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Tan BXH, Chong SY, Ho DWS, Wee YX, Jamal MH, Tan RKJ. Fostering citizen-engaged HIV implementation science. J Int AIDS Soc 2024; 27 Suppl 1:e26278. [PMID: 38965981 PMCID: PMC11224582 DOI: 10.1002/jia2.26278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 05/07/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Successful implementation of evidence-based practices depends on contextual factors like stakeholder engagement, the socio-political environment, resource availability, and stakeholders' felt needs and preferences. Nevertheless, inequities in implementation exist and undermine efforts to address HIV in marginalized key populations. Implementation science shows promise in addressing such inequities in the HIV response, but can be limited without meaningful engagement from citizens or communities. DISCUSSION We define the concept of a citizen-engaged HIV implementation science as one that involves citizens and communities deeply in HIV implementation science activities. In this commentary, we discuss how citizen science approaches can be leveraged to spur equity in HIV implementation science. Drawing on three areas previously defined by Geng and colleagues that serve to drive impactful implementation science in the HIV response, we discuss how citizens can be engaged when considering "whose perspectives?", "what questions are being asked?" and "how are questions asked?". With respect to "whose perspectives?" a citizen-engaged HIV implementation science would leverage participatory methods and tools, such as co-creation, co-production and crowdsourcing approaches, to engage the public in identifying challenges, solve health problems and implement solutions. In terms of "what questions are being asked?", we discuss how efforts are being made to synthesize citizen or community-led approaches with existing implementation science frameworks and approaches. This also means that we ensure communities have a say in interrogating and deconstructing such frameworks and adapting them to local contexts through participatory approaches. Finally, when considering "how are questions asked?", we argue for the development and adoption of broad, guiding principles and frameworks that account for dynamic contexts to promote citizen-engaged research in HIV implementation science. This also means avoiding narrow definitions that limit the creativity, innovation and ground-up wisdom of local citizens. CONCLUSIONS By involving communities and citizens in the development and growth of HIV implementation science, we can ensure that our implementation approaches remain equitable and committed to bridging divides and ending AIDS as a public health threat. Ultimately, efforts should be made to foster a citizen- and community-engaged HIV implementation science to spur equity in our global HIV response.
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Affiliation(s)
| | | | | | | | | | - Rayner Kay Jin Tan
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingaporeSingapore
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Li DH, Macapagal K, Mongrella M, Saber R, Mustanski B. "Your Package Could Not Be Delivered": The State of Digital HIV Intervention Implementation in the US. Curr HIV/AIDS Rep 2024; 21:152-167. [PMID: 38502421 DOI: 10.1007/s11904-024-00693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE OF REVIEW Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions. RECENT FINDINGS We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement. Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain "on the shelf" absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.
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Affiliation(s)
- Dennis H Li
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Blackburn AM, Katz BW, Oesterle DW, Orchowski LM. Preventing sexual violence in sexual orientation and gender diverse communities: A call to action. Eur J Psychotraumatol 2024; 15:2297544. [PMID: 38197295 PMCID: PMC10783832 DOI: 10.1080/20008066.2023.2297544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.
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Affiliation(s)
- Allyson M. Blackburn
- Department of Psychology, Division of Clinical-Community Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Benjamin W. Katz
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Daniel W. Oesterle
- Department of Psychological Sciences, College of Health & Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Lindsay M. Orchowski
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Zapata JP, Queiroz A, Rodriguez-Diaz CE, Mustanski B. Factors Associated with HIV Testing Among Spanish and English-Speaking Latino Adolescents Aged 13-18. AIDS Behav 2024; 28:343-356. [PMID: 37848599 DOI: 10.1007/s10461-023-04206-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
Adolescent Latino men who have sex with men (LMSM) in the U.S. are disproportionately impacted by HIV. However, there has been limited focus on their HIV prevention and risk behaviors. In this study, we examine the rates of HIV testing and explore the significant demographic and healthcare factors that influence HIV prevention among adolescent LMSM. The analysis for this study utilized data collected during the baseline assessment of SMART, a pragmatic trial aimed at evaluating the effectiveness of an online HIV prevention intervention for adolescent LMSM (N = 524). Only 35.5% of participants had ever had an HIV test in their lifetime. Rates of testing increased among adolescent LMSM who had a doctor with whom they spoke about their sexual health (odds ratio: 4.0; 95% confidence interval: 2.1-8.4; P < 0.001) or HIV testing (odds ratio: 5.8; 95% confidence interval: 3.1-10.7; P < 0.001). Out of the 61 participants who took part in the survey conducted in Spanish, only 26% reported ever having an HIV test. Additionally, 24.5% stated that they had discussed their sexual orientation with a doctor, and only 8.2% had undergone HIV testing. Spanish-speaking adolescents who completed the SMART survey were less likely to openly discuss their sexual orientation or sexual health with most people or have a doctor with whom they discussed these topics, compared to those who completed the survey in English. These findings suggest that Spanish-speaking adolescent LMSM may face obstacles in accessing HIV prevention services in the U.S.
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Affiliation(s)
- Juan Pablo Zapata
- Department of Medical Social Science and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
| | - Artur Queiroz
- Department of Medical Social Science and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
| | - Carlos E Rodriguez-Diaz
- School of Public Health, Boston University, 801 Massachusetts Ave. Suite 431, Boston, MA, USA
| | - Brian Mustanski
- Department of Medical Social Science and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA.
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O'Brien KK, Ibáñez-Carrasco F, Birtwell K, Donald G, Brown DA, Eaton AD, Kasadha B, Stanmore E, St Clair-Sullivan N, Townsend L, Vera JH, Solomon P. Research priorities in HIV, aging and rehabilitation: building on a framework with the Canada-International HIV and Rehabilitation Research Collaborative. AIDS Res Ther 2023; 20:86. [PMID: 38071351 PMCID: PMC10709904 DOI: 10.1186/s12981-023-00582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In 2016, the Canada-International HIV and Rehabilitation Research Collaborative established a framework of research priorities in HIV, aging and rehabilitation. Our aim was to review and identify any new emerging priorities from the perspectives of people living with HIV, clinicians, researchers, and representatives from community organizations. METHODS We conducted a multi-stakeholder international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations. Stakeholders convened for a one-day Forum in Manchester, United Kingdom (UK) to discuss research priorities via a web-based questionnaire and facilitated discussions. We analyzed data using conventional content analytical techniques and mapped emerging priorities onto the foundational framework. RESULTS Thirty-five stakeholders from the UK(n = 29), Canada(n = 5) and Ireland(n = 1) attended the Forum, representing persons living with HIV or representatives from community-based organizations(n = 12;34%), researchers or academics(n = 10;28%), service providers(n = 6;17%), clinicians(n = 4;11%); and trainees(n = 4;11%). Five priorities mapped onto the Framework of Research Priorities across three content areas: A-Episodic Health and Disability Aging with HIV (disability, frailty, social participation), B-Rehabilitation Interventions for Healthy Aging across the Lifespan (role, implementation and impact of digital and web-based rehabilitation interventions) and C-Outcome Measurement in HIV and Aging (digital and web-based rehabilitation health technology to measure physical activity). Stakeholders indicated methodological considerations for implementing digital and web-based rehabilitation interventions into research and practice and the importance of knowledge transfer and exchange among the broader community. CONCLUSION Results highlight the sustained importance of the Framework of Research Priorities and provide further depth and areas of inquiry related to digital and web-based rehabilitation interventions and technology aging with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada.
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, M5G 1V7, Canada.
| | - Francisco Ibáñez-Carrasco
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M7, Canada
| | - Kelly Birtwell
- Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Graeme Donald
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Andrew D Eaton
- Faculty of Social Work, University of Regina, Saskatoon Campus, The Concourse, 111-116 Research Drive, Saskatoon, SK, S7N 3R3, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada
| | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom
| | - Emma Stanmore
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
- Healthy Ageing Research Group (HARG), University of Manchester, Manchester, United Kingdom
| | - Natalie St Clair-Sullivan
- The Lawson Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, United Kingdom
| | - Liam Townsend
- Department of Infectious Diseases, St James's Hospital, Dublin 8, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, St. James's Hospital, Dublin 8, Dublin, Ireland
| | - Jaime H Vera
- The Lawson Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, United Kingdom
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, East Sussex, United Kingdom
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON, L8S 1C7, Canada
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Huang A, Pan J, Guo R, La T, Isidro S, Isidro T, Rendely A, Niehaus W, Huang D. Quantifying the dissemination of research in the PM&R journal via alternative metrics. PM R 2023; 15:1673-1677. [PMID: 37873946 DOI: 10.1002/pmrj.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/28/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Austin Huang
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Joann Pan
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Raymond Guo
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ton La
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Stacey Isidro
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Tracey Isidro
- Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterian Columbia University Medical Center, New York, New York, USA
| | - Alexandra Rendely
- Department of Physical Medicine and Rehabilitation, University Health Network, Toronto, Ontario, Canada
| | - William Niehaus
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado, USA
| | - Donna Huang
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Doshi RK, Hull S, Broun A, Boyani S, Moch D, Visconti AJ, Castel AD, Baral S, Colasanti J, Rodriguez AE, Jones J, Coffey S, Monroe AK. Lessons learned from U.S. rapid antiretroviral therapy initiation programs. Int J STD AIDS 2023; 34:945-955. [PMID: 37461333 PMCID: PMC11000141 DOI: 10.1177/09564624231185622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US. PURPOSE The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S. RESEARCH DESIGN This was a qualitative design involving semi-structured interviews. STUDY SAMPLE The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART. DATA COLLECTION AND ANALYSIS In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis. RESULTS We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships. CONCLUSIONS Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients' mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.
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Affiliation(s)
- Rupali K Doshi
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), District of Columbia Department of Health, Washington, DC, USA
| | - Shawnika Hull
- Rutgers University School of Communication and Information, New Brunswick, NJ, USA
| | - Aaron Broun
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Saanjh Boyani
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Darryl Moch
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Adam J Visconti
- The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), District of Columbia Department of Health, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Joyce Jones
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susa Coffey
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Gottschlich A, Payne BA, Trawin J, Albert A, Jeronimo J, Mitchell-Foster S, Mithani N, Namugosa R, Naguti P, Pedersen H, Rawat A, Simelela PN, Singer J, Smith LW, van Niekerk D, Orem J, Nakisige C, Ogilvie G. Community-integrated self-collected HPV-based cervix screening in a low-resource rural setting: a pragmatic, cluster-randomized trial. Nat Med 2023; 29:927-935. [PMID: 37037880 DOI: 10.1038/s41591-023-02288-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/02/2023] [Indexed: 04/12/2023]
Abstract
Effective approaches to improve coverage of self-collected human papillomavirus (HPV)-based cervix screening (SCS) as well as attendance at treatment for HPV-positive participants are needed to inform policy on optimal integration of cervical cancer screening programs within existing infrastructure in low-resource settings. ASPIRE Mayuge was a pragmatic cluster-randomized trial in rural Mayuge district, Uganda, comparing the superiority of two recruitment implementation strategies for SCS: Door-to-Door versus Community Health Day. Villages were randomized (unblinded) to a strategy, and participants aged 25-49 years with no previous history of hysterectomy or treatment for cervical cancer or pre-cancer were eligible. Participants completed a survey and participated in SCS. The primary outcome was rate of attendance at treatment after a positive SCS. The trial randomized 31 villages and 2,019 participants included in these analyses (Door-to-Door: 16 clusters, 1,055 participants; Community Health Day: 15 clusters, 964 participants). Among HPV-positive participants, attendance at treatment rates were 75% (Door-to-Door) and 67% (Community Health Day) (P = 0.049). Participants in the Community Health Day intervention were less likely to attend treatment compared to Door-to-Door (risk ratio = 0.78, 95% confidence interval: 0.64-0.96). No adverse events were reported. Policymakers in low-resource settings can use these results to guide implementation of SCS programs. ISRCTN registration: 12767014 . ClinicalTrials.gov registration: NCT04000503 .
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Affiliation(s)
- Anna Gottschlich
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada.
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.
| | - Beth A Payne
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jessica Trawin
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Arianne Albert
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Sheona Mitchell-Foster
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Northern Medical Program, University of British Columbia, Prince George, British Columbia, Canada
| | - Nadia Mithani
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Heather Pedersen
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Angeli Rawat
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Joel Singer
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Laurie W Smith
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Gina Ogilvie
- BC Women's Hospital and Health Center, Women's Health Research Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Health Equity and Implementation Science and Practice: Making the Implicit Explicit. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:115-116. [PMID: 36715589 DOI: 10.1097/phh.0000000000001712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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11
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Choi SK, Golinkoff J, Lin WY, Hightow-Weidman L, Muessig K, Bauermeister J. Current and Future Perspectives of HIV Prevention Research Among Young Sexual Minority Men in South Korea. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:721-732. [PMID: 36097068 PMCID: PMC9466347 DOI: 10.1007/s10508-022-02403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Social stigma within Korean society hinders structural efforts to reduce HIV disparities among sexual minority men (SMM). To date, however, there have been limited intervention efforts to reduce HIV disparities among SMM in Korea. Therefore, the current mixed-methods study (n = 180) explored young Korean SMM's perspectives on the acceptability of HIV prevention mHealth interventions to inform effective strategies for future intervention studies. We then analyzed participants' comments and suggestions on HIV research and examined associations with the acceptability of mHealth interventions. Through our textual coding and analysis, we identified four primary themes for comments and suggestions for HIV research in Korea: the centrality of stigma, health service accessibility, informational accessibility, and cultural adaptation. Our study suggests culturally adapted HIV intervention addressing stigma, health service accessibility, and information accessibility and mHealth interventions disseminating information and resources for stigmatized young SMM in Korea.
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Affiliation(s)
- Seul Ki Choi
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA.
| | - Jesse Golinkoff
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA
| | - Willey Y Lin
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA
| | - Lisa Hightow-Weidman
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - José Bauermeister
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA
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12
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Bise CG, Cupler Z, Mathers S, Turner R, Sundaram M, Catelani MB, Dahler S, Popchak A, Schneider M. Face-to-face telehealth interventions in the treatment of low back pain: A systematic review. Complement Ther Clin Pract 2023; 50:101671. [PMID: 36379145 PMCID: PMC9613794 DOI: 10.1016/j.ctcp.2022.101671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Christopher G Bise
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA; UPMC Health Plan - Department of Health Economics, USA.
| | - Zachary Cupler
- Physical Medicine & Rehabilitation Services, Butler VA Healthcare System, USA
| | - Sean Mathers
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Rose Turner
- Department of Medicine, Health Science Library System, University of Pittsburgh, USA
| | - Meenakshi Sundaram
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Maria Beatriz Catelani
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Sarah Dahler
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Adam Popchak
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
| | - Michael Schneider
- School of Health and Rehabilitation Science, Department of Physical Therapy, University of Pittsburgh, USA
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13
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Uberoi D, Ojo T, Sriharan A, Lau L. What can implementation science offer civil society in their efforts to drive rights-based health reform? Glob Health Res Policy 2023; 8:1. [PMID: 36650592 PMCID: PMC9843858 DOI: 10.1186/s41256-023-00284-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023] Open
Abstract
Over the years, civil society organizations (CSOs) have made tremendous efforts to ensure that state policies, programmes, and actions facilitate equitable access to healthcare. While CSOs are key actors in the realization of the right to health, a systematic understanding of how CSOs achieve policy change is lacking. Implementation science, a discipline focused on the methods and strategies facilitating the uptake of evidence-based practice and research can bring relevant, untapped methodologies to understand how CSOs drive health reforms. This article argues for the use of evidence-based strategies to enhance civil society action. We hold that implementation science can offer an actionable frame to aid CSOs in deciphering the mechanisms and conditions in which to pursue rights-based actions most effectively. More empirical studies are needed to generate evidence and CSOs have already indicated the need for more data-driven solutions to empower activists to hold policymakers to account. Although implementation science may not resolve all the challenges CSOs face, its frameworks and approaches can provide an innovative way for organizations to chart out a course for reform.
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Affiliation(s)
- Diya Uberoi
- Faculty of Law, McGill University, 3644 Peel St, Montreal, QC, H3A 1W9, Canada.
| | - Tolulope Ojo
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | - Abi Sriharan
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | - Lincoln Lau
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
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14
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Garner BR, Burrus O, Ortiz A, Tueller SJ, Peinado S, Hedrick H, Harshbarger C, Galindo C, Courtenay-Quirk C, Lewis MA. A Longitudinal Mixed-Methods Examination of Positive Health Check: Implementation Results From a Type 1 Effectiveness-Implementation Hybrid Trial. J Acquir Immune Defic Syndr 2022; 91:47-57. [PMID: 35583962 PMCID: PMC9377502 DOI: 10.1097/qai.0000000000003018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Positive Health Check is an evidence-based video doctor intervention developed for improving the medication adherence, retention in care, and viral load suppression of people with HIV receiving clinical care. SETTING Four HIV primary care clinics within the United States. METHODS As part of a type 1 hybrid trial, a mixed-methods approach was used to longitudinally assess the following 3 key implementation constructs over a 23-month period: innovation-values fit (ie, the extent to which staff perceive innovation use will foster the fulfillment of their values), organizational readiness for change (ie, the extent to which organizational members are psychologically and behaviorally prepared to implement organizational change), and implementation climate (ie, the extent to which implementation is expected, supported, and rewarded). Quantitative mixed-effects regression analyses were conducted to assess changes over time in these constructs. Qualitative analyses were integrated to help provide validation and understanding. RESULTS Innovation-values fit and organizational readiness for change were found to be high and relatively stable. However, significant curvilinear change over time was found for implementation climate. Based on the qualitative data, implementation climate declined toward the end of implementation because of decreased engagement from clinic champions and differences in priorities between research and clinic staff. CONCLUSIONS The Positive Health Check intervention was found to fit within HIV primary care service settings, but there were some logistical challenges that needed to be addressed. Additionally, even within the context of an effectiveness trial, significant and nonlinear change in implementation climate should be expected over time.
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Affiliation(s)
| | | | - Alexa Ortiz
- RTI International, Research Triangle Park, NC; and
| | | | | | | | - Camilla Harshbarger
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
| | - Carla Galindo
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
| | - Cari Courtenay-Quirk
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
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Drabo EF, Moucheraud C, Nguyen A, Garland WH, Holloway IW, Leibowitz A, Suen SC. Using Microsimulation Modeling to Inform EHE Implementation Strategies in Los Angeles County. J Acquir Immune Defic Syndr 2022; 90:S167-S176. [PMID: 35703769 PMCID: PMC9216245 DOI: 10.1097/qai.0000000000002977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is essential to ending HIV. Yet, uptake remains uneven across racial and ethnic groups. We aimed to estimate the impacts of alternative PrEP implementation strategies in Los Angeles County. SETTING Men who have sex with men, residing in Los Angeles County. METHODS We developed a microsimulation model of HIV transmission, with inputs from key local stakeholders. With this model, we estimated the 15-year (2021-2035) health and racial and ethnic equity impacts of 3 PrEP implementation strategies involving coverage with 9000 additional PrEP units annually, above the Status-quo coverage level. Strategies included PrEP allocation equally (strategy 1), proportionally to HIV prevalence (strategy 2), and proportionally to HIV diagnosis rates (strategy 3), across racial and ethnic groups. We measured the degree of relative equalities in the distribution of the health impacts using the Gini index (G) which ranges from 0 (perfect equality, with all individuals across all groups receiving equal health benefits) to 1 (total inequality). RESULTS HIV prevalence was 21.3% in 2021 [Black (BMSM), 31.1%; Latino (LMSM), 18.3%, and White (WMSM), 20.7%] with relatively equal to reasonable distribution across groups (G, 0.28; 95% confidence interval [CI], 0.26 to 0.34). During 2021-2035, cumulative incident infections were highest under Status-quo (n = 24,584) and lowest under strategy 3 (n = 22,080). Status-quo infection risk declined over time among all groups but remained higher in 2035 for BMSM (incidence rate ratio, 4.76; 95% CI: 4.58 to 4.95), and LMSM (incidence rate ratio, 1.74; 95% CI: 1.69 to 1.80), with the health benefits equally to reasonably distributed across groups (G, 0.32; 95% CI: 0.28 to 0.35). Relative to Status-quo, all other strategies reduced BMSM-WMSM and BMSM-LMSM disparities, but none reduced LMSM-WMSM disparities by 2035. Compared to Status-quo, strategy 3 reduced the most both incident infections (% infections averted: overall, 10.2%; BMSM, 32.4%; LMSM, 3.8%; WMSM, 3.5%) and HIV racial inequalities (G reduction, 0.08; 95% CI: 0.02 to 0.14). CONCLUSIONS Microsimulation models developed with early, continuous stakeholder engagement and inputs yield powerful tools to guide policy implementation.
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Affiliation(s)
- Emmanuel F. Drabo
- Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
| | - Anthony Nguyen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
| | - Wendy H. Garland
- Los Angeles County Department of Public Health, Division of HIV and STD Programs, Los Angeles, CA
| | - Ian W. Holloway
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Arleen Leibowitz
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
- Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Sze-chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
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16
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Mustanski B, Smith JD, Keiser B, Li DH, Benbow N. Supporting the Growth of Domestic HIV Implementation Research in the United States Through Coordination, Consultation, and Collaboration: How We Got Here and Where We Are Headed. J Acquir Immune Defic Syndr 2022; 90:S1-S8. [PMID: 35703749 PMCID: PMC9643076 DOI: 10.1097/qai.0000000000002959] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Ending the HIV Epidemic (EHE) initiative sets a goal to virtually eliminate new HIV infections in the United States by 2030. The plan is predicated on the fact that tools exist for diagnosis, prevention, and treatment, and the current scientific challenge is how to implement them effectively and with equity. Implementation research (IR) can help identify strategies that support effective implementation of HIV services. SETTING NIH funded the Implementation Science Coordination Initiative (ISCI) to support rigorous and actionable IR by providing technical assistance to NIH-funded projects and supporting local implementation knowledge becoming generalizable knowledge. METHODS We describe the formation of ISCI, the services it provided to the HIV field, and data it collected from 147 NIH-funded studies. We also provide an overview of this supplement issue as a dissemination strategy for HIV IR. CONCLUSION Our ability to reach EHE 2030 goals is strengthened by the knowledge compiled in this supplement, the services of ISCI and connected hubs, and a myriad of investigators and implementation partners collaborating to better understand what is needed to effectively implement the many evidence-based HIV interventions at our disposal.
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Affiliation(s)
- Brian Mustanski
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Third Coast Center for AIDS Research, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | - Brennan Keiser
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Dennis H. Li
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Third Coast Center for AIDS Research, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Gore DJ, Schueler K, Ramani S, Uvin A, Phillips G, McNulty M, Fujimoto K, Schneider J. HIV Response Interventions that Integrate HIV Molecular Cluster and Social Network Analysis: A Systematic Review. AIDS Behav 2022; 26:1750-1792. [PMID: 34779940 PMCID: PMC9842229 DOI: 10.1007/s10461-021-03525-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/19/2023]
Abstract
Due to improved efficiency and reduced cost of viral sequencing, molecular cluster analysis can be feasibly utilized alongside existing human immunodeficiency virus (HIV) prevention strategies. The goal of this paper is to elucidate how HIV molecular cluster and social network analyses are being integrated to implement HIV response interventions. We searched PubMed, Scopus, PsycINFO, and Cochrane Library databases for studies incorporating both HIV molecular cluster and social network data. We identified 32 articles that combined analyses of HIV molecular sequences and social or sexual networks. All studies were descriptive. Six studies described network interventions informed by molecular and social data but did not fully evaluate their efficacy. There is no current standard for incorporating molecular and social network analyses to inform interventions or data demonstrating its utility. More research must be conducted to delineate benefits and best practices for leveraging molecular data for network-based interventions.
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Affiliation(s)
- Daniel J Gore
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kellie Schueler
- Department of Obstetrics and Gynecology, University of California San Diego, San Diego, CA, USA
| | - Santhoshini Ramani
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Arno Uvin
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Moira McNulty
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - John Schneider
- The Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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18
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Louw A, Puentedura EJ, Denninger TR, Lutz AD, Cox T, Zimney K, Landers MR. The clinical impact of pain neuroscience continuing education on physical therapy outcomes for patients with low back and neck pain. PLoS One 2022; 17:e0267157. [PMID: 35482780 PMCID: PMC9049561 DOI: 10.1371/journal.pone.0267157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/03/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Research suggests that attendance by physical therapists at continuing education (CE) targeting the management of low back pain (LBP) and neck pain does not result in positive impacts on clinical outcomes. The aim of this study was to determine if therapists attending a self-paced 3-hour online Pain Neuroscience Education (PNE) program was associated with any observed changes to patient outcomes and also clinical practice. Methods Participants were 25 different physical therapists who treated 3,705 patients with low back pain (LBP) or neck pain before and after they had completed an online PNE CE course. Change in outcomes measures of pain and disability at discharge were compared for the patients treated before and after the therapist training. Clinical practice patterns of the therapists, including total treatment visits, duration of care, total units billed, average units billed per visit, percentage of ‘active’ billing units and percentage of ‘active and manual’ billing units, were also compared for the patient care episodes before and after the therapist training. Results There was no significant difference for change in pain scores at discharge for patients treated after therapist CE training compared to those treated before regardless of the condition (LBP or neck pain). However, patients with LBP who were treated after therapist CE training did report greater improvement in their disability scores. Also after CE training, for each episode of care, therapists tended to use less total visits, billed fewer units per visit, and billed a greater percentage of more ‘active’ and ‘active and manual’ billing units. Discussion Attending an online 3-hour CE course on PNE resulted in improved disability scores for patients with LBP, but not for those with neck pain. Changes in clinical behavior by the therapists included using less visits, billing fewer total units, and shifting to more active and manual therapy interventions. Further prospective studies with control groups should investigate the effect of therapist CE on patient outcomes and clinical practice.
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Affiliation(s)
- Adriaan Louw
- Evidence in Motion, Story City, Iowa, United States of America
| | - Emilio J. Puentedura
- Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States of America
- * E-mail:
| | | | - Adam D. Lutz
- ATI Physical Therapy, Greenville, South Carolina, United States of America
| | - Terry Cox
- Department of Physical Therapy, Southwest Baptist University, Bolivar, Missouri, United States of America
| | - Kory Zimney
- Department of Physical Therapy, School of Health Sciences, University of South Dakota, Vermillion, South Dakota, United States of America
| | - Merrill R. Landers
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
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19
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Coste M, Badji MA, Diallo A, Mora M, Boyer S, Prah JJ. Applying the health capability profile to empirically study chronic hepatitis B in rural Senegal: a social justice mixed-methods study protocol. BMJ Open 2022; 12:e055957. [PMID: 35410929 PMCID: PMC9003616 DOI: 10.1136/bmjopen-2021-055957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Despite the early implementation of hepatitis B vaccination and the ongoing decentralisation of chronic hepatitis B (CHB) care, over 10% of the Senegalese adult population lives with CHB and liver cancer remains a main cause of death. Investigating factors associated with CHB infection, prevention of CHB-related morbidity, and prevention and treatment of mortality secondary to CHB calls for a holistic and multidimensional approach. This paper presents the adaptation of the health capability profile (HCP) to a specific epidemiological issue and empirical setting: it seeks to identify and analyse inter-related abilities and conditions (health capabilities) in relation to the CHB epidemic in the rural area of Niakhar, Senegal. METHODS AND ANALYSIS This ongoing study relies on a sequential social justice mixed-methods design. The HCP is comprehensively adapted to CHB in rural Senegal and guides the design and conduct of the study. Objective and subjective data are collected at the individual level following a mixed-methods explanatory core design. The quantitative module, embedded in the ANRS12356 AmBASS cross-sectional survey (exhaustive sampling), is used to select a purposeful sampling of participants invited for one-on-one qualitative interviews. Additional data are collected at the institutional and community level through health facility surveys and an ethnography (in-depth interviews) of local and national CHB stakeholders. Data analysis adopts a synergistic approach to produce a multilayered analysis of individual HCPs and crosscutting analysis of the 15 health capabilities. The data integration strategy relies on a mixed-methods convergent core design, and will use 0-100 health capability scores as well as flow diagrams to measure and characterise levels of development and interactions among health capabilities, respectively. ETHICS AND DISSEMINATION This study was approved by Senegalese and French authorities. Results dissemination through local workshops and scientific publications aim at fuelling effective policy change towards CHB-related health capability.
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Affiliation(s)
- Marion Coste
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Aix-Marseille University, CNRS, AMSE, Marseille, France
| | | | - Aldiouma Diallo
- Campus International IRD-UCAD de l'IRD, UMR VITROME, IRD-Université Aix Marseille, AP-HM, SSA, IHU-Méditerranée Infection, Dakar, Senegal
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Jennifer J Prah
- School of Social Policy and Practice & Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Lessons Learned From 10 Years of Preschool Intervention for Health Promotion. J Am Coll Cardiol 2022; 79:283-298. [DOI: 10.1016/j.jacc.2021.10.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022]
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21
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Wechsberg WM, Browne FA, Ndirangu J, Bonner CP, Kline TL, Gichane M, Zule WA. Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa. AIDS Behav 2021; 25:276-289. [PMID: 33891233 PMCID: PMC8063777 DOI: 10.1007/s10461-021-03251-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 01/05/2023]
Abstract
Women in South Africa living with HIV who use alcohol may not adhere to ART, affecting the country’s 90-90-90 targets. The Women’s Health CoOp (WHC), a woman-focused HIV intervention, has shown efficacy in numerous trials with key populations of women in South Africa who use alcohol and drugs. In a hybrid implementation effectiveness study, the WHC was implemented in usual care clinics by healthcare providers in a modified stepped-wedge design. We present the outcomes of alcohol use and ART adherence with 480 women, with a 95% 6-month follow-up rate across 4 implementation cycles. Compared with the first cycle, women in the fourth cycle were significantly less likely (OR = 0.10 [95% CI 0.04, 0.24]) to report alcohol use disorder risk and were 4 times more likely (OR = 4.16 [95% CI 1.05, 16.51]) to report ART adherence at 6-month follow-up. Overall, acceptability and satisfaction were extremely high. The WHC intervention was successful in reaching key populations of women to reduce alcohol use and increase ART adherence, which is essential for South Africa to reach the 90-90-90 goals.
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22
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Kazis LE, Sager A, Bailey HM, Vasudevan A, Garrity B, Tompkins R. Physical Rehabilitation and Mental Health Care after Burn Injury: A Multi-Nation Study. J Burn Care Res 2021; 43:868-879. [PMID: 34788851 DOI: 10.1093/jbcr/irab214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
While remarkable improvements have been made to acute hospital burn care in recent decades, it is not matched by improvements in post-acute care, including physical rehabilitation and mental health. Progress in acute hospital treatment of burn survivors now highlights the next important step-addressing care once a patient leaves intensive treatment and is discharged to the community. Long-term physical rehabilitation and mental health services are vital to improving quality of life for burn survivors. Using qualitative methods, we apply the adapted Reeve framework to assess and compare post-acute physical rehabilitation and mental health care across thirteen countries on six continents. Twenty semi-structured interviews were conducted with burn surgeons and rehabilitation specialists. One major theme that emerged was the importance of training and resources to the quality of post-acute care. This exploratory study suggests the value of investing scarce resources in a range of low-cost interventions to improve follow-up burn care. One intervention identified here is short-term training in post-acute rehabilitation and mental health to upgrade and standardize best clinical practices to address as-yet unmet post-discharge needs of burn survivors.
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Affiliation(s)
- Lewis E Kazis
- Boston University School of Public Health, Department of Health Law, Policy & Management
| | - Alan Sager
- Boston University School of Public Health, Department of Health Law, Policy & Management
| | - Hannah M Bailey
- Boston University School of Public Health, Department of Health Law, Policy & Management
| | | | - Brigid Garrity
- Boston University School of Public Health, Department of Health Law, Policy & Management
| | - Ron Tompkins
- Massachusetts General Hospital, Center for Engineering in Medicine & Surgery
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Richesson RL, Marsolo KS, Douthit BJ, Staman K, Ho PM, Dailey D, Boyd AD, McTigue KM, Ezenwa MO, Schlaeger JM, Patil CL, Faurot KR, Tuzzio L, Larson EB, O'Brien EC, Zigler CK, Lakin JR, Pressman AR, Braciszewski JM, Grudzen C, Fiol GD. Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory. J Am Med Inform Assoc 2021; 28:2626-2640. [PMID: 34597383 PMCID: PMC8633608 DOI: 10.1093/jamia/ocab202] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/05/2021] [Accepted: 09/02/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE We identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research. MATERIALS AND METHODS Since 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements. RESULTS We received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data. DISCUSSION Based on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries. CONCLUSION We are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.
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Affiliation(s)
- Rachel L Richesson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Keith S Marsolo
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian J Douthit
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,US Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Karen Staman
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - P Michael Ho
- Department of Medicine, University of Colorado Medicine, Denver, Colorado, USA
| | - Dana Dailey
- Center for Health Sciences, St. Ambrose University, Davenport, Iowa and Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Andrew D Boyd
- Department of Biomedical and Health Information Sciences University of Illinois Chicago, Chicago, Illinois, USA
| | - Kathleen M McTigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, University of Florida, College of Nursing, Gainesville, Florida, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois, USA
| | - Crystal L Patil
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina K Zigler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joshua R Lakin
- Palliative Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alice R Pressman
- Center for Health Systems Research, Sutter Health Center for Health Systems Research, Walnut Creek, California, USA
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Corita Grudzen
- Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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24
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O’Brien KK, Davis AM, Chan Carusone S, Avery L, Tang A, Solomon P, Aubry R, Zobeiry M, Ilic I, Pandovski Z, Bayoumi AM. Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study. PLoS One 2021; 16:e0257639. [PMID: 34559851 PMCID: PMC8462727 DOI: 10.1371/journal.pone.0257639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. METHODS We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. RESULTS Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). CONCLUSION Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. CLINICALTRIALS.GOV IDENTIFIER NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Avery Information, Oshawa, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Ivan Ilic
- Central Toronto YMCA, Toronto, Ontario, Canada
| | | | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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25
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Behrens L, Boltz M, Riley K, Eshraghi K, Resnick B, Galik E, Ellis J, Kolanowski A, Van Haitsma K. Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives. BMC Health Serv Res 2021; 21:1006. [PMID: 34551782 PMCID: PMC8458006 DOI: 10.1186/s12913-021-07001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders' perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. METHODS EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. CONCLUSION Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. TRIAL REGISTRATION The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov ( NCT03014570 ) January 9, 2017.
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Affiliation(s)
- Liza Behrens
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA.
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Kiernan Riley
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Karen Eshraghi
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Ann Kolanowski
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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Nagy SM, Butame SA, Todd L, Sheffler JL, Budhwani H, Fernandez MI, MacDonell K, Naar S. Barriers and facilitators to implementing a motivational interviewing-based intervention: a multi-site study of organizations caring for youth living with HIV. AIDS Care 2021; 34:486-491. [PMID: 34251935 PMCID: PMC8752625 DOI: 10.1080/09540121.2021.1950604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Understanding possible barriers and facilitators to effective implementation of evidence-based interventions to help high-risk youth prevent and manage HIV is crucial for their scale-up. This manuscript analyzes qualitative interview data collected during the early phase implementation of a motivational interviewing (MI) based intervention at 10 HIV care clinics in the United States providing services to youth. Using the Exploration-Preparation-Implementation-Sustainment (EPIS) framework to understand the implementation and the dynamic adaptation process (DAP) model to balance notions of intervention fidelity and flexibility, providers and stakeholders at each site (N = 97) were interviewed prior to implementation to gather their perspectives on organizational readiness for the intervention, as well as provider and client characteristics. The interviewers summarized their experience with rapid feedback forms (RFFs). Data extracted from the RFFs highlighted anticipated barriers to and facilitators of the proposed MI-based intervention, with the EPIS framework used to organize these findings. Study findings illustrate the inner and outer contextual factors that affect implementation and denote the points at which the MI-based intervention may be tailored to fit the unique context of a clinic while remaining faithful to the intervention's original design.
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Affiliation(s)
- Samantha M Nagy
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Seyram A Butame
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Lisa Todd
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, WA, USA
| | - Julia L Sheffler
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Henna Budhwani
- School of Public Health, Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria I Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Miami, FL, USA
| | - Karen MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, WA, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
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Twomey R, Matthews TW, Nakoneshny SC, Schrag C, Chandarana SP, Matthews J, McKenzie D, Hart RD, Li N, Dort JC, Sauro KM. From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction. Cancers (Basel) 2021; 13:2890. [PMID: 34207711 PMCID: PMC8228478 DOI: 10.3390/cancers13122890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022] Open
Abstract
One of the foundational elements of enhanced recovery after surgery (ERAS) guidelines is early postoperative mobilization. For patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction, the ERAS guideline recommends patients be mobilized within 24 h postoperatively. The objective of this study was to evaluate compliance with the ERAS recommendation for early postoperative mobilization in 445 consecutive patients who underwent HNC surgery in the Calgary Head and Neck Enhanced Recovery Program. This retrospective analysis found that recommendation compliance increased by 10% despite a more aggressive target for mobilization (from 48 to 24 h). This resulted in a decrease in postoperative mobilization time and a stark increase in the proportion of patients mobilized within 24 h (from 10% to 64%). There was a significant relationship between compliance with recommended care and time to postoperative mobilization (Spearman's rho = -0.80; p < 0.001). Hospital length of stay was reduced by a median of 2 days, from 12 (1QR = 9-16) to 10 (1QR = 8-14) days (z = 3.82; p < 0.001) in patients who received guideline-concordant care. Engaging the clinical team and changing the order set to support clinical decision-making resulted in increased adherence to guideline-recommended care for patients undergoing major HNC surgery with free flap reconstruction.
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Affiliation(s)
- Rosie Twomey
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - T Wayne Matthews
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - Christiaan Schrag
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Shamir P Chandarana
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Jennifer Matthews
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - David McKenzie
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Robert D Hart
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Na Li
- Department of Community Health Sciences, Surgery & Oncology, University of Calgary Cumming School of Medicine, 3D10, 3280 Hospital Drive NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - Joseph C Dort
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Section of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Foothills Medical Centre, Alberta Health Services, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
- Department of Community Health Sciences, Surgery & Oncology, University of Calgary Cumming School of Medicine, 3D10, 3280 Hospital Drive NW Calgary, Calgary, AB T2N 4Z6, Canada
| | - Khara M Sauro
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, University of Calgary Cumming School of Medicine, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Community Health Sciences, Surgery & Oncology, University of Calgary Cumming School of Medicine, 3D10, 3280 Hospital Drive NW Calgary, Calgary, AB T2N 4Z6, Canada
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Fonner VA, Kennedy S, Desai R, Eichberg C, Martin L, Meissner EG. Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study. JMIR Form Res 2021; 5:e22513. [PMID: 34042596 PMCID: PMC8193483 DOI: 10.2196/22513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/29/2020] [Accepted: 04/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients.
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Affiliation(s)
- Virginia A Fonner
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, United States
| | - Samuel Kennedy
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, United States
| | - Rohan Desai
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Christie Eichberg
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, United States
| | - Lisa Martin
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, United States
| | - Eric G Meissner
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, United States
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Brown M, Rosenthal M, Yeh DD. Implementation Science and Nutrition: From Research to Practice. Nutr Clin Pract 2021; 36:586-597. [PMID: 34021636 DOI: 10.1002/ncp.10677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/09/2021] [Indexed: 11/11/2022] Open
Abstract
Implementation science (IS) is a young field that seeks to minimize the gap between what we know and what we practice, otherwise known as the "know-do gap." Recently, IS has focused on research that expedites the dissemination of evidence-based knowledge, accelerates the translation of interventions to improve knowledge gaps, shrinks healthcare disparities, enhances care of complex medical conditions, and narrows variation in clinical practice and policy. This article seeks to review theoretical frameworks of IS and demonstrate how IS can be utilized to improve nutrition care. Specific examples in this article include implementation of initiatives to improve documentation of malnutrition, increase provision of oral nutrition supplements, increase use of Enhanced Recovery After Surgery protocols, and increase energy and protein delivery. Clinical nutrition is a growing field with more and more research findings pointing to new therapies. In implementing these new therapies, practitioners should recognize the complex system present in healthcare and lean on IS findings to speed implementation and more rapidly improve clinical outcomes.
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Affiliation(s)
- Michelle Brown
- Clinical Nutrition, UF Health Shands Hospital, Gainesville, Florida, USA
| | - Martin Rosenthal
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - D Dante Yeh
- Surgery, General Surgery Residency, Division of Trauma and Surgical Critical Care, The DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
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30
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Law S, Seepamore B, Oxlade O, Sikhakhane N, Dawood H, Chetty S, Padayatchi N, Menzies D, Daftary A. Acceptability, feasibility, and impact of a pilot tuberculosis literacy and treatment counselling intervention: a mixed methods study. BMC Infect Dis 2021; 21:449. [PMID: 34006254 PMCID: PMC8132373 DOI: 10.1186/s12879-021-06136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is a need for innovative strategies to improve TB testing uptake and patient retention along the continuum of TB care early-on in treatment without burdening under-resourced health systems. We used a mixed methods approach to develop and pilot test a tuberculosis literacy and counselling intervention at an urban clinic in KwaZulu Natal, South Africa, to improve TB testing uptake and retention in tuberculosis care. Methods We engaged in discussions with clinic staff to plan and develop the intervention, which was delivered by senior social work students who received one-week training. The intervention included: 1) group health talks with all patients attending the primary clinic; and 2) individual counselling sessions, using motivational interviewing techniques, with newly diagnosed tuberculosis patients. We compared social work students’ tuberculosis knowledge, attitudes, and practices before and after their training. We assessed the change in number of tuberculosis diagnostic tests performed after implementation via an interrupted time series analysis with a quasi-Poisson regression model. We compared pre- and post-intervention probabilities of treatment initiation and completion using regression analyses, adjusting for potential baseline confounders. We conducted focus groups with the students, as well as brief surveys and one-on-one interviews with patients, to assess acceptability, feasibility, and implementation. Results During the study period, 1226 individuals received tuberculosis diagnostic testing and 163 patients started tuberculosis treatment, of whom 84 (51.5%) received individual counselling. The number of diagnostic tuberculosis tests performed increased by 1.36 (95%CI 1.23–1.58) times post-intervention, adjusting for background calendar trend. Probabilities of TB treatment initiation and treatment completion increased by 10.1% (95%CI 1.5–21.3%) and 4.4% (95%CI -7.3-16.0%), respectively. Patients found the counselling sessions alleviated anxiety and increased treatment self-efficacy. Social work students felt the clinic staff were collaborative and highly supportive of the intervention, and that it improved patient engagement and adherence. Conclusions Engaging clinic staff in the development of an intervention ensures buy-in and collaboration. Education and counselling before and early-on in tuberculosis treatment can increase tuberculosis testing and treatment uptake. Training junior social workers can enable task-shifting in under-resourced settings, while addressing important service gaps in tuberculosis care. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06136-1.
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Affiliation(s)
- Stephanie Law
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,McGill International TB Centre, Research Institute of the McGill University Health Centre, 1001 rue Decarie, Montreal, Quebec, H4A 3J1, Canada.
| | - Boitumelo Seepamore
- School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, 238 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa
| | - Olivia Oxlade
- McGill International TB Centre, Research Institute of the McGill University Health Centre, 1001 rue Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Nondumiso Sikhakhane
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - Halima Dawood
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa.,Department Medicine, Infectious Disease Unit, Greys Hospital, The Msunduzi, Town Hill, Pietermaritzburg, 3201, South Africa
| | - Sheldon Chetty
- East Boom Community Healthcare Centre, 541 Boom Street, Pietermaritzburg, 3201, South Africa
| | - Nesri Padayatchi
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - Dick Menzies
- McGill International TB Centre, Research Institute of the McGill University Health Centre, 1001 rue Decarie, Montreal, Quebec, H4A 3J1, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, Quebec, H3A 1A2, Canada
| | - Amrita Daftary
- CAPRISA- MRC HIV-TB Treatment and Pathogenesis Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa.,School of Global Health and Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd, North York, ON, M3J 2S5, Canada
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Benfield A, Krueger RB. Making Decision-Making Visible-Teaching the Process of Evaluating Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3635. [PMID: 33807379 PMCID: PMC8036716 DOI: 10.3390/ijerph18073635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/06/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
Significant efforts in the past decades to teach evidence-based practice (EBP) implementation has emphasized increasing knowledge of EBP and developing interventions to support adoption to practice. These efforts have resulted in only limited sustained improvements in the daily use of evidence-based interventions in clinical practice in most health professions. Many new interventions with limited evidence of effectiveness are readily adopted each year-indicating openness to change is not the problem. The selection of an intervention is the outcome of an elaborate and complex cognitive process, which is shaped by how they represent the problem in their mind and is mostly invisible processes to others. Therefore, the complex thinking process that support appropriate adoption of interventions should be taught more explicitly. Making the process visible to clinicians increases the acquisition of the skills required to judiciously select one intervention over others. The purpose of this paper is to provide a review of the selection process and the critical analysis that is required to appropriately decide to trial or not trial new intervention strategies with patients.
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Affiliation(s)
- Angela Benfield
- Occupational Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Robert B. Krueger
- Entry-Level Doctor of Occupational Therapy, Whitworth University, Spokane, WA 97149, USA;
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Krebs E, Nosyk B. Cost-Effectiveness Analysis in Implementation Science: a Research Agenda and Call for Wider Application. Curr HIV/AIDS Rep 2021; 18:176-185. [PMID: 33743138 PMCID: PMC7980756 DOI: 10.1007/s11904-021-00550-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Purpose of Review Cost-effectiveness analysis (CEA) can help identify the trade-offs decision makers face when confronted with alternative courses of action for the implementation of public health strategies. Application of CEA alongside implementation scientific studies remains limited. We aimed to identify areas for future development in order to enhance the uptake and impact of model-based CEA in implementation scientific research. Recent Findings Important questions remain about how to broadly implement evidence-based public health interventions in routine practice. Establishing population-level implementation strategy components and distinct implementation phases, including planning for implementation, the time required to scale-up programs, and sustainment efforts required to maintain them, can help determine the data needed to quantify each of these elements. Model-based CEA can use these data to determine the added value associated with each of these elements across systems, settings, population subgroups, and levels of implementation to provide tailored guidance for evidence-based public health action. There is a need to integrate implementation science explicitly into CEA to adequately capture diverse real-world delivery contexts and make detailed, informed recommendations on the aspects of the implementation process that provide good value. Summary We describe examples of how model-based CEA can integrate implementation scientific concepts and evidence to help tailor evaluations to local context. We also propose six distinct domains for methodological advancement in order to enhance the uptake and impact of model-based cost-effectiveness analysis in implementation scientific research.
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Affiliation(s)
- Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive V5A 1S6, Burnaby, British Columbia, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive V5A 1S6, Burnaby, British Columbia, Canada.
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Psihopaidas D, Cohen SM, West T, Avery L, Dempsey A, Brown K, Heath C, Cajina A, Phillips H, Young S, Stubbs-Smith A, Cheever LW. Implementation science and the Health Resources and Services Administration's Ryan White HIV/AIDS Program's work towards ending the HIV epidemic in the United States. PLoS Med 2020; 17:e1003128. [PMID: 33156852 PMCID: PMC7647058 DOI: 10.1371/journal.pmed.1003128] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Demetrios Psihopaidas and co-authors discuss the implementation science framework of an HIV/AIDS program in the United States.
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Affiliation(s)
- Demetrios Psihopaidas
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Stacy M. Cohen
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Tanchica West
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Latham Avery
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Antigone Dempsey
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Kim Brown
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Corliss Heath
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Adan Cajina
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Harold Phillips
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Steve Young
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - April Stubbs-Smith
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Laura W. Cheever
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
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Di Ciaccio M, Sagaon-Teyssier L, Mimi M, Suzan-Monti M, Protiere C, Rojas Castro D, Meyer L, Tremblay C, Chidiac C, Capitant C, Préau M, Molina JM, Spire B. Changes in Sexual Behaviors in Men Who Have Sex with Men: A Comparison Between the Double-Blind and Open-Label Extension Phases of the ANRS-IPERGAY Trial. AIDS Behav 2020; 24:3093-3106. [PMID: 32306213 DOI: 10.1007/s10461-020-02864-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) is changing the landscape of HIV prevention, and may bring changes in sexual behaviors. The double-blind phase (DBP) and open-label extension (OLE) study of the ANRS-IPERGAY trial allowed us to assess changes in sexual behavior of men who have sex with men (MSM) taking sexual activity-based (i.e., on-demand) PrEP. Generalized Estimating Equation (GEE) models found a significant decrease in the number of sexual partners (Coefficient [CI95%], p value; - 0.37[- 0.70 to - 0.04], p = 0.03) between the DBP and OLE as well as in the number of sexual relations (- 0.25 [- 0.49 to 0.00], 0.04). GEE estimates also showed that respondents' most recent sexual relation was less likely to have been with an unknown casual partner during the OLE than during the DBP (Odds Ratio [CI95%], p value: 0.75[0.62-0.92], 0.005). Furthermore, they showed an increase in the proportion of condomless anal sex in the OLE (1.32[1.04-1.67], 0.02), a decrease in the proportion of 'suboptimal PrEP adherence' over time (0.75[0.58-0.97], p = 0.03), a decrease in PrEP only use (0.73[0.55-0.96], 0.03) and in both PrEP and condom use over time (0.70[0.51-0.95], 0.02) and finally, a decrease in alcohol consumption between the DBP and OLE (0.74[0.61-0.90], 0.002). We observed both protective and risky behaviors in terms of HIV and STI risk after on-demand PrEP uptake in the OLE phase. Our findings are consistent with results from previous PrEP trials.
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Affiliation(s)
- Marion Di Ciaccio
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France.
- Groupe de Recherche En Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France.
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Mohamed Mimi
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Christel Protiere
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
- Groupe de Recherche En Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
- AIDES (Mission Innovation Recherche Expérimentation), Pantin, France
- Coalition Internationale Sida, Pantin, France
| | | | - Cécile Tremblay
- Centre Hospitalier de l'Université de Montréal- Hôtel Dieu, Montréal, Canada
| | - Christian Chidiac
- Département Des Maladies Infectieuses, Hôpital de la Croix Rousse, Centre Hospitalier et Universitaire de Lyon, Lyon, France
| | - Catherine Capitant
- Département des maladies infectieuses, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot Paris 7, INSERM U941, Paris, France
| | - Marie Préau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
- Groupe de Recherche En Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
| | - Jean Michel Molina
- Département des maladies infectieuses, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot Paris 7, INSERM U941, Paris, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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Davis T, DiClemente RJ, Prietula M. Using ADAPT-ITT to Modify a Telephone-Based HIV Prevention Intervention for SMS Delivery: Formative Study. JMIR Form Res 2020; 4:e22485. [PMID: 32831178 PMCID: PMC7576465 DOI: 10.2196/22485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND African American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application. OBJECTIVE This paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator-led phone calling to text-based communication. METHODS The formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board's request, this phase included an optional, additional week of text-based PMI messages. RESULTS The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted. CONCLUSIONS The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives.
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Affiliation(s)
- Teaniese Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, United States
| | - Ralph Joseph DiClemente
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Michael Prietula
- Goizueta Business School & Hubert Department of Global Health, Emory University, Atlanta, GA, United States
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Hill BJ, Motley DN, Rosentel K, VandeVusse A, Garofalo R, Kuhns LM, Kipke MD, Reisner S, Rupp B, West Goolsby R, McCumber M, Renshaw L, Schneider JA. Work2Prevent, an Employment Intervention Program as HIV Prevention for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 3): Protocol for a Single-Arm Community-Based Trial to Assess Feasibility and Acceptability in a Real-World Setting. JMIR Res Protoc 2020; 9:e18051. [PMID: 32915162 PMCID: PMC7519435 DOI: 10.2196/18051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the United States, young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth face elevated rates of HIV infection. However, racial and ethnic disparities in adolescent HIV infection cannot be attributed to individual-level factors alone and are situated within larger social and structural contexts that marginalize and predispose sexual and gender minority youth of color to HIV. Addressing broader ecological factors that drive transmission requires interventions that focus on the distal drivers of HIV infection, including violence exposure, housing, food insecurity, educational attainment, and employment. Given the ways that economic instability may make YMSM, YTW, and GNC youth of color vulnerable to HIV exposure, this study focuses on employment as an HIV prevention intervention. More specifically, the intervention, called Work2Prevent (W2P), targets economic stability through job readiness and employment as a means of preventing behaviors and factors associated with adolescent and young adult HIV, such as transactional sex work and homelessness. The intervention was adapted from iFOUR, an evidence-based employment program for HIV-positive adults in phase 1 of this study, and pilot tested in a university-based setting in phase 2. OBJECTIVE This paper aims to describe the protocol for the community-based test phase of W2P. The purpose of this phase was to pilot test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color within a lesbian, gay, bisexual, transgender, and queer (LGBTQ) community setting. METHODS The employment intervention was pilot tested using a single-arm pretest-posttest trial design implemented among a sample of vulnerable YMSM, YTW, and GNC youth of color using services within a community-based LGBTQ center. Assessments will examine intervention feasibility, acceptability, and preliminary estimates of efficacy. RESULTS Phase 3 of W2P research activities began in May 2019 and was completed in December 2019. Overall, 41 participants were enrolled in the community-based pilot. CONCLUSIONS This study will assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce vulnerability to HIV when implemented in a community-based setting serving LGBTQ youth of color. Testing the intervention in a community setting is an opportunity to evaluate how recruitment, retention, and other outcomes are impacted by delivery in a venue akin to where this intervention could eventually be used by nonresearchers. If W2P demonstrates feasibility and acceptability, a larger multisite trial implemented in multiple community settings serving YMSM, YTW, and GNC youth of color is planned. TRIAL REGISTRATION ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18051.
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Affiliation(s)
- Brandon J Hill
- Planned Parenthood Great Plains, Overland Park, KS, United States
| | - Darnell N Motley
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Kris Rosentel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | | | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sari Reisner
- Fenway Health, The Fenway Institute, Boston, MA, United States
| | - Betty Rupp
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rachel West Goolsby
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Micah McCumber
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura Renshaw
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Ventuneac A, Li DH, Mongrella MC, Moskowitz DA, Weingardt KR, Brown CH, Parsons JT, Mustanski B. Exploring potential implementation barriers and facilitators of the SMART Program, a stepped-care package of eHealth HIV prevention interventions for adolescent men who have sex with men. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2020; 17:378-388. [PMID: 32884583 PMCID: PMC7462358 DOI: 10.1007/s13178-019-00402-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about how to best implement eHealth HIV interventions for adolescent men who have sex with men (AMSM) in real-world settings. In response, our current study describes formative implementation research with community-based organizations (CBOs) in preparation for future implementation of the SMART Program, a stepped-care package of three interventions adapted for AMSM. In-depth interviews focusing on eHealth implementation were conducted with a convenience sample of 12 stakeholders from nine CBOs that actively implemented sexual-minority-focused HIV/AIDS prevention programs. Qualitative analysis was conducted using Dedoose to identify salient themes. Most programs implemented at the CBOs engaged adult MSM for HIV prevention, but CBOs reported less experience with outreach of AMSM for HIV prevention. While comfortable with and skilled at implementing traditional in-person HIV prevention programs, interviewees reported that eHealth programs fell outside of their organizations' technical capacities. They suggested specific strategies to facilitate successful implementation of SMART and other eHealth programs, including technical-capacity-building at CBOs, better training of staff, and partnering with a national coordinating center that provides support for the technology. Overall, the CBOs reported enthusiasm for the SMART Program and thought it an efficient way to bridge their current gaps in online programming and lack of AMSM HIV prevention strategies.
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Affiliation(s)
- Ana Ventuneac
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, New York, NY, USA
| | - Dennis H. Li
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Melissa C. Mongrella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - David A. Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | | | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Northwestern University, Chicago, IL, USA
| | - Jeffrey T. Parsons
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Northwestern University, Chicago, IL, USA
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Mustanski B, Moskowitz DA, Moran KO, Newcomb ME, Macapagal K, Rodriguez-Díaz C, Rendina HJ, Laber EB, Li DH, Matson M, Talan AJ, Cabral C. Evaluation of a Stepped-Care eHealth HIV Prevention Program for Diverse Adolescent Men Who Have Sex With Men: Protocol for a Hybrid Type 1 Effectiveness Implementation Trial of SMART. JMIR Res Protoc 2020; 9:e19701. [PMID: 32779573 PMCID: PMC7448177 DOI: 10.2196/19701] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/07/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are. OBJECTIVE This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART. METHODS Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements. RESULTS The trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing. CONCLUSIONS SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03511131; https://clinicaltrials.gov/ct2/show/NCT03511131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19701.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David A Moskowitz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kevin O Moran
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Carlos Rodriguez-Díaz
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, United States
| | - Eric B Laber
- Department of Statistics, North Carolina State University, Raleigh, NC, United States
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Margaret Matson
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Ali J Talan
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, United States
| | - Cynthia Cabral
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, United States
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Iwelunmor J, Nwaozuru U, Obiezu-Umeh C, Uzoaru F, Ehiri J, Curley J, Ezechi O, Airhihenbuwa C, Ssewamala F. Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework. Implement Sci Commun 2020; 1:53. [PMID: 32885209 PMCID: PMC7427963 DOI: 10.1186/s43058-020-00042-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention's impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. METHODS We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions. RESULTS A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%). CONCLUSIONS Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.
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Affiliation(s)
- Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Florida Uzoaru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - John Ehiri
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85724 USA
| | - Jami Curley
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos State Nigeria
| | - Collins Airhihenbuwa
- School of Public Health, Global Research Against Noncommunicable Diseases, Georgia State University, 140 Decatur Street SE, Atlanta, GA 30303 USA
| | - Fred Ssewamala
- Brown School, Washington University in Saint Louis, 1 Brookings Drive, Saint Louis, MO 63130 USA
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Puppo C, Spire B, Morel S, Génin M, Béniguel L, Costagliola D, Ghosn J, Mabire X, Molina JM, Rojas Castro D, Préau M. How PrEP users constitute a community in the MSM population through their specific experience and management of stigmatization. The example of the French ANRS-PREVENIR study. AIDS Care 2020; 32:32-39. [PMID: 32174136 DOI: 10.1080/09540121.2020.1742863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The ANRS-PREVENIR (2017-2020) prospective cohort study aims to reduce the number of new HIV infections in the "Ile-de-France" region in France, by enrolling individuals at high risk of HIV infection and proposing daily and on-demand pre-exposure prophylaxis (PrEP). The qualitative component of the ANRS-PREVENIR study aimed to investigate social and relational evolutions associated with PrEP use in men who have sex with men (MSM). In 2018, 12 focus groups with MSM (n = 68) were conducted by a social sciences researcher in Paris. A thematic analysis was performed. Results showed that stigma concerning PrEP use is a complex issue, with various kinds of stigmatization being practiced, sometimes even by the wider MSM population and PrEP users themselves. All types of stigma identified were expressed in forms of verbal abuse which made PrEP use taboo. Inside the wider MSM population a PrEP-user "community" was identified which shared a certain complicity in terms of values and a positive attitude towards PrEP. The emergence of new intragroup and intergroup social norms should be taken into account by policy makers to promote a more positive image of PrEP users.
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Affiliation(s)
- C Puppo
- GRePS, Lyon 2 University, Lyon, France
| | - B Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - S Morel
- AIDES, Paris, France.,Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - M Génin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - L Béniguel
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - D Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - J Ghosn
- APHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Nord site Bichat-Claude Bernard, Université Paris Diderot, INSERM U 1137 IAME, PRES Sorbonne Paris-Cité, Paris, France
| | - X Mabire
- GRePS, Lyon 2 University, Lyon, France
| | - J M Molina
- Department of infectious Diseases, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - D Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,Aix Marseille Université, Inserm, IRD, Sesstim (Sciences économiques et sociales de la santé et traitement de l'information médicale), Marseille, France
| | - M Préau
- GRePS, Lyon 2 University, Lyon, France
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The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six United States cities. AIDS 2020; 34:447-458. [PMID: 31794521 DOI: 10.1097/qad.0000000000002455] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Effective interventions to reduce the public health burden of HIV/AIDS can vary in their ability to deliver value at different levels of scale and in different epidemiological contexts. Our objective was to determine the cost-effectiveness of HIV treatment and prevention interventions implemented at previously documented scales of delivery in six US cities with diverse HIV microepidemics. DESIGN Dynamic HIV transmission model-based cost-effectiveness analysis. METHODS We identified and estimated previously documented scale of delivery and costs for 16 evidence-based interventions from the US CDC's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. Using a model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City and Seattle, we estimated averted HIV infections, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratios (healthcare perspective; 3% discount rate, 2018$US), for each intervention and city (10-year implementation) compared with the status quo over a 20-year time horizon. RESULTS Increased HIV testing was cost-saving or cost-effective across cities. Targeted preexposure prophylaxis for high-risk MSM was cost-saving in Miami and cost-effective in Atlanta ($6123/QALY), Baltimore ($18 333/QALY) and Los Angeles ($86 117/QALY). Interventions designed to improve antiretroviral therapy initiation provided greater value than other treatment engagement interventions. No single intervention was projected to reduce HIV incidence by more than 10.1% in any city. CONCLUSION Combination implementation strategies should be tailored to local epidemiological contexts to provide the most value. Complementary strategies addressing factors hindering access to HIV care will be necessary to meet targets for HIV elimination in the United States.
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Gamble-George JC, Longenecker CT, Webel AR, Au DH, Brown AF, Bosworth H, Crothers K, Cunningham WE, Fiscella KA, Hamilton AB, Helfrich CD, Ladapo JA, Luque A, Tobin JN, Wyatt GE. ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): Combatting chronic disease comorbidities in HIV populations through implementation research. Prog Cardiovasc Dis 2020; 63:79-91. [PMID: 32199901 PMCID: PMC7237329 DOI: 10.1016/j.pcad.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
Antiretroviral therapy (ART) prevented premature mortality and improved the quality of life among people living with the human immunodeficiency virus (PLWH), such that now more than half of PLWH in the United States are 50 years of age and older. Increased longevity among PLWH has resulted in a significant rise in chronic, comorbid diseases. However, the implementation of guideline-based interventions for preventing, treating, and managing such age-related, chronic conditions among the HIV population is lacking. The PRECluDE consortium supported by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute catalyzes implementation research on proven-effective interventions for co-occurring heart, lung, blood, and sleep diseases and conditions among PLWH. These collaborative research studies use novel implementation frameworks with HIV, mental health, cardiovascular, and pulmonary care to advance comprehensive HIV and chronic disease healthcare in a variety of settings and among diverse populations.
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Affiliation(s)
- Joyonna Carrie Gamble-George
- Health Scientist Administrator and AAAS Science and Technology Policy Fellow, Implementation Science Branch (ISB), Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), U.S. Department of Health and Human Services, Bethesda, MD 20892, United States of America; Office of Science Policy (OSP), Office of the Director (OD), National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD 20892, United States of America.
| | - Christopher T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States of America
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - David H Au
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA 98195, United States of America; Seattle-Denver Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - Arleen F Brown
- Department of Medicine, Division of General Internal Medicine and Health Services Research (GIM and HSR), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, United States of America; GIM and HSR, Olive View-UCLA Medical Center Sylmar, Los Angeles, CA 90095, United States of America; Community Engagement and Research Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA 90095, United States of America
| | - Hayden Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, NC 27701, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, United States of America
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA 98195, United States of America; Pulmonary and Critical Care Section, VA Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - William E Cunningham
- Department of Medicine, GIM and HSR, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, United States of America; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, United States of America
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Center for Communication and Disparities Research, University of Rochester Medical Center, Rochester, NY 14620, United States of America; Greater Rochester Practice-Based Research Network, Clinical and Translational Science Institute (CTSI), University of Rochester Medical Center, Rochester, NY 14642, United States of America
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; VA Health Services Research and Development (HSR&D) Service, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, North Hills, CA 91343, United States of America
| | - Christian D Helfrich
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA 98101, United States of America; Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration (VA) Puget Sound Health Care System, Seattle, WA 98108, United States of America
| | - Joseph A Ladapo
- Department of Medicine, GIM and HSR, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, United States of America; Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY 10016, United States of America
| | - Amneris Luque
- HIV Clinical Services, Parkland Health and Hospital System, Dallas, TX 75235, United States of America; Department of Internal Medicine, University of Texas (UT) Southwestern Medical Center, Dallas, TX 75390, United States of America
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY 10018; Community-Engaged Research, The Rockefeller University Center for Clinical and Translational Science, New York, NY 10065, United States of America
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; Sexual Health Programs, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States of America; The Center for Culture, Trauma, and Mental Health Disparities, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, United States of America; University of Cape Town, Rondebosch, Cape Town 7701, South Africa
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Greene M, Myers J, Tan JY, Blat C, O’Hollaren A, Quintanilla F, Hsue P, Shiels M, Hicks ML, Olson B, Grochowski J, Oskarsson J, Havlir D, Gandhi M. The Golden Compass Program: Overview of the Initial Implementation of a Comprehensive Program for Older Adults Living with HIV. J Int Assoc Provid AIDS Care 2020; 19:2325958220935267. [PMID: 32715875 PMCID: PMC7385829 DOI: 10.1177/2325958220935267] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
The population with HIV is aging and has unique health needs. We present findings from an evaluation of the geriatric-HIV program, Golden Compass, at San Francisco General Hospital. We used the implementation science framework, RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to guide the evaluation and used quantitative and qualitative methods to assess RE-AIM dimensions. From January 2017 to June 2018, 198 adults age ≥50 years participated in the program, with an estimated reach of 17%. Providers and patients indicated high acceptability of the program and were satisfied with clinics and classes. Colocation of services, specific pharmacy and geriatric assessments, and social support from classes were valued (effectiveness). Provider adoption was high, and the program was implemented as originally designed. Areas for improvement included challenges of framing aging services to patients. Future efforts will focus on expanding the reach of the program and examining long-term outcomes.
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Affiliation(s)
- Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Janet Myers
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Judy Y. Tan
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Cinthia Blat
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California–San Francisco, San Francisco, CA, USA
| | - Allison O’Hollaren
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Francisco Quintanilla
- Division of Geriatrics, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Priscilla Hsue
- Division of Cardiology, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Mary Shiels
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Mary Lawrence Hicks
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Bill Olson
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Janet Grochowski
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Jon Oskarsson
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Diane Havlir
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, CA, USA
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Research Capacity Strengthening in Sub-Saharan Africa: Recognizing the Importance of Local Partnerships in Designing and Disseminating HIV Implementation Science to Reach the 90-90-90 Goals. AIDS Behav 2019; 23:206-213. [PMID: 31098746 PMCID: PMC6773819 DOI: 10.1007/s10461-019-02538-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Capacity building in implementation science is integral to PEPFAR’s mission and to meeting the 90–90–90 goals. The USAID funded Project SOAR sponsored a 4 day workshop for investigators and governmental and non-governmental partners from 12 African countries. The workshop was designed to address both findings from a pre-workshop online needs assessment as well as capacity challenges across the capacity building pyramid, from individual skills to institutional systems and resources. Activities were output-oriented and skill based. An online survey evaluated sessions and changes in perceptions of needs; a majority of respondents strongly agreed that after the workshop, they better understood their personal and institutional capacity strengthening needs. Participants ‘strongly agreed’ that workshop content was relevant to their jobs (90%) and that they left the workshop with a specific plan for conducting future research (65%). Workshop results suggest that skill-building should be done in conjunction with systems capacity building within the cultural context.
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Cavanaugh C, Campbell J, Whitt V, Wingood G. Pilot Test of an Adapted, Evidence-Based Intervention for Preventing HIV for Women Residing in Domestic Violence Shelters. Violence Against Women 2019; 26:771-783. [PMID: 30946627 DOI: 10.1177/1077801219838329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This pilot study examined whether an evidence-based intervention for preventing HIV that was adapted for women residing in domestic violence shelters improved residents' HIV knowledge and condom use self-efficacy. The intervention acceptability, feasibility, and fidelity were also assessed. Seven domestic violence shelter workers facilitated the intervention to 32 shelter residents. Residents had significantly higher HIV knowledge and condom use self-efficacy after the intervention. Residents found the intervention highly acceptable. Intervention facilitators generally agreed that the intervention was acceptable and feasible. Facilitators taught the intervention mostly as suggested, but with some changes. Study implications are discussed.
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Program-Led Program-Science: The Public Health Impact of the CDC Category C Health Department Model for HIV Prevention. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 23:560-563. [PMID: 28492451 DOI: 10.1097/phh.0000000000000585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Addison D, Baim-Lance A, Suchman L, Katz B, Swain CA, Piersanti K, Steinbock C, Sawicki S, Agins B, Nash D. Factors Influencing the Successful Implementation of HIV Linkage and Retention Interventions in Healthcare Agencies Across New York State. AIDS Behav 2019; 23:105-114. [PMID: 29492740 DOI: 10.1007/s10461-018-2060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
As part of the System Linkages and Access to Care Initiative, 12 HIV service delivery organizations in New York implemented one of the following three interventions to improve linkage to and retention in HIV care at their site: Peer Support, Appointment Procedures, and Anti-Retroviral Treatment and Access to Services. Aggregate process measure data describing intervention delivery, in conjunction with qualitative findings to help explain barriers and facilitators to achieving full implementation were examined. Process data from the interventions showed shortcomings in the percentage of eligible patients who went on to be enrolled, and the number of enrollees who ultimately received the components of the interventions. Factors identified in qualitative interviews that facilitated implementation and intervention delivery included: concerted buy-in and coordination of staff, building upon existing infrastructure including ensuring sufficient staff capacity, and allowing adaptability of certain parts of the intervention to better fit patient needs and clinical settings.
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Owczarzak J, Broaddus M, Tarima S. Effectiveness of an evidence-based HIV prevention intervention when implemented by frontline providers. Transl Behav Med 2018; 8:917-926. [PMID: 29385559 PMCID: PMC6248864 DOI: 10.1093/tbm/ibx041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Carefully conducted randomized trials have established that sexual behavior change interventions can significantly reduce intervention participants' risk of acquiring HIV. Establishing the effectiveness of these evidence-based interventions when implemented by frontline HIV prevention service providers is increasingly important in order to achieve maximum public health impact. This study sought to assess the effectiveness of an evidence-based intervention when implemented by frontline HIV prevention service providers. We evaluated Sisters Informing Sisters on Topics about AIDS (SISTA), an HIV prevention intervention for heterosexual African American women, as implemented by four AIDS service organizations. Women enrolled in HIV counseling, testing, and referral (CTR) at each agency served as contemporaneous controls. Measures included self-reported number of occasions of unprotected vaginal intercourse and number of vaginal sex partners in the previous 90 days. 1,262 participants completed baseline and follow-up assessments across both conditions (SISTA = 537 [57%]; CTR = 725 [62%]). In the full sample of HIV-negative women, CTR participants' odds of having had unprotected sex decreased over time by 38% while SISTA participants' odds of having had unprotected sex did not change. Similar results were found among only those participants who had sex at baseline. Hypothesized interaction effects indicating positive changes in sexual risks over time for SISTA participants were not observed.
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Affiliation(s)
- Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins
- Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle Broaddus
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sergey Tarima
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
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Thymi M, Rollman A, Visscher CM, Wismeijer D, Lobbezoo F. Experience with bruxism in the everyday oral implantology practice in the Netherlands: a qualitative study. BDJ Open 2018; 4:17040. [PMID: 30425840 PMCID: PMC6226535 DOI: 10.1038/s41405-018-0006-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 12/29/2022] Open
Abstract
Objective To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice. Materials and methods Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach. Results Oral implant treatments in bruxing patients were a generally well-accepted practice. Complications were often expected, with most being of minor impact. Contradictive attitudes emerged on the topic of bruxism being an etiologic factor for peri-implant bone loss and loss of osseointegration. Views on the ideal treatment plan varied, though the importance of the superstructure’s occlusion and articulation features was repeatedly pointed at. Similarly, views on protective splints varied, regarding their necessity and material choice. Bruxism was diagnosed mainly by clinical examination, alongside with patient anamnesis and clinician’s intuition. There was little attention for awake bruxism. Discussion Bruxism was generally not considered a contraindication for implantological treatments by accredited oral implantologists. Views on the interaction between bruxism and bone loss/loss of osseointegration varied, as did views on the ideal treatment plan. Conclusions There is a need for better understanding of the extent to which, and under which circumstances, sleep and/or awake bruxism can be seen as causal factors for the occurrence of oral implant complications.
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Affiliation(s)
- Magdalini Thymi
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Annemiek Rollman
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Corine M Visscher
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Daniel Wismeijer
- 2Section of Oral Implantology and Prosthetic Dentistry, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- 1Section of Oral Kinesiology, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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50
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Mugwanya KK, Irungu E, Bukusi E, Mugo NR, Odoyo J, Wamoni E, Ngure K, Morton JF, Peebles K, Masyuko S, Barnabee G, Donnell D, Barnabas R, Haberer J, O'Malley G, Baeten JM. Scale up of PrEP integrated in public health HIV care clinics: a protocol for a stepped-wedge cluster-randomized rollout in Kenya. Implement Sci 2018; 13:118. [PMID: 30180860 PMCID: PMC6123996 DOI: 10.1186/s13012-018-0809-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 12/26/2022] Open
Abstract
Background Antiretroviral therapy (ART) for HIV-infected persons and pre-exposure prophylaxis (PrEP) for uninfected persons are extraordinarily effective strategies for HIV prevention. In Africa, the region which shoulders the highest HIV burden, HIV care is principally delivered through public health HIV care clinics, offering an existing platform to incorporate PrEP delivery and maximize ART and PrEP synergies. However, successfully bringing this integrated approach to scale requires an implementation science evaluation in public health settings. Methods The Partners Scale Up Project is a prospective, pragmatic implementation evaluation, designed as a stepped-wedge, cluster-randomized trial, operating at 24 clinics in Kenya. In collaboration with the Kenya Ministry of Health, we are catalyzing scaled implementation of PrEP delivery integrated in HIV care clinics. The intervention package includes staff training, clinic streamlined access to PrEP commodity from the Kenya Medical Supply Authority, and ongoing intensive technical assistance to rigorously assess how PrEP delivery is implemented. PrEP service delivery including retention efforts are conducted by the clinic staff with no additional resources from the project. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework and Consolidated Framework for Implementation Science Research, project progress and learning are documented through ongoing monitoring and process evaluations, including chart abstraction and individual and key informant interviews, to evaluate pragmatic rollout and understand barriers and facilitators for successful PrEP delivery in this setting. In this staged rollout design, each step provides data for both pre-implementation (baseline) and implementation periods, and we will compare time points across steps in the baseline versus implementation periods. Discussion Cost-effective delivery models are urgently needed to maximize the public health impact of PrEP and ART. The Partners Scale Up Project will set the stage for full-scale PrEP implementation fully run and owned by the Kenya Ministry of Health. The work combines nationally sponsored PrEP delivery with technical support and implementation science from academic partners, defining a new but sustainable paradigm for public health collaboration. Trial registration Registered with ClinicalTrials.gov on February 14, 2017:NCT03052010.
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Affiliation(s)
- Kenneth K Mugwanya
- Department of Global Health, University of Washington, 325 Ninth Avenue, #HMC 359927, Seattle, WA, 98104, USA.
| | | | - Elizabeth Bukusi
- Kenya Medical Research Institute, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - Nelly R Mugo
- Department of Global Health, University of Washington, 325 Ninth Avenue, #HMC 359927, Seattle, WA, 98104, USA.,Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Kenneth Ngure
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jennifer F Morton
- Department of Global Health, University of Washington, 325 Ninth Avenue, #HMC 359927, Seattle, WA, 98104, USA
| | - Kathryn Peebles
- Department of Global Health, University of Washington, 325 Ninth Avenue, #HMC 359927, Seattle, WA, 98104, USA
| | - Sarah Masyuko
- National AIDS and STI Control Program Ministry of Health, Nairobi, Kenya
| | - Gena Barnabee
- Department of Global Health, University of Washington, 325 Ninth Avenue, #HMC 359927, Seattle, WA, 98104, USA
| | - Deborah Donnell
- Department of Global Health, University of Washington, 325 Ninth Avenue, #HMC 359927, Seattle, WA, 98104, USA.,Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Ruanne Barnabas
- Departments of Global Health and Medicine, University of Washington, Seattle, USA
| | | | - Gabrielle O'Malley
- Department of Global Health, University of Washington, 325 Ninth Avenue, #HMC 359927, Seattle, WA, 98104, USA
| | - Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, USA
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