Hicks Sarah, Abuna Felix, Odhiambo Ben, Dettinger Julia C, Ngumbau Nancy, Gómez Laurén, Sila Joseph, Oketch George, Sifuna Enock, Weiner Bryan J, John-Stewart Grace C, Kinuthia John, Wagner Anjuli D
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Medicine, University of Washington, Seattle, WA, USA.
Implement Sci Commun. 2023 Jul 12;4(1):76. doi: 10.1186/s43058-023-00457-9.
There is a lack of consensus about how to prioritize potential implementation strategies for HIV pre-exposure prophylaxis (PrEP) delivery. We compared several prioritization methods for their agreement and pragmatism in practice in a resource-limited setting.
We engaged diverse stakeholders with clinical PrEP delivery and PrEP decision-making experience across 55 facilities in Kenya to prioritize 16 PrEP delivery strategies. We compared four strategy prioritization methods: (1) "past experience surveys" with experienced practitioners reflecting on implementation experience (N = 182); (2 and 3) "pre- and post-small-group ranking" surveys before and after group discussion (N = 44 and 40); (4) "go-zone" quadrant plots of perceived effectiveness vs feasibility. Kendall's correlation analysis was used to compare strategy prioritization using the four methods. Additionally, participants were requested to group strategies into three bundles with up to four strategies/bundle by phone and online survey.
The strategy ranking correlation was strongest between the pre- and post-small-group rankings (Tau: 0.648; p < 0.001). There was moderate correlation between go-zone plots and post-small-group rankings (Tau: 0.363; p = 0.079) and between past-experience surveys and post-small-group rankings (Tau: 0.385; p = 0.062). For strategy bundling, participants primarily chose bundles of strategies in the order in which they were listed, reflecting option ordering bias. Neither the phone nor online approach was effective in selecting strategy bundles. Participants agreed that the strategy ranking activities conducted during the workshop were useful in prioritizing a final set of strategies.
Both experienced and inexperienced stakeholder participants' strategy rankings tended to prioritize strategies perceived as feasible. Small group discussions focused on feasibility and effectiveness revealed moderately different priorities than individual rankings. The strategy bundling approach, though less time- and resource-intensive, was not effective. Future research should further compare the relative effectiveness and pragmatism of methodologies to prioritize implementation strategies.
对于如何确定艾滋病毒暴露前预防（PrEP）实施策略的优先顺序，目前尚无共识。我们比较了几种优先排序方法在资源有限环境下实际应用中的一致性和实用性。
我们邀请了肯尼亚55个机构中参与临床PrEP实施和PrEP决策的不同利益相关者，对16种PrEP实施策略进行优先排序。我们比较了四种策略优先排序方法：（1）“过往经验调查”，让有经验的从业者反思实施经验（N = 182）；（2和3）小组讨论前后的“小组前和小组后排名”调查（N = 44和40）；（4）感知有效性与可行性的“可行区域”象限图。使用肯德尔相关性分析来比较四种方法的策略优先排序。此外，通过电话和在线调查要求参与者将策略分成三个组，每组最多四个策略。
小组前和小组后排名之间的策略排名相关性最强（Tau：0.648；p < 0.001）。可行区域图与小组后排名之间存在中等相关性（Tau：0.363；p = 0.079），过往经验调查与小组后排名之间也存在中等相关性（Tau：0.385；p = 0.062）。对于策略分组，参与者主要按照列出的顺序选择策略组，这反映了选项排序偏差。电话和在线方法在选择策略组方面均无效。参与者一致认为，研讨会上进行的策略排名活动有助于确定最终的策略集。
有经验和无经验的利益相关者参与者的策略排名都倾向于将被认为可行的策略列为优先。专注于可行性和有效性的小组讨论揭示出与个人排名略有不同的优先顺序。策略分组方法虽然耗时和资源较少，但效果不佳。未来的研究应进一步比较各种方法在确定实施策略优先顺序方面的相对有效性和实用性。
