Sophia M. Bartels, Hong Linh T. Dang, Jane S. Chen, Ha T. T. Nong, Van Anh T. Cao, Ha V. Tran, Teerada Sripaipan, Byron J. Powell, Clare Barrington, Luz M. Reyes, Le Minh Giang, Huong T. T. Phan, William C. Miller, Vivian F. Go
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Little is known about which characteristics are most important for HIV intervention scale-up success in low and middle-income countries (LMICs), and how they influence implementation in these contexts.</p>\n </section>\n \n <section>\n \n <h3> Aims and Objectives</h3>\n \n <p>We sought to examine the relationship between organizational characteristics and scale-up success within an implementation trial testing strategies to scale up Systems Navigation and Psychosocial Counselling (SNaP) for people who inject drugs (PWID) with HIV in Vietnam.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This study was conducted in 42 HIV testing clinics in Vietnam. Informed by the Exploration, Preparation, Implementation, and Sustainment Framework, we assessed the association between five organizational characteristics and SNaP scale-up success: (1) implementation leadership; (2) staff workload; (3) percent PWID; (4) implementation climate; and (5) organizational readiness. 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引用次数: 0
摘要
组织特征，包括结构、文化和气候，是干预扩大成功的重要决定因素。对于哪些特征对于在低收入和中等收入国家成功扩大艾滋病毒干预措施最为重要，以及它们如何影响在这些情况下的实施，人们知之甚少。我们试图在一项实施试验测试策略中研究组织特征与扩大规模成功之间的关系，该策略旨在扩大越南注射毒品（PWID）感染者的系统导航和社会心理咨询（SNaP）。方法本研究在越南42个HIV检测诊所进行。在探索、准备、实施和维持框架的指导下，我们评估了五个组织特征与SNaP扩大成功之间的关系：(1)实施领导力；(2)人员工作量；(3) PWID百分比；(4)实施氛围；(5)组织准备。我们进行了一项混合方法研究，包括对所有诊所的临床工作人员和PWID参与者进行基线和终点调查，并对6个高绩效诊所和6个低绩效诊所的临床工作人员进行访谈（n = 48）。为了为我们的结果测量制定一个情境驱动的放大成功指数，我们与14位HIV、PWID和实施科学方面的专家进行了改进的德尔菲过程。我们使用主题和多元线性回归分析评估了我们的组织特征与扩大规模成功之间的关系，并探索了结果的收敛性。结果与结论更强的实施领导力（ß = 12.20, p = 0.004）、更高的员工工作量（ß = 4.71, p = 0.008）和更低的实施氛围得分（ß = - 6.23, p = 0.046）与规模扩大的成功显著相关。从质量上讲，与会者描述了实施领导力的重要性，特别是在2019冠状病毒病疫情期间，以及在较小程度上描述了实施氛围和组织准备程度对扩大成功的重要性。一些人还描述了在SNaP交付上花费更多时间如何提高了保真度，但增加了工作量。这些发现表明，优先考虑实施以领导为重点的战略，以扩大SNaP等艾滋病毒干预措施，可以改善实施结果。
A Mixed Methods Assessment of the Effect of Organizational Characteristics on Intervention Scale-Up Success in 42 HIV Testing Clinics in Vietnam
Rationale
Organizational characteristics, including structures, culture, and climate, are important determinants of intervention scale-up success. Little is known about which characteristics are most important for HIV intervention scale-up success in low and middle-income countries (LMICs), and how they influence implementation in these contexts.
Aims and Objectives
We sought to examine the relationship between organizational characteristics and scale-up success within an implementation trial testing strategies to scale up Systems Navigation and Psychosocial Counselling (SNaP) for people who inject drugs (PWID) with HIV in Vietnam.
Methods
This study was conducted in 42 HIV testing clinics in Vietnam. Informed by the Exploration, Preparation, Implementation, and Sustainment Framework, we assessed the association between five organizational characteristics and SNaP scale-up success: (1) implementation leadership; (2) staff workload; (3) percent PWID; (4) implementation climate; and (5) organizational readiness. We conducted a mixed methods study including surveys at baseline and endline with clinic staff and PWID participants in all clinics and interviews with clinic staff (n = 48) in six high and six low-performing clinics. To develop a context-driven scale-up success index for our outcome measure, we undertook a modified Delphi process with 14 experts in HIV, PWID, and implementation science. We assessed the relationship between our organizational characteristics and scale-up success using thematic and multiple linear regression analyses and explored the convergence of results.
Results and Conclusion
Greater implementation leadership (ß = 12.20, p = 0.004), high staff workload (ß = 4.71, p = 0.008), and lower implementation climate scores (ß = −6.23, p = 0.046) were significantly associated with scale-up success. Qualitatively, participants described the importance of implementation leadership, particularly during COVID-19, and, to a lesser extent, implementation climate and organizational readiness for scale-up success. Some also described how more time spent on SNaP delivery improved fidelity but exacerbated workload. These findings demonstrate that prioritizing implementation leadership-focused strategies for the scale-up of HIV interventions like SNaP could improve implementation outcomes.
期刊介绍：
The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
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