Mangale Dorothy Imbuka, Onyango Alvin, Mugo Cyrus, Mburu Caren, Chhun Nok, Wamalwa Dalton, Njuguna Irene, Means Arianna Rubin, John-Stewart Grace, Weiner Bryan J, Beima-Sofie Kristin
Department of Global Health, University of Washington, Seattle, USA.
Research & Programs, Kenyatta National Hospital, Nairobi, Kenya.
Implement Sci Commun. 2023 Aug 14;4(1):95. doi: 10.1186/s43058-023-00446-y.
The COVID-19 pandemic resulted in disruptions to routine HIV services for youth living with HIV (YLH), provoking rapid adaptation to mitigate interruptions in care. The Adolescent Transition to Adult Care for HIV-infected adolescents (ATTACH) study (NCT03574129) was a hybrid I cluster randomized trial testing the effectiveness of a healthcare worker (HCW)-delivered disclosure and transition intervention - the Adolescent Transition Package (ATP). During the pandemic, HCWs leveraged phone delivery of the ATP and were supported to make adaptations. We characterized real-time, provider-driven adaptations made to support phone delivery of the ATP.
We conducted continuous quality improvement (CQI) meetings with HCWs involved in phone delivery of the ATP at 10 intervention sites. CQI meetings used plan-do-study-act (PDSA) cycles and were audio-recorded. Adaptations were coded by two-independent coders using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Adaptation testing outcomes (adopt, retest, or abandon) and provider experience implementing the adaptations were also recorded. We summarized adaptation characteristics, provider experience, and outcomes.
We identified 72 adaptations, 32 were unique. Overall, adaptations included modification to context (53%, n = 38), content (49%, n = 35), and evaluation processes (13%, n = 9). Context adaptations primarily featured changes to personnel, format, and setting, while content and evaluation adaptations were frequently achieved by simple additions, repetition, and tailoring/refining of the phone delivery strategy. Nine adaptations involved abandoning, then returning to phone delivery. HCWs sought to increase reach, improve fidelity, and intervention fit within their context. Most adaptations (96%, n = 69) were perceived to increase the feasibility of phone delivery when compared to before the changes were introduced, and HCWs felt 83% (n = 60) of adaptations made phone delivery easier. Most adaptations were either incorporated into routine workflows (47%) or tested again (47%).
Adaptation of phone delivery was a feasible and effective way of addressing challenges with continuity of care for YLH during the COVID-19 pandemic. Adaptations were primarily context adaptions. While FRAME-IS was apt for characterizing adaptations, more use cases are needed to explore the range of its utility.
Trial registered on ClinicalTrial.gov as NCT03574129.
新冠疫情导致感染艾滋病毒青年（YLH）的常规艾滋病毒服务中断，促使迅速调整以减轻护理中断的影响。青少年艾滋病毒感染者向成人护理过渡（ATTACH）研究（NCT03574129）是一项混合I类整群随机试验，测试医护人员（HCW）提供的披露和过渡干预措施——青少年过渡套餐（ATP）的有效性。在疫情期间，医护人员利用电话方式提供ATP，并得到支持进行调整。我们描述了为支持通过电话提供ATP而由提供者推动的实时调整。
我们与参与在10个干预地点通过电话提供ATP的医护人员召开了持续质量改进（CQI）会议。CQI会议采用计划-实施-研究-改进（PDSA）循环，并进行了录音。两名独立编码员使用《基于证据的实施策略的调整和修改报告框架》（FRAME-IS）对调整进行编码。还记录了调整测试结果（采用、重新测试或放弃）以及提供者实施调整的经验。我们总结了调整的特点、提供者的经验和结果。
我们确定了72项调整，其中32项是独特的。总体而言，调整包括对背景（53%，n = 38）、内容（49%，n = 35）和评估过程（13%，n = 9）的修改。背景调整主要包括人员、形式和环境的变化，而内容和评估调整通常通过简单添加、重复以及调整/完善电话提供策略来实现。有9项调整涉及先放弃，然后再恢复电话提供方式。医护人员试图扩大覆盖范围、提高保真度并使干预更符合实际情况。与引入这些变化之前相比，大多数调整（96%，n = 69）被认为增加了通过电话提供服务的可行性，83%（n = 60）的调整让医护人员感觉通过电话提供服务变得更容易。大多数调整要么被纳入常规工作流程（47%），要么再次进行测试（47%）。
在新冠疫情期间，调整电话提供方式是应对YLH护理连续性挑战的一种可行且有效的方法。调整主要是背景方面的调整。虽然FRAME-IS适合描述调整情况，但需要更多用例来探索其效用范围。
该试验在ClinicalTrial.gov上注册，注册号为NCT03574129。
