Exploring the Impact of Organizational Readiness and Inner Setting on Implementation of HIV Programming in South African Health Clinics

探索组织准备情况和内部环境对南非卫生诊所实施艾滋病规划的影响

• 批准号: 10082889
• 负责人: Sheri Ann Lippman
• 金额: $ 20.55万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-21 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10082889
• 关键词: AIDS prevention; Address; Affect; Area; Behavior Therapy; Belief; Caring; Characteristics; Clinic; Clinical; Clinical Data; Cluster randomized trial; Collaborations; Communities; Complex; Consultations; Country; Data Collection; Databases; Development; Disease Management; Elements; Ensure; Environment; Evidence based intervention; Feedback; Future; Guidelines; HIV; Health; Health care facility; Health system; Human Resources; Incidence; Institutes; Intervention; Interview; Investments; Lead; Light; Measures; Monitor; Organizational Culture; Patients; Performance; Pharmaceutical Preparations; Policies; Postdoctoral Fellow; Primary Health Care; Process; Protocols documentation; Provider; Readiness; Research; Research Personnel; Resources; Self Efficacy; Services; Shapes; Site; South Africa; South African; Specific qualifier value; Translating; Translations; United States National Institutes of Health; Variant; Work; aging population; antiretroviral therapy; base; burden of illness; care delivery; clinical care; clinical practice; cognitive interview; contextual factors; evidence base; experience; implementation research; implementation science; improved; innovation; meetings; member; multidisciplinary; primary care setting; programs; skills; success; theories; tool; uptake

PROJECT SUMMARY/ABSTRACT In South Africa there are more people on treatment for HIV than ever before, placing a growing burden on health systems. While strategies for effective disease management exist for those who engage in care for HIV, the challenge of implementing best-practice at scale in the context of increasingly complex care remains. Implementation science (IS) seeks to bridge the gap between research and practice to ensure that efficacious interventions translate into effective implementation at scale. The theory of Organizational Readiness for Change (ORC) is an IS theory that posits that organizational members' shared resolve to implement a change (change commitment) and shared belief in their collective capability to do so (change efficacy) impacts successful program uptake. The Consolidated Framework for Implementation Research (CFIR), an IS framework, specifies elements in the facility inner setting that affect change commitment and efficacy. We propose to adapt scales assessing of ORC and of CFIR inner setting to the South African context to better measure the factors that should be addressed for successful translation of evidence-based interventions into clinical practice, specifically focusing on HIV, in order to close the gap towards optimized delivery of health programs in high disease burden settings. Specifically, we will use cognitive interviewing and expert consultations to culturally adapt measures of organizational readiness for implementing change (ORIC) and inner setting (CFIR) that have been developed in Western contexts (Aim 1). We will then implement the refined measures with 168 providers and 14 clinic managers in 14 South African primary care facilities in KwaZulu Natal (KZN), South Africa (Aim 2). We will assess which elements of ORC and CFIR are associated with successful implementation of a) new HIV treatment initiation and ART guidelines, and b) national decongestion programming for expedited care and medication dispensing for stable HIV patients. Results will be shared in a feedback process with experts, providers and clinic managers to validate findings. This developmental, exploratory R21 leverages an experienced research site, an established collaboration, and a multidisciplinary team of South African and US investigators to address the NIH priority of advancing research on factors associated with the successful implementation of evidence-based interventions and guidelines. This proposal can lead to targeted interventions advancing HIV program implementation and integrated care in primary care settings in high disease burden areas where scaled programming is vital.

项目总结/摘要 在南非，接受艾滋病毒治疗的人数比以往任何时候都多，这给艾滋病患者带来了越来越大的负担。 卫生系统。虽然为那些从事艾滋病毒护理的人制定了有效的疾病管理战略， 在护理工作日益复杂的情况下，大规模实施最佳做法的挑战依然存在。 实施科学（IS）旨在弥合研究与实践之间的差距，以确保有效的 干预措施转化为大规模的有效执行。组织准备理论 变革（ORC）是一种IS理论，它假定组织成员共同决心实施变革， （改变承诺）和对集体能力的共同信念（改变效能） 成功的方案。实施研究综合框架（CFIR），一个 框架，规定了影响变革承诺和效率的设施内部设置的要素。我们 建议调整ORC和CFIR内部环境的评估量表，以更好地适应南非的情况， 衡量成功将循证干预措施转化为 临床实践，特别是以艾滋病毒为重点，以缩小在优化保健服务方面的差距 在高疾病负担环境中的项目。具体来说，我们将使用认知访谈和专家访谈。 进行协商，以在文化上调整组织实施变革准备程度的衡量标准， 内部设置（CFIR），已在西方背景下开发（目标1）。然后我们将实施完善的 与夸祖鲁省14个南非初级保健设施的168名提供者和14名诊所管理人员一起采取措施 南非纳塔尔（KZN）（目标2）。我们将评估ORC和CFIR的哪些元素与 成功实施a）新的艾滋病毒治疗启动和抗逆转录病毒疗法指南，以及B）国家缓解拥堵 为病情稳定的艾滋病毒患者制定快速护理和药物分配方案。结果将在 与专家、医疗服务提供者和诊所管理者进行反馈，以验证调查结果。这种发展， 探索性R21利用了经验丰富的研究站点，建立了合作关系，以及多学科 一个由南非和美国调查人员组成的小组，致力于推动因子研究的NIH优先事项 与成功实施循证干预措施和指导方针有关。这项建议 可以导致有针对性的干预措施，促进艾滋病毒项目的实施和初级保健中的综合护理 在高疾病负担地区，规模化规划至关重要。