4将节省成本 相对于护理标准。 C4代表了卢旺达计划生育2020年的重要贡献 目标和卫生部充满热情，看到我们成功的飞行员努力扩展到了更多的设施 产生更大和持续的影响。我们的PPFP实施模型设计为可复制和可扩展的 对于该地区的其他国家，对PPFP的需求也很高。