Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research.
Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research.
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DOI：
10.1186/s43058-021-00188-9
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发表时间：
2021-08-11
影响因子：
--
通讯作者：
Finocchario-Kessler S
中科院分区：
文献类型：
--
作者：
Wexler C;Kamau Y;Muchoki E;Babu S;Maosa N;Maloba M;Brown M;Goggin K;Mabachi N;Gautney B;Finocchario-Kessler S
出生时和护理点（POC）检测可以加快艾滋病毒的早期婴儿诊断并改善婴儿结局。在实施研究综合框架（CFIR）的指导下，本研究从实施提供者的角度描述了出生时POC检测试点的实施情况，并确定了可能支持和阻碍这些有希望的干预措施扩大规模的因素。我们进行了28个焦点小组讨论（FGD）与48个供应商在4个研究中心在整个试点研究过程中评估的可行性和影响出生POC测试。对FGD进行录音、转录，并分析与CFIR结构相关的先验主题。这项定性研究嵌套在一项更大的研究中，以试点和评估出生时和POC HIV检测。在39个CFIR构建体中，有30个在FGD中进行了处理。虽然所有五个领域都有代表，但主要主题围绕着与干预特征、内部环境和外部环境相关的结构。关于干预特征，出生时POC（快速周转时间，改善患者管理和增强患者动力）的优势足以鼓励提供者的吸收和热情。干预层面的挑战（机器故障、处理错误）、内部环境（工作量、领导参与有限、获取信息的挑战）和外部环境（患者层面的挑战、与外部环境利益相关者的参与有限）阻碍了实施，使提供者感到沮丧，并导致错过测试机会。提供者讨论了在整个研究过程中如何对执行进行调整（改善沟通渠道，修改执行后勤）以克服其中一些挑战。为了改进执行工作，提供者指出，需要加强培训，并让执行小组以外的利益攸关方更多地参与（即，其他临床医生、医院管理人员和执行伙伴、州和国家卫生官员）。尽管提供者对干预措施充满热情，但提供者认为，缺乏医院内部和外部环境领导的参与将妨碍研究环境之外的持续实施。尽管在实施提供者中表现出了可行性和热情，但缺乏外部环境支持使得目前不太可能持续实施出生时POC检测。调查结果突出了执行的多层面，以及需要考虑五个CFIR领域中的每一个领域的促进者和障碍。ClinicalTrials.gov，NCT 03435887。2020年2月19日登记的追溯
At-birth and point-of-care (POC) testing can expedite early infant diagnosis of HIV and improve infant outcomes. Guided by the Consolidated Framework for Implementation Research (CFIR), this study describes the implementation of an at-birth POC testing pilot from the perspective of implementing providers and identifies the factors that might support and hinder the scale up of these promising interventions. We conducted 28 focus group discussions (FGDs) with 48 providers across 4 study sites throughout the course of a pilot study assessing the feasibility and impact of at-birth POC testing. FGDs were audio-recorded, transcribed, and analyzed for a priori themes related to CFIR constructs. This qualitative study was nested within a larger study to pilot and evaluate at-birth and POC HIV testing. Out of the 39 CFIR constructs, 30 were addressed in the FGDs. While all five domains were represented, major themes revolved around constructs related to intervention characteristics, inner setting, and outer setting. Regarding intervention characteristics, the advantages of at-birth POC (rapid turnaround time resulting in improved patient management and enhanced patient motivation) were significant enough to encourage provider uptake and enthusiasm. Challenges at the intervention level (machine breakdown, processing errors), inner settings (workload, limited leadership engagement, challenges with access to information), and outer setting (patient-level challenges, limited engagement with outer setting stakeholders) hindered implementation, frustrated providers, and resulted in missed opportunities for testing. Providers discussed how throughout the course of the study adaptations to implementation (improved channels of communication, modified implementation logistics) were made to overcome some of these challenges. To improve implementation, providers cited the need for enhanced training and for greater involvement among stakeholders outside of the implementing team (i.e., other clinicians, hospital administrators and implementing partners, county and national health officials). Despite provider enthusiasm for the intervention, providers felt that the lack of engagement from leadership within the hospital and in the outer setting would preclude sustained implementation outside of a research setting. Despite demonstrated feasibility and enthusiasm among implementing providers, the lack of outer setting support makes sustained implementation of at-birth POC testing unlikely at this time. The findings highlight the multi-dimensional aspect of implementation and the need to consider facilitators and barriers within each of the five CFIR domains. ClinicalTrials.gov, NCT03435887. Retrospectively registered on 19 February 2020
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
2.9
作者：
Stokes, Tim;Tumilty, Emma;Gauld, Robin
通讯作者：
Gauld, Robin
DOI：
10.1097/qai.0000000000002372
发表时间：
2020-07-01
影响因子：
3.6
作者：
Bianchi, Flavia;Clemens, Sara;Cohn, Jennifer
通讯作者：
Cohn, Jennifer
影响因子：
4.5
作者：
Spooner, Elizabeth;Govender, Kerusha;Coutsoudis, Anna
通讯作者：
Coutsoudis, Anna
影响因子：
16.1
作者：
Technau, Karl-Gunter;Strehlau, Renate;Kuhn, Louise
通讯作者：
Kuhn, Louise