Department of Behavioral Science and Health Education, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Ave, Saint Louis, MO, 63104, USA.
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Curr HIV/AIDS Rep. 2023 Apr;20(2):111-120. doi: 10.1007/s11904-023-00652-2. Epub 2023 Mar 29.
Sustaining evidence-based interventions in resource-limited settings is a perennial challenge. Despite growing research on the significance of sustainability, few frameworks describe why and how to plan for sustainability in settings limited with resources. Drawing on a synthesis of the literature on sustainability, including the Dynamic Sustainability Framework, we review lessons learned from research to date, to point out a path forward for sustaining evidence-based interventions in resource-limited settings.
We describe PLAN or why people learning, adapting, and nurturing the core values of an intervention can enhance its sustainability over time. PLAN is a dynamic framework that simplifies the process of planning for sustainability of evidence-based interventions throughout the lifecyle of an intervention, taking into consideration the people that matter as well as the learning, adaptation, and nurturing involved with understanding and studying the interactions between interventions/innovations, practice settings, intervention fit, and the broader ecological contexts in which implementation occurs. We use case-study data from our ongoing pragmatic HIV implementation trial, the 4 Youth by Youth project, to detail the value and implications of why people learning, adapting, and nurturing HIV interventions implemented in resource-limited settings matter. PLAN is designed to further the dialogue on ways research and practice teams can critically work to ensure the sustainability of their evidence-based interventions from the onset, particularly in settings and with populations limited with resources. It also illustrates how attention to sustainability from the beginning may foster actions necessary for sustained program → sustained benefits → sustained capacity → sustained value, but in the absence of early and active planning, none of this will occur. Ultimately, we hope to accelerate the sustainability of evidence-based HIV interventions, and making a PLAN at the bare minimum may ensure that the goals of continuing and maintaining desirable features of any evidence-based interventions can be realized.
在资源有限的环境中维持基于证据的干预措施是一个长期存在的挑战。尽管关于可持续性意义的研究不断增加，但很少有框架描述如何在资源有限的环境中规划可持续性。本研究借鉴了关于可持续性的文献综述，包括动态可持续性框架，综述了迄今为止从研究中获得的经验教训，为在资源有限的环境中维持基于证据的干预措施指明了前进的道路。
我们描述了 PLAN，即为什么学习、适应和培养干预核心价值观的人可以随着时间的推移增强其可持续性。PLAN 是一个动态框架，简化了在干预的整个生命周期中规划基于证据的干预措施可持续性的过程，同时考虑到重要的人以及理解和研究干预/创新、实践环境、干预适应度以及实施发生的更广泛生态环境之间相互作用所涉及的学习、适应和培养。我们使用来自我们正在进行的实用 HIV 实施试验——4 Youth by Youth 项目的案例研究数据，详细说明了在资源有限的环境中学习、适应和培养 HIV 干预措施的人的价值和意义。PLAN 的目的是进一步探讨研究和实践团队如何能够批判性地努力从一开始就确保其基于证据的干预措施的可持续性，特别是在资源有限的环境中和人群中。它还说明了从一开始就关注可持续性如何可以促进持续计划→持续利益→持续能力→持续价值的必要行动，但如果没有早期和积极的规划，这一切都不会发生。最终，我们希望加速基于证据的 HIV 干预措施的可持续性，而至少制定一个 PLAN 可以确保继续和维持任何基于证据的干预措施的理想特征的目标能够实现。
