Implementation research for today's HIV response: from theory to applied insights

Journal of the International AIDS Society, Journal Year: 2024, Volume and Issue: 27(S1)

Published: July 1, 2024

Global progress over the past 20 years has turned tide on HIV epidemic. Many countries are close to, and some have even reached, UNAIDS 90-90-90 (and now 95-95-95) goals. Looking into future, however, requires not only continued attention, but a shift in scientific strategic directions. Programmes must advance equitable reach to ensure that prevention treatment services meet needs of populations contexts outside mainstream health services. We from rapid growth capacity sustainable systems embedded within policy economic commitments around world. Finally, response evolve sole focus towards integrated for comorbid conditions, both persons living with as well contribute global push universal coverage all persons. Implementation research is well-positioned address this new generation challenges is, therefore, needed more than ever today. The growing prominence implementation reflected assembly collection articles supplement Journal International AIDS Society (JIAS) response: Taking stock charting way forward, number funding opportunities, publication venues professional settings which research. been defined methods promote systematic uptake findings other evidence-based practices routine practice improve quality, sustainability [1]. questions we seek answer today fundamentally about implementation: how achieve greater reach; sustain changing environment; integrate wider public structures. At same time, community also provide critical testing ground assess refine science optimally deliver actionable insights real-world problems help us epidemic control. Is up task? This responds strongly affirmative. solicitation received 100 submissions, studies conducted Africa, Asia, Europe, North South America. 12 ultimately included cover wide range interventions—partner services, self-testing, long-acting injectable antiretroviral therapy (ART) stepped care ART retention, pre-exposure prophylaxis (PrEP)—as responses at population level key populations, such infants young women. make use frameworks, Consolidated Framework Research (CFIR) Normalization Process Theory (NPT), ways classifying strategies (using Expert Recommendations Implementing Change) adaptations Reporting Adaptations Modifications-Enhanced [FRAME]). Together, they offer concrete examples can be used produce and, examples, meaningfully clinical level. Several innovative extend efficiency testing—a step remaining gaps response. Even though people an diagnosis globally risen rapidly last decade, much 30% still present advanced disease diagnosis, motivating renewed efforts testing. observation who most need particular often receive them was coined "inverse law" 1971 [2]. explore overcome tendency, using technological (e.g. self-testing kits) novel distribute traditional brick-and-mortar Other through leveraging social networks. Through large cluster-randomized trial, Roy Paladhi et al. [3] demonstrated distributing kits partners newly diagnosed equivalent standard in-person offered contacts, thus offering route partner-assisted Such approaches interpersonal networks networks) technologies should provoke considerations screening chronic conditions diabetes, hypertension). Sharma [4] examined extending partner partners, showed programmatic leverage sexual detect cases feasible useful. potential internet-based Asia highlighted by paper Nguyen [5] reported successful web-based programme population-based observational study 17,000 individuals Vietnam. provides detailed examination subnational carry out vast expansion testing, case, mediated internet, so contact testers person, potentially reaching segment reluctant engage Three papers information integration interventions environments. Each guided frameworks connect literature (including those HIV). Vanhamel [6] extended (NPT) explain PrEP clinics Belgium interviews clinic staff observations. shows adoption intervention simply replication scale, instead adaptive process where individual given sufficient leeway innovate. Specifically, found relational normative restructuring (i.e. changes rules relationships) shaped existing facility. For example, lower-volume workflows, whereas high-volume created procedures (such grouping patients 1 day week). In focused integrating formulations United States, [7] CFIR conduct cross-sectional survey 38 clinics. were interested technical assistance workflow development, payor challenges, staffing shortages patient coordination demand generation. underscore implementation, find approach works each setting. Chapuma [8] narrative synthesis identify failure points early infant deductive coding CFIR), Proctor's actor, action, action target framework [9] develop recommendations directed policymakers, providers patients. Another important role developing actions taken implement desires patients, likely up. notion "preferences" drawn theory suggesting humans rational trade-offs under constraints (time, money) decide goods consume, illuminate these preferences increasingly [10]. Importantly, idea qualitatively different acceptability because it places individual's relationship any good or service product, rather context their choices costs). Mugambi [11] one method, discrete choice experiment, attributes pregnant women want delivered pharmacies. Interestingly, available PrEP, care) desirable, willing give conveniences location cost) diversity Pregnant Kenya chose choice, itself may create demand. Velloza [12] drew human-centred design [13]—another method applied frequently services—to adapt peer counselling delivery Africa. Design begin cognitive technique, affective one—empathy. Empathic engagement between designers end users enables truly collaborative co-creation solutions. paper, mental originally Zimbabwe. article Tan [14] takes complementary approach. Instead end-users positions "citizens" working advocacy capacities drivers standards. Chhun [15] report applies standards—FRAME case [16, 17]—to provider perceptions improved retention youth, carefully tracking Kenya. Simulation modelling decision analysis cost-effectiveness offers great promise date underutilized field addressing [18]. Enns [19] utility simulation project outcomes selection PrEP. highlights scalability determinant impact city level, otherwise pre-implementation stage highlight contrast aspects reach, adaptation maintenance necessary desired outcomes, especially longer term. methodology primed further valuable addition toolbox. round issue, piece landscape. Lujintanon [20] call attention literature, highlighting providers, act higher processes systems—and mostly policymakers—often lacking. raises question posed before challenge science, structures policies neglected our rigorous trials) difficult levels system [21]. adapted decades change proven resilient, once again innovate today's challenges. After financial crisis 2007–2008, commitment defied expectations. While overall deteriorated during COVID-19 pandemic, programmes world managed continue delivering lifesaving therapy. New climate change, insecurity, increasing criminalization regions, coming destabilize Our work far done. Embracing represents nimble, person-centred efficient demonstrate steps toward realization tools solving contemporary prevention. biomedical developed represent game-changing innovations medicine century [23, 24]. Can similar prevent, diagnose, engage, treat affected HIV? hope featuring exciting, still-developing its application tackling authors declare no competing interests. EHG conceptualized co-wrote first draft; BN EMN made substantial contributions revision; AT revised final drafts. thank Makella Courdray, MD supporting editorial process. Data sharing applicable datasets generated analysed current study.

Language: Английский

Targeting youth mental health in a demographically young country: a scoping review focused on South Africa

International Review of Psychiatry, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 13

Published: Dec. 2, 2024

Evidence from South Africa shows a high burden of mental health conditions and large treatment gap for uninsured people with common disorders. For young seeking healthcare, the primary care community settings are potentially more accessible appropriate, but public sector services in country mostly hospital-based. We undertook scoping review needs preferences care-based youth as well evaluations interventions Africa. A PubMed search using relevant terms was conducted, articles were evaluated based on set inclusion exclusion criteria. Of 405 publications search, 29 met criteria inclusion. Two additional papers included searching reference lists. Youth emphasized stigma barrier to healthcare highlighted importance considering local context when developing interventions. The community-based digital identified demonstrated feasibility acceptability efficacy. This provides foundation which base future implementation research advocate polices services.

Language: Английский