International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America.
Health Res Policy Syst. 2018 Apr 17;16(1):32. doi: 10.1186/s12961-018-0309-x.
Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation.
Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas.
The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.
实施研究（IR）通过在具体环境下为已证实有效的策略的推广提供证据，促进卫生系统的强化和优化患者结局。因此，需要预见并解决生成 IR 证据方面的困难，尤其是在资源有限且疾病预防和治疗差距较大的环境中。尼日利亚是预防母婴传播艾滋病毒（PMTCT）的重点国家。本文分析了在全球计划评估期间（2011 年至 2015 年）在尼日利亚进行的四项 PMTCT IR 研究的经验，并提出了解决实施过程中遇到的主要挑战的方法。
纳入了在尼日利亚进行的全球计划评估期间开展的多中心 PMTCT IR 研究。确定了四项研究，即“婴儿洗礼试验”、“优化 PMTCT”、“MoMent 和 Lafiyan Jikin Mata”。主要的共同挑战分为“外部”（超出研究团队控制范围）和“内部”（研究团队可纠正）。外部挑战包括医护人员罢工和离职、种族和政治暴力和恐怖主义行为及威胁，以及所需的多次当地伦理审查。内部挑战包括研究人员研究能力有限、研究人员离职和旅行限制阻碍了研究现场访问。在研究实施之前和期间，通过多次机会为研究人员提供了有针对性的研究能力建设。为研究人员提供了研究结束后的就业机会和进一步研究职业发展的途径，作为留住研究人员的激励措施。在暴力事件频发地区，让研究社区常驻人员参与可减少研究人员的离职。
尼日利亚的 IR 环境非常多样化和具有挑战性，但通过当地经验和预期规划，可以实施创新的解决方案来调节内部挑战。医护人员罢工和经常不可预测的不安全问题仍然存在。尼日利亚各机构审查委员会之间需要进行合作，以尽量减少多中心研究的审查次数。外部挑战需要由高级利益相关者解决，因为尼日利亚在抗击艾滋病毒流行方面具有至关重要的区域和全球地位。
