Eastment McKenna C, Long Jessica E, Wanje George, Richardson Barbra A, Mwaringa Emily, Sherr Kenneth, Barnabas Ruanne V, Mandaliya Kishorchandra, Jaoko Walter, McClelland R Scott
Department of Medicine, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA.
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Implement Sci Commun. 2022 Sep 8;3(1):97. doi: 10.1186/s43058-022-00342-x.
Significant gaps remain in HIV testing and counseling (HTC) in family planning (FP) clinics. To address these gaps, our group tested an implementation strategy called the Systems Analysis and Improvement Approach (SAIA), an evidenced-based multi-component implementation strategy focused on improving entire care cascades. In a cluster randomized trial of 24 FP clinics in Mombasa County, Kenya, SAIA led to a significant increase in HTC in intervention clinics compared to control clinics. The objective of this manuscript was to evaluate SAIA using the Consolidated Framework for Implementation Research (CFIR) and assess the Implementation Outcomes Framework outcomes of acceptability, appropriateness, and feasibility.
This qualitative assessment was nested within the cluster-randomized trial. Data collection included questionnaires to assess modifiable and non-modifiable health system factors related to HTC and in-depth interviews to query clinic norms, priorities, communication strategies, and readiness for change. The primary outcomes of interest were feasibility, appropriateness, and acceptability of SAIA. Data on inner setting and structural characteristics of FP clinics were collected to inform how context may impact outcomes. All interviews were recorded and analyzed using a rapid assessment approach.
Of the 12 intervention clinics, 6 (50%) were public facilities. Availability of resources varied by clinic. Most clinics had a positive implementation climate, engaged leadership, and access to resources and information. While not all clinics identified HTC as a clinic priority, most reported a strong culture of embracing change and recognition of the importance of HIV testing within FP clinics. Interviews highlighted very high acceptability, appropriateness, and feasibility of SAIA. The implementation strategy was not complicated and fit well into existing clinic processes. In particular, staff appreciated that SAIA allowed clinic staff to generate contextually relevant solutions that they implemented.
SAIA was implemented in FP clinics of varying sizes, capacity, and management support and was found to be acceptable, appropriate, and feasible. The agency that clinic staff felt in proposing and implementing their own solutions was likely part of SAIA's success. We anticipate this will continue to be a mechanism of SAIA's success when it is scaled up to more clinics in future trials.
ClinicalTrials.gov (NCT02994355) registered 16 December 2016.
计划生育（FP）诊所的艾滋病毒检测与咨询（HTC）仍存在显著差距。为弥补这些差距，我们团队测试了一种名为系统分析与改进方法（SAIA）的实施策略，这是一种基于证据的多组件实施策略，专注于改善整个护理流程。在肯尼亚蒙巴萨县24家计划生育诊所的整群随机试验中，与对照诊所相比，SAIA使干预诊所的HTC显著增加。本手稿的目的是使用实施研究综合框架（CFIR）评估SAIA，并评估其在可接受性、适宜性和可行性方面的实施结果框架成果。
这项定性评估嵌套在整群随机试验中。数据收集包括用于评估与HTC相关的可修改和不可修改卫生系统因素的问卷，以及用于询问诊所规范、优先事项、沟通策略和变革准备情况的深入访谈。感兴趣的主要结果是SAIA的可行性、适宜性和可接受性。收集计划生育诊所内部环境和结构特征的数据，以了解背景如何影响结果。所有访谈均进行记录，并采用快速评估方法进行分析。
在12家干预诊所中，6家（50%）为公共设施。各诊所的资源可用性各不相同。大多数诊所具有积极的实施氛围、敬业的领导层，并且能够获取资源和信息。虽然并非所有诊所都将HTC确定为诊所的优先事项，但大多数诊所报告称有强烈的拥抱变革的文化，并认识到计划生育诊所内艾滋病毒检测的重要性。访谈突出了SAIA的极高可接受性、适宜性和可行性。该实施策略并不复杂，且很好地融入了现有的诊所流程。特别是，工作人员赞赏SAIA使诊所工作人员能够生成并实施与具体情况相关的解决方案。
SAIA在规模、能力和管理支持各不相同的计划生育诊所中得到实施，并且被发现是可接受的、适宜的和可行的。诊所工作人员在提出和实施自己的解决方案时所感受到的自主性可能是SAIA成功的一部分。我们预计，在未来试验中将SAIA推广到更多诊所时，这将继续是其成功的一个机制。
ClinicalTrials.gov（NCT02994355）于2016年12月16日注册。
