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

项目摘要/摘要 在南非，接受艾滋病毒治疗的人比以往任何时候都多，这给 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， 在日益复杂的护理背景下大规模实施最佳做法的挑战依然存在。 实施科学(IS)试图弥合研究和实践之间的差距，以确保有效 干预措施转化为大规模的有效实施。组织准备性理论 变革(ORC)是一种IS理论，它假定组织成员实施变革的共同决心 (改变承诺)和对其集体能力的共同信念(改变效力)影响 成功地吸收了程序。实施研究综合框架(CFIR) 框架，指定设施内部设置中影响更改承诺和有效性的元素。我们 建议调整ORC和CFIR内部环境的比额表评估以适应南非的情况，以更好地 衡量为成功地将循证干预措施转化为 临床实践，特别侧重于艾滋病毒，以缩小实现最佳保健服务的差距 在疾病负担较高的情况下的方案。具体地说，我们将使用认知访谈和专家 协商，以文化适应组织实施变革准备的衡量标准(ORIC)和 在西方背景下开发的内部环境(CFIR)(目标1)。然后我们将实施精细化的 对夸祖鲁14个南非初级保健机构的168名提供者和14名诊所经理采取的措施 纳塔尔(KZN)，南非(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治疗指南，以及b)国家减充血 为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、供应商和诊所经理一起进行反馈，以验证调查结果。这个发展， 探索性R21利用了经验丰富的研究站点、成熟的协作和多学科 由南非和美国调查人员组成的团队将解决NIH推进因素研究的优先事项 这与成功实施循证干预措施和准则有关。这项建议 可导致有针对性的干预措施，促进艾滋病毒方案的实施和初级保健中的综合保健 在疾病负担高的地区，大规模规划至关重要。

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.