Iwelunmor Juliet, Ezechi Oliver, Obiezu-Umeh Chisom, Oladele David, Nwaozuru Ucheoma, Aifah Angela, Gyamfi Joyce, Gbajabiamila Titilola, Musa Adesola Z, Onakomaiya Deborah, Rakhra Ashlin, Jiyuan Hu, Odubela Oluwatosin, Idigbe Ifeoma, Engelhart Alexis, Tayo Bamidele O, Ogedegbe Gbenga
College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA.
Nigerian Institute of Medical Research, Lagos, Nigeria.
Implement Sci Commun. 2022 Apr 15;3(1):43. doi: 10.1186/s43058-022-00289-z.
Evidence-based task-strengthening strategies for hypertension (HTN) control (TASSH) are not readily available for patients living with HIV in sub-Saharan Africa where the dual burden of HTN and HIV remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of practice facilitation versus a self-directed control (i.e., receipt of TASSH with no practice facilitation) in reducing blood pressure and increasing the adoption of task-strengthening strategies for HTN control within HIV clinics in Nigeria. Prior to implementing the trial, we conducted formative research to identify factors that may influence the integration of TASSH within HIV clinics in Nigeria.
This mixed-methods study was conducted with purposively selected healthcare providers at 29 HIV clinics, followed by a 1-day stakeholder meeting with 19 representatives of HIV clinics. We collected quantitative practice assessment data using two instruments: (a) an adapted Service Availability and Readiness Assessment (SARA) tool to assess the capacity of the clinic to manage NCDs and (b) Implementation Climate Scale to assess the degree to which there is a strategic organizational climate supportive of the evidence-based practice implementation. The quantitative data were analyzed using descriptive statistics and measures of scale reliability. We also used the Consolidated Framework for Implementation Research (CFIR), to thematically analyze qualitative data generated and relevant to the aims of this study.
Across the 29 clinics surveyed, the focus on TASSH (mean=1.77 (SD=0.59)) and educational support (mean=1.32 (SD=0.68)) subscales demonstrated the highest mean score, with good-excellent internal consistency reliability (Cronbach's alphas ranging from 0.84 to 0.96). Within the five CFIR domains explored, the major facilitators of the intervention included relative advantage of TASSH compared to current practice, compatibility with clinic organizational structures, support of patients' needs, and intervention alignment with national guidelines. Barriers included the perceived complexity of TASSH, weak referral network and patient tracking mechanism within the clinics, and limited resources and diagnostic equipment for HTN.
Optimizing healthcare workers' implementation of evidence-based TASSH within HIV clinics requires attention to both the implementation climate and contextual factors likely to influence adoption and long-term sustainability. These findings have implications for the development of effective practice facilitation strategies to further improve the delivery and integration of TASSH within HIV clinics in Nigeria.
ClinicalTrials.gov , NCT04704336.
在撒哈拉以南非洲，高血压（HTN）控制的循证任务强化策略（TASSH）不易提供给感染艾滋病毒的患者，在那里，高血压和艾滋病毒的双重负担仍然很高。我们正在进行一项整群随机对照试验，比较实践促进与自我指导对照（即接受TASSH但无实践促进）在降低血压以及在尼日利亚艾滋病毒诊所内增加采用高血压控制任务强化策略方面的有效性。在开展该试验之前，我们进行了形成性研究，以确定可能影响TASSH在尼日利亚艾滋病毒诊所内整合的因素。
这项混合方法研究是在29家艾滋病毒诊所中，对经过有目的选择的医疗保健提供者进行的，随后与19名艾滋病毒诊所代表举行了为期1天的利益相关者会议。我们使用两种工具收集定量实践评估数据：（a）一种经过改编的服务可用性和准备情况评估（SARA）工具，以评估诊所管理非传染性疾病的能力；（b）实施氛围量表，以评估是否存在支持循证实践实施的战略组织氛围。定量数据使用描述性统计和量表信度测量进行分析。我们还使用实施研究综合框架（CFIR），对生成的与本研究目标相关的定性数据进行主题分析。
在接受调查的29家诊所中，对TASSH（均值=1.77（标准差=0.59））和教育支持（均值=1.32（标准差=0.68））子量表的关注显示出最高平均分，具有良好至优秀的内部一致性信度（克朗巴哈系数范围为0.84至0.96）。在所探讨的CFIR五个领域中，干预的主要促进因素包括TASSH相对于当前实践的相对优势、与诊所组织结构的兼容性、对患者需求的支持以及干预与国家指南的一致性。障碍包括TASSH被认为复杂、诊所内转诊网络和患者追踪机制薄弱，以及高血压的资源和诊断设备有限。
在艾滋病毒诊所内优化医护人员对循证TASSH的实施，需要关注实施氛围以及可能影响采用和长期可持续性的背景因素。这些发现对制定有效的实践促进策略具有启示意义，以进一步改善TASSH在尼日利亚艾滋病毒诊所内的提供和整合。
ClinicalTrials.gov，NCT04704336。
