van Heerden Alastair, Ntinga Xolani, Lippman Sheri A, Leslie Hannah H, Steward Wayne T
Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, 3201, KZN, South Africa.
SAMRC/WITS Developmental Pathways for Health Research Unit Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Arch Public Health. 2022 Oct 9;80(1):221. doi: 10.1186/s13690-022-00975-3.
There is an increasingly urgent gap in knowledge regarding the translation of effective HIV prevention and care programming into scaled clinical policy and practice. Challenges limiting the translation of efficacious programming into national policy include the paucity of proven efficacious programs that are reasonable for clinics to implement and the difficulty in moving a successful program from research trial to scaled programming. This study aims to bridge the divide between science and practice by exploring health care providers' views on what is needed to implement new HIV programs within existing HIV care.
We conducted 20 in-depth interviews with clinic managers and clinic program implementing staff and five key informant interviews with district health managers overseeing programming in the uMgungundlovu District of KwaZulu-Natal Province, South Africa. Qualitative data were analyzed using a template approach. A priori themes were used to construct templates of relevance, including current care context for HIV and past predictors of successful implementation. Data were coded and analyzed by these templates.
Heath care providers identified three main factors that impact the integration of HIV programming into general clinical care: perceived benefits, resource availability, and clear communication. The perceived benefits of HIV programs hinged on the social validation of the program by early adopters. Wide program availability and improved convenience for providers and patients increased perceived benefit. Limited staffing capacity and a shortage of space were noted as resource constraints. Programs that specifically tackled these constraints through clinic decongestion were reported as being the most successful. Clear communication with all entities involved in clinic-based programs, some of which include external partners, was noted as central to maximizing program function and provider uptake.
Amid the COVID-19 pandemic, new programs are continuously being developed for implementation at the primary health care level. A better understanding of the factors that facilitate and prevent programmatic success will improve public health outcomes. Implementation is likely to be most successful when programs capitalize on endorsements from early adopters, tackle resource constraints, and foster greater communication among partners responsible for implementation.
在将有效的艾滋病病毒预防和护理方案转化为大规模临床政策和实践方面，知识差距日益紧迫。限制将有效方案转化为国家政策的挑战包括可供诊所实施的经证实有效的方案匮乏，以及将成功的方案从研究试验推广到大规模方案存在困难。本研究旨在通过探索医疗保健提供者对在现有艾滋病病毒护理中实施新的艾滋病病毒方案所需条件的看法，弥合科学与实践之间的差距。
我们对诊所经理和诊所方案实施人员进行了20次深入访谈，并对南非夸祖鲁 - 纳塔尔省乌姆贡古德洛武区监督方案的地区卫生管理人员进行了5次关键信息访谈。定性数据采用模板法进行分析。先验主题用于构建相关模板包括当前艾滋病病毒护理背景和过去成功实施的预测因素。数据通过这些模板进行编码和分析。
医疗保健提供者确定了影响将艾滋病病毒方案纳入一般临床护理的三个主要因素：感知效益、资源可用性和清晰沟通。艾滋病病毒方案的感知效益取决于早期采用者对该方案的社会认可。广泛的方案可用性以及为提供者和患者提高的便利性增加了感知效益。人员配备能力有限和空间短缺被指出是资源限制。据报告，通过缓解诊所拥挤状况专门解决这些限制的方案最为成功。与参与基于诊所的方案的所有实体（其中一些包括外部合作伙伴）进行清晰沟通被认为是最大限度发挥方案功能和提高提供者接受度的核心。
在新冠疫情期间，新的方案不断被开发用于在初级卫生保健层面实施。更好地理解促进和阻碍方案成功的因素将改善公共卫生结果。当方案利用早期采用者的认可、解决资源限制并促进负责实施的合作伙伴之间加强沟通时，实施可能最成功。
