Kozhumam Arthi, Singh Revika, Agbaji Oche, Adetunji Adedotun, Taiwo Bopo, Omigbodun Olayinka, Kuti Kehinde, David Agatha, Akanmu Sulaimon, Adekambi Folashade, Akinbami Akinsegun, Oladeji Bibilola, Taiwo Babafemi, Kuhns Lisa M, Okonkwor Ogochukwu, Berzins Baiba, Johnson Amy K, Badru Titilope, Janulis Patrick, Adewumi Olubusuyi M, Cervantes Marbella, Awolude Olutosin, Garofalo Robert, Ahonkhai Aima A, Hirschhorn Lisa R
Feinberg School of Medicine, Northwestern University, Chicago, USA.
Robert J Havey Institute for Global Health, Chicago, USA.
Implement Sci Commun. 2025 Jan 8;6(1):6. doi: 10.1186/s43058-024-00671-z.
Youth living with HIV (YLH) are disproportionately impacted by HIV with poor outcomes along the entire HIV care continuum. In a 2020-2022 pilot study, iCARE Nigeria, successfully tested a combination intervention incorporating mobile health technology and peer navigation to: 1) improve testing and linkage to HIV care for young men, especially young men who have sex with men (YMSM) and 2) improve medication adherence and treatment outcomes for YLH. The intervention was scaled up to 5 sites in 3 Nigerian cities. Implementation research was used to understand site perspectives on feasibility, readiness and potential facilitators and barriers soon after scale-up commencement.
An explanatory mixed-methods implementation study was conducted, including quantitative surveys on adoption and reach among peer navigators (PNs) and other study staff (55 testing, 172 treatment), and interviews and focus group discussions with PNs and other study staff in both intervention groups (n = 31). Data were analyzed using descriptive statistics (quantitative) and directed content analysis using the Consolidated Framework for Implementation Research and RE-AIM (qualitative).
Early into scale-up, PNs and other study staff in the testing and treatment interventions reported high readiness, adoption, feasibility, and appropriateness. Facilitating factors and strategies across both interventions, included supportive institutional culture, ongoing supportive supervision, provision of a manual and training, relevant PN working experiences, communication methods designed to ensure anonymity of targeted youth (testing) or confidentiality (treatment), and access to cellular data and internet. Facilitators specific to each intervention were also identified including PN knowledge of the MSM community, using multiple social media platforms for outreach (testing) and problem-solving by PN and staff to respond to client needs (treatment). Barriers in both interventions included client financial and transportation challenges, and societal stigma. Intervention-specific barriers included legal limitations for MSM and few YMSM friendly clinics (testing), limited client financial resources and cell-phone access (treatment).
Implementers of the initial scale-up of both components of the iCARE Nigeria intervention reported high readiness and adoption, supported by implementation strategies and facilitating factors including intervention design. These results are important for informing future work to scale-out iCARE and similar interventions to new settings.
ClinicalTrials.gov number, NCT04950153, retrospectively registered July 6, 2021, https:// clinicaltrials.gov/.
感染艾滋病毒的青年（YLH）在整个艾滋病毒护理连续过程中受到艾滋病毒的影响尤为严重，结局不佳。在2020 - 2022年的一项试点研究中，尼日利亚iCARE成功测试了一种结合移动健康技术和同伴导航的综合干预措施，以：1）改善年轻男性，特别是男男性行为者（YMSM）的检测及与艾滋病毒护理的联系，以及2）提高YLH的药物依从性和治疗效果。该干预措施已扩大到尼日利亚3个城市的5个地点。扩大规模开始后不久，便采用实施研究来了解各地点对可行性、准备情况以及潜在促进因素和障碍的看法。
开展了一项解释性混合方法实施研究，包括对同伴导航员（PN）和其他研究人员进行关于采用情况和覆盖范围的定量调查（检测方面55人，治疗方面172人），以及对两个干预组中的PN和其他研究人员进行访谈和焦点小组讨论（n = 31）。使用描述性统计（定量）和采用实施研究综合框架及RE - AIM进行定向内容分析（定性）对数据进行分析。
在扩大规模初期，检测和治疗干预措施中的PN和其他研究人员报告了较高的准备情况、采用率、可行性和适宜性。两种干预措施的促进因素和策略包括支持性的机构文化、持续的支持性监督、提供手册和培训、PN的相关工作经验、旨在确保目标青年匿名（检测）或保密（治疗）的沟通方法，以及获取蜂窝数据和互联网。还确定了每种干预措施特有的促进因素，包括PN对男男性行为者社区的了解、使用多个社交媒体平台进行外展（检测）以及PN和工作人员通过解决问题来满足客户需求（治疗）。两种干预措施中的障碍包括客户的财务和交通挑战以及社会耻辱感。干预措施特有的障碍包括男男性行为者的法律限制和很少有对男男性行为者友好的诊所（检测）、客户财务资源有限和手机使用受限（治疗）。
尼日利亚iCARE干预措施两个组成部分的初始扩大规模的实施者报告了较高的准备情况和采用率，这得到了包括干预设计在内的实施策略和促进因素的支持。这些结果对于为未来将iCARE及类似干预措施推广到新环境的工作提供信息很重要。
ClinicalTrials.gov编号，NCT04950153，于2021年7月6日追溯注册，https:// clinicaltrials.gov/ 。
