Applying the Exploration Preparation Implementation Sustainment (EPIS) Framework to the Kigali Imbereheza Project for Rwandan Adolescents Living With HIV
| Autor: | Sabin Nsanzimana, Geri R Donenberg, Erin Emerson, Eric Remera, Charles Ingabire, Ashley D. Kendall, Mary Fabri, Mardge H. Cohen, Olivier Manzi |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Human immunodeficiency virus (HIV) MEDLINE HIV Infections 030312 virology medicine.disease_cause behavioral disciplines and activities Article Medication Adherence law.invention 03 medical and health sciences Randomized controlled trial law Humans Medicine Pharmacology (medical) Retrospective Studies Depressive Disorder 0303 health sciences Cognitive Behavioral Therapy business.industry Extramural Rwanda Retrospective cohort study Patient Acceptance of Health Care Mental health Antiretroviral therapy Cognitive behavioral therapy Infectious Diseases Anti-Retroviral Agents Adolescent Behavior Family medicine Feasibility Studies Female business |
| Zdroj: | J Acquir Immune Defic Syndr |
| ISSN: | 1525-4135 |
| DOI: | 10.1097/qai.0000000000002204 |
| Popis: | BACKGROUND: Sub-Saharan African adolescents living with HIV face challenges to antiretroviral therapy (ART) adherence. Poor mental health drives non-adherence, but can be improved with cognitive behavioral therapy (CBT). CBT delivered by peers may strengthen effects while building capacity for sustainment in low-income countries. This case study retrospectively applied the Exploration Preparation Implementation Sustainment (EPIS) framework to characterize the execution of the Kigali Imbereheza Project (KIP), a 2-arm individually randomized group controlled trial of Trauma-Informed Adherence-Enhanced CBT (TI-CBTe) delivered by Rwandan youth leaders (YL) to adolescents living with HIV. METHODS: YL (n=14, 43% female, M=22.71 years-old) had confirmed HIV and self-reported ART adherence > 95%. Participants (n=356, 51% female, M=16.78 years-old) living with HIV were randomized to TI-CBTe or usual care. Two YL co-led TI-CBTe sessions over two months for a total of 12 hours, while other YL observed and rated fidelity. Participants reported on YL competence. Additional data evaluated feasibility, acceptability, uptake and fidelity. RESULTS: In the Exploration phase, focus groups, stakeholder meetings, and individual interviews revealed strong consensus for delivering TI-CBT to reduce adolescent depression and trauma and improve ART adherence. In the Preparation phase, curriculum revisions were made, YL were successfully trained, and a cascading supervision model was established. In the Implementation phase, YL delivered TI-CBTe with close monitoring and supervision. Findings revealed strong feasibility, acceptability, uptake and fidelity, increasing the likelihood of Sustainment. CONCLUSIONS: EPIS can guide implementation planning and delivery and evaluate implementation outcomes. |
| Databáze: | OpenAIRE |
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