| Autor: |
Nok Chhun, Dorothy Oketch, Kawango Agot, Dorothy I. Mangale, Jacinta Badia, James Kibugi, Wenwen Jiang, Mary Kirk, Barbra A. Richardson, Pamela K. Kohler, Grace John‐Stewart, Kristin Beima‐Sofie |
| Jazyk: |
angličtina |
| Rok vydání: |
2024 |
| Předmět: |
|
| Zdroj: |
Journal of the International AIDS Society, Vol 27, Iss S1, Pp n/a-n/a (2024) |
| Druh dokumentu: |
article |
| ISSN: |
1758-2652 |
| DOI: |
10.1002/jia2.26261 |
| Popis: |
Abstract Introduction The Data‐informed Stepped Care (DiSC) study is a cluster‐randomized trial implemented in 24 HIV care clinics in Kenya, aimed at improving retention in care for adolescents and youth living with HIV (AYLHIV). DiSC is a multi‐component intervention that assigns AYLHIV to different intensity (steps) of services according to risk. We used the Framework for Reporting Adaptations and Modifications‐Expanded (FRAME) to characterize provider‐identified adaptations to the implementation of DiSC to optimize uptake and delivery, and determine the influence on implementation outcomes. Methods Between May and December 2022, we conducted continuous quality improvement (CQI) meetings with providers to optimize DiSC implementation at 12 intervention sites. The meetings were guided by plan‐do‐study‐act processes to identify challenges during early phase implementation and propose targeted adaptations. Meetings were audio‐recorded and analysed using FRAME to categorize the level, context and content of planned adaptations and determine if adaptations were fidelity consistent. Providers completed surveys to quantify perceptions of DiSC acceptability, appropriateness and feasibility. Mixed effects linear regression models were used to evaluate these implementation outcomes over time. Results Providers participated in eight CQI meetings per facility over a 6‐month period. A total of 65 adaptations were included in the analysis. The majority focused on optimizing the integration of DiSC within the clinic (83%, n = 54), and consisted of improving documentation, addressing scheduling challenges and improving clinic workflow. Primary reasons for adaptation were to align delivery with AYLHIV needs and preferences and to increase reach among AYLHIV: with reminder calls to AYLHIV, collaborating with schools to ensure AYLHIV attended clinic appointments and addressing transportation challenges. All adaptations to optimize DiSC implementation were fidelity‐consistent. Provider perceptions of implementation were consistently high throughout the process, and on average, slightly improved each month for intervention acceptability (β = 0.011, 95% CI: 0.002, 0.020, p = 0.016), appropriateness (β = 0.012, 95% CI: 0.007, 0.027, p |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
|
|
Nepřihlášeným uživatelům se plný text nezobrazuje |
K zobrazení výsledku je třeba se přihlásit.
|
