Gregory A Aarons1,2,3, Kendal Reeder4,5,6, Nadia A Sam-Agudu7,8, Susan Vorkoper9, Rachel Sturke9. 1. Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA. gaarons@health.ucsd.edu. 2. UC San Diego Dissemination and Implementation Science Center (UC San Diego ACTRI DISC), Altman Clinical and Translational Research Institute, La Jolla, CA, 92093, USA. gaarons@health.ucsd.edu. 3. Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA. gaarons@health.ucsd.edu. 4. Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA. 5. UC San Diego Dissemination and Implementation Science Center (UC San Diego ACTRI DISC), Altman Clinical and Translational Research Institute, La Jolla, CA, 92093, USA. 6. Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA. 7. Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, USA. 8. International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert Macaulay Way, Abuja, Nigeria. 9. NIH Fogarty International Center, Center for Global Health Studies, Bethesda, MD, USA.
Abstract
INTRODUCTION: Adolescent HIV prevention and treatment is a high priority for youth healthcare in sub-Saharan Africa. METHODS: This study employed concept mapping to identify factors that impact the implementation of HIV prevention and intervention programs for adolescents in sub-Saharan Africa. Key stakeholders including researchers, policymakers, and non-governmental organization (NGO) personnel constituting membership of the NIH-sponsored Adolescent HIV Prevention and Treatment Implementation Science Alliance responded to the question: "In your experience, what factors have facilitated or hindered implementation of evidence-based HIV prevention or treatment for adolescents in sub-Saharan Africa?" Participants generated statements in response to the focus question, sorted them into thematically relevant groups, and rated each statement on its importance and changeability. RESULTS: Through data analyses and participant feedback, 15 distinct themes were derived. "Workforce/Workflow" and "HIV Stigma and Adolescent Development" were rated highest for importance, and "Threshold Conditions for Treatment" and "Structure of Implementation Efforts" were rated most changeable. CONCLUSIONS: Understanding implementation science determinants and mechanisms can facilitate the uptake of successful implementation and sustainment strategies for the prevention and treatment of HIV in a given context. We placed determinants and mechanisms within the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to provide greater contextual integration with broader theories in implementation science. Implementers across multiple disciplines can use these findings to improve the scale-up of evidence-based practices for adolescent HIV prevention and treatment in sub-Saharan Africa. Implementation approaches that consider the determinants and mechanisms identified in this study and integrated in implementation frameworks will likely have utility for other health conditions and contexts.
INTRODUCTION: Adolescent HIV prevention and treatment is a high priority for youth healthcare in sub-Saharan Africa. METHODS: This study employed concept mapping to identify factors that impact the implementation of HIV prevention and intervention programs for adolescents in sub-Saharan Africa. Key stakeholders including researchers, policymakers, and non-governmental organization (NGO) personnel constituting membership of the NIH-sponsored Adolescent HIV Prevention and Treatment Implementation Science Alliance responded to the question: "In your experience, what factors have facilitated or hindered implementation of evidence-based HIV prevention or treatment for adolescents in sub-Saharan Africa?" Participants generated statements in response to the focus question, sorted them into thematically relevant groups, and rated each statement on its importance and changeability. RESULTS: Through data analyses and participant feedback, 15 distinct themes were derived. "Workforce/Workflow" and "HIV Stigma and Adolescent Development" were rated highest for importance, and "Threshold Conditions for Treatment" and "Structure of Implementation Efforts" were rated most changeable. CONCLUSIONS: Understanding implementation science determinants and mechanisms can facilitate the uptake of successful implementation and sustainment strategies for the prevention and treatment of HIV in a given context. We placed determinants and mechanisms within the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to provide greater contextual integration with broader theories in implementation science. Implementers across multiple disciplines can use these findings to improve the scale-up of evidence-based practices for adolescent HIV prevention and treatment in sub-Saharan Africa. Implementation approaches that consider the determinants and mechanisms identified in this study and integrated in implementation frameworks will likely have utility for other health conditions and contexts.
Authors: Echezona E Ezeanolue; Michael C Obiefune; Chinenye O Ezeanolue; John E Ehiri; Alice Osuji; Amaka G Ogidi; Aaron T Hunt; Dina Patel; Wei Yang; Jennifer Pharr; Gbenga Ogedegbe Journal: Lancet Glob Health Date: 2015-11 Impact factor: 26.763
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