المؤلفون: Jerusha Nyabiage Mogaka, Felix Abuna Otieno, Eunita Akim, Kristin Beima-Sofie, Julia Dettinger, Lauren Gomez, Mary Marwa, Ben Odhiambo, Kenneth Ngure, Keshet Ronen, Monisha Sharma, Grace John-Stewart, Barbra Richardson, Joshua Stern, Jennifer Unger, Jenna Udren, Salphine Watoyi, Jillian Pintye, John Kinuthia

المصدر: JMIR Research Protocols, Vol 12, p e47124 (2023)

مصطلحات موضوعية: Medicine, Computer applications to medicine. Medical informatics, R858-859.7

وصف الملف: electronic resource

العلاقة: https://www.researchprotocols.org/2023/1/e47124Test; https://doaj.org/toc/1929-0748Test

الوصول الحر: https://doaj.org/article/2932fe015f6342e29da4768c36b2f9fbTest

المؤلفون: Jerusha Nyabiage Mogaka, Felix Abuna Otieno, Eunita Akim, Kristin Beima-Sofie, Julia Dettinger, Lauren Gomez, Mary Marwa, Ben Odhiambo, Kenneth Ngure, Keshet Ronen, Monisha Sharma, Grace John-Stewart, Barbra Richardson, Joshua Stern, Jennifer Unger, Jenna Udren, Salphine Watoyi, Jillian Pintye, John Kinuthia

المصدر: JMIR Research Protocols, Vol 12, p e41170 (2023)

مصطلحات موضوعية: Medicine, Computer applications to medicine. Medical informatics, R858-859.7

الوصف: BackgroundCisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. ObjectiveWe are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women’s and Children’s Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. MethodsThe mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. ResultsEnrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. ConclusionsThis trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. Trial RegistrationClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884Test International Registered Report Identifier (IRRID)DERR1-10.2196/41170

وصف الملف: electronic resource

العلاقة: https://www.researchprotocols.org/2023/1/e41170Test; https://doaj.org/toc/1929-0748Test

الوصول الحر: https://doaj.org/article/d6d37308a527435b89ae644554102048Test

المؤلفون: Amy Jane Griffiths, John Brady, Nicholas Riley, James Alsip, Vanessa Trine, Lauren Gomez

المصدر: Frontiers in Education, Vol 5 (2021)

مصطلحات موضوعية: stem education, students with disabilities, evaluation of STEM programs, assessment, autism, Education (General), L7-991

الوصف: Some students with autism spectrum disorder and other learning differences may have superior visual acuity, increased attentional focus, and logical thinking abilities, lending to an affinity for science, technology, engineering, and mathematics (STEM) fields. At the same time, economists report that, the United States will experience a 28.2% increase in STEM-related jobs between 2014 and 2024. Although students with disabilities (SWD) can help to fill those positions, 85% of SWD graduates are either underemployed or unemployed as they enter young adulthood. Thus, there is a need to develop, evaluate, and report outcomes of STEM preparation programs specifically tailored to SWD. This mixed-methods study was designed to develop an evaluation procedure to measure a STEM school’s program for SWD and to analyze the first two years of data to help shape the evaluation process. A comprehensive evaluation model of STEM education for children with learning differences was developed and tested. Implications for practice and future research are discussed.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/feduc.2020.545701/fullTest; https://doaj.org/toc/2504-284XTest

الوصول الحر: https://doaj.org/article/61053a0780ea48428b72cb2cea906051Test

المؤلفون: Anna Larsen, Jillian Pintye, Felix Abuna, Julia C. Dettinger, Laurén Gómez, Mary M. Marwa, Nancy Ngumbau, Ben Odhiambo, Barbra A. Richardson, Salphine Watoyi, Joshua Stern, John Kinuthia, Grace John‐Stewart

مصطلحات موضوعية: Impact of Maternal Mental Health on Offspring, Public Health, Environmental and Occupational Health, Medicine, Health Sciences, Global Maternal and Child Health Outcomes, Pediatrics, Perinatology and Child Health, Mortality and Sequelae of Preterm Birth, Prenatal Stress, Preterm Birth, Perinatal Depression, Pregnancy and Mental Health, Incidence geometry, Demography, FOS Sociology, Receiver operating characteristic, Obstetrics, Prospective cohort study, Edinburgh Postnatal Depression Scale, Internal medicine, Depressive symptoms, Psychiatry, Physics, Sociology, Optics, Anxiety

الوصف: Background: Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in sub-Saharan Africa where 40% of global neonatal deaths occur. We identified and combined correlates of PTB among Kenyan women to develop a risk score. Methods: We used data from a prospective study enrolling HIV-negative women from 20 antenatal clinics in Western Kenya (NCT03070600). Depressive symptoms were assessed by study nurses using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence (IPV) with the Hurt, Insult, Threaten, Scream scale (HITS), and social support using the Medical Outcomes Survey scale (MOS-SSS). Predictors of PTB (birth <37 weeks gestation) were identified using multivariable Cox proportional hazards models, clustered by facility. We used stratified k-fold cross-validation methods for risk score derivation and validation. Area under the receiver operating characteristic curve (AUROC) was used to evaluate discrimination of the risk score and Brier ... : نبذة مختصرة: الولادة المبكرة (PTB) هي السبب الرئيسي لوفيات الأطفال حديثي الولادة، لا سيما في أفريقيا جنوب الصحراء الكبرى حيث تحدث 40 ٪ من وفيات الأطفال حديثي الولادة في العالم. حددنا ودمجنا الارتباطات بين مرض السل التاجي بين النساء الكينيات لتطوير درجة المخاطر. الطرق: استخدمنا بيانات من دراسة مستقبلية لتسجيل النساء غير المصابات بفيروس نقص المناعة البشرية من 20 عيادة قبل الولادة في غرب كينيا (NCT03070600). تم تقييم أعراض الاكتئاب من قبل ممرضات الدراسة باستخدام مقياس الاكتئاب لمركز الدراسات الوبائية (CESD -10)، وعنف الشريك الحميم (IPV) مع مقياس الأذى والإهانة والتهديد والصراخ (HITS)، والدعم الاجتماعي باستخدام مقياس مسح النتائج الطبية (MOS - SSS). تم تحديد تنبؤات PTB (الولادة <37 أسبوعًا من الحمل) باستخدام نماذج مخاطر COX النسبية متعددة المتغيرات، مجمعة حسب المنشأة. استخدمنا طرق التحقق الطبقي المتبادل من k - fold لاشتقاق درجة المخاطر والتحقق من صحتها. تم استخدام المنطقة الموجودة تحت منحنى خصائص تشغيل جهاز الاستقبال (AUROC) لتقييم التمييز في درجة المخاطر ودرجة Brier للمعايرة. النتائج: من بين 4084 امرأة، كانت ...

العلاقة: https://dx.doi.org/10.60692/varpr-4yt56Test

الإتاحة: https://doi.org/10.60692/z80vj-y6m7210.60692/varpr-4yt56Test

المؤلفون: Michelle A. Bulterys, Irene Njuguna, Maureen King'e, Daisy Chebet, Hellen Moraa, Laurén Gómez, Alvin Onyango, Kenneth Malavi, Gladys Nzia, MN Chege, Jillian Neary, Anjuli D. Wagner, Kendall A. Lawley, Dalton Wamalwa, Sarah Benki‐Nugent, Grace John‐Stewart

مصطلحات موضوعية: Prevention and Treatment of HIV/AIDS Infection, Infectious Diseases, FOS Health sciences, Medicine, Health Sciences, Maternal and Child Nutrition in Developing Countries, Nutrition and Dietetics, Nursing, Impact of Child Labor Interventions, Safety Research, Social Sciences, Child Development, Gross motor skill, Confounding, Human immunodeficiency virus HIV, Pediatrics, Demography, FOS Sociology, Motor skill, Internal medicine, Psychiatry, Immunology, FOS Clinical medicine, Sociology

الوصف: Introduction Predictors of neurodevelopment among children who are HIV‐exposed uninfected (CHEU) are poorly understood. Methods Mothers with and without HIV and their children were enrolled during 6‐week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1‐year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site. Results At 1‐year evaluation, CHEU ( n = 709) and children who are HIV‐unexposed uninfected (CHUU) ( n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate‐to‐severe ... : مقدمة إن تنبؤات النمو العصبي بين الأطفال غير المصابين بفيروس نقص المناعة البشرية (CHEU) غير مفهومة بشكل جيد. الطرق تم تسجيل الأمهات المصابات بفيروس نقص المناعة البشرية وغير المصابات به وأطفالهن خلال زيارات رعاية ما بعد الولادة لمدة 6 أسابيع عبر سبعة مواقع في كينيا بين مارس 2021 ويونيو 2022. تم تقييم النمو العصبي للرضع باستخدام أداة التقييم التنموي في ملاوي، بما في ذلك المجالات الاجتماعية واللغوية والحركية الدقيقة والمجالات الحركية الإجمالية. استخدمنا نماذج تأثيرات مختلطة خطية متعددة المتغيرات لتحديد الارتباطات بين درجات النمو العصبي لمدةعام واحد، والتعرض لفيروس نقص المناعة البشرية والعلاج المضاد للفيروسات القهقرية (ART)، والعوامل المنزلية، مع تعديلها للارتباكات المحتملة وتجميعها حسب الموقع. النتائج في تقييمعام واحد، كان لدى CHEU ( العدد = 709) والأطفال غير المصابين بفيروس نقص المناعة البشرية (CHUU) ( العدد = 715) متوسط عمر مماثل (52 أسبوعًا) وتوزيع الجنس (49 ٪ مقابل 52 ٪ أنثى). كانت الأمهات المصابات بفيروس نقص المناعة البشرية أكبر سنًا (31 مقابل 27 عامًا)، وحصلن على تعليم أقل (50 ٪ مقابل 26 ٪ في المرحلة ...

العلاقة: https://dx.doi.org/10.60692/b0q24-tzr18Test

الإتاحة: https://doi.org/10.60692/se2yk-n112610.60692/b0q24-tzr18Test

المؤلفون: Christina Mazumder, Annabel Dollah, Rosebel Ouda, Moses Okombo, Judith Nyakina, Monica L. Makia, Julia C. Dettinger, Laurén Gómez, Mary M. Marwa, Ben Ochieng, Felix Abuna, Claire Gwayi-Chore, Jillian Pintye, John Kinuthia, Grace John‐Stewart, James Pfeiffer, Melissa Latigo Mugambi

مصطلحات موضوعية: Global Maternal and Child Health Outcomes, Pediatrics, Perinatology and Child Health, Medicine, Health Sciences, Impact of COVID-19 Infection on Pregnancy Outcomes, Obstetrics and Gynecology, Prenatal Aneuploidy Diagnosis and Screening Techniques, Noninvasive Prenatal Testing, Pregnancy, Test biology, Family medicine, Pregnancy test, Qualitative research, Paleontology, Social science, Genetics, FOS Biological sciences, Sociology, FOS Sociology, Biology

الوصف: Background There are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy. Methods From April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests. Results We conducted 48 ... : معلومات أساسية هناك بيانات محدودة حول استخدام اختبار الحمل المنزلي بين النساء في البلدان منخفضة ومتوسطة الدخل. وجدت دراسة استقصائية سابقة أن 20 ٪ فقط من النساء في غرب كينيا استخدمن اختبار الحمل المنزلي لتأكيد حملهن قبل الذهاب إلى الرعاية السابقة للولادة. تهدف هذه الدراسة النوعية إلى فهم سبب عدم استخدام النساء لاختبارات الحمل المنزلية في المراحل المبكرة من الحمل. الأساليب من أبريل 2021 إلى يوليو 2021، أجرينا مقابلات مع نساء من أربع عيادات للرعاية السابقة للولادة في مقاطعتي هوما باي وسيايا. قمنا بتوظيف النساء المسجلات سابقًا في دراسة تنفيذ العلاج الوقائي قبل الولادة للأمهات في الرعاية السابقة للولادة (PRIMA)، وهي تجربة عشوائية عنقودية قيمت أفضل الأساليب لتنفيذ العلاج الوقائي قبل الولادة في عيادات صحة الأم والطفل في غرب كينيا (NCT03070600). أجريت المقابلات عبر الهاتف والصوت المسجل والمترجم والمدون حرفيًا. قمنا بترميز وتحليل النصوص لتسجيل العوامل التي تؤثر على قدرة المرأة وفرصها ودوافعها لاستخدام اختبارات الحمل المنزلية. النتائج أجرينا 48 مقابلة شبه منظمة مع نساء تتراوح أعمارهن بين 21 و 42 عامًا. لم تستخدم 27 ...

العلاقة: https://dx.doi.org/10.60692/qradp-a3t31Test

الإتاحة: https://doi.org/10.60692/s951a-8255110.60692/qradp-a3t31Test

المؤلفون: Michelle A. Bulterys, Irene Njuguna, Maureen King'e, Daisy Chebet, Hellen Moraa, Laurén Gomez, Alvin Onyango, Kenneth Malavi, Gladys Nzia, Martin Chege, Jillian Neary, Anjuli D. Wagner, Kendall A. Lawley, Dalton Wamalwa, Sarah Benki‐Nugent, Grace John‐Stewart

المصدر: Journal of the International AIDS Society, Vol 26, Iss S4, Pp n/a-n/a (2023)

مصطلحات موضوعية: neurodevelopment, HIV exposure, children who are HIV‐exposed uninfected, CHEU, maternal mental health, intimate partner violence, Immunologic diseases. Allergy, RC581-607

الوصف: Introduction Predictors of neurodevelopment among children who are HIV‐exposed uninfected (CHEU) are poorly understood. Methods Mothers with and without HIV and their children were enrolled during 6‐week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1‐year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site. Results At 1‐year evaluation, CHEU (n = 709) and children who are HIV‐unexposed uninfected (CHUU) (n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate‐to‐severe food insecurity (26% vs. 9%) (p < 0.01 for all). Compared to CHUU, CHEU had higher language scores (adjusted coeff: 0.23, 95% CI: 0.06, 0.39) and comparable social, fine and gross motor scores. Among all children, preterm birth was associated with lower gross motor scores (adjusted coeff: −1.38, 95% CI: −2.05, −0.71), food insecurity was associated with lower social scores (adjusted coeff: −0.37, 95% CI: −0.73, −0.01) and maternal report of intimate partner violence (IPV) was associated with lower fine motor (adjusted coeff: −0.76, 95% CI: −1.40, −0.13) and gross motor scores (adjusted coeff: −1.07, 95% CI: −1.81, −0.33). Among CHEU, in utero efavirenz (EFV) exposure during pregnancy was associated with lower gross motor scores compared to dolutegravir (DTG) exposure (adjusted coeff: −0.51, 95% CI: −1.01, −0.03). Lower fine and gross motor scores were also associated with having a single or widowed mother (adjusted coeff: −0.45, 95% CI: −0.87, −0.03) or a deceased or absent father (adjusted coeff: −0.81, 95% ...

العلاقة: https://doi.org/10.1002/jia2.26149Test; https://doaj.org/toc/1758-2652Test; https://doaj.org/article/bb519f5fb15b4ec4b503b53bb5040710Test

الإتاحة: https://doi.org/10.1002/jia2.26149Test
https://doaj.org/article/bb519f5fb15b4ec4b503b53bb5040710Test

المؤلفون: Joseph Sila, Anjuli D. Wagner, Felix Abuna, Julia C. Dettinger, Ben Odhiambo, Nancy Ngumbau, George Oketch, Enock Sifuna, Laurén Gómez, Sarah Hicks, Grace John-Stewart, John Kinuthia

المصدر: Frontiers in Reproductive Health, Vol 5 (2023)

مصطلحات موضوعية: pre-exposure prophylaxis (PrEP), pregnancy, postpartum, implementation science, video education, HIV self testing, Reproduction, QH471-489, Medicine (General), R5-920

الوصف: BackgroundPre-exposure prophylaxis (PrEP) is recommended by the World Health Organization and the Kenyan Ministry of Health for HIV prevention in pregnancy and postpartum for women at risk for HIV. Integration of PrEP into antenatal care is promising, but delivery gaps exist in the face of healthcare provider shortages in resource-limited settings.MethodsBetween May and November 2021, we conducted a difference-in-differences study (3 months pre-intervention data collection and 3 months post-intervention data collection) analyzing four intervention facilities, where the strategies were implemented, and four comparison facilities, where no strategies were implemented. We tested a combination of three implementation strategies—video-based PrEP information in the waiting bay, HIV self-testing, and dispensing of PrEP in the antenatal care rooms—to improve PrEP delivery. We compared absolute changes in the proportion of antenatal attendees screened for PrEP (PrEP penetration), the proportion receiving all PrEP-specific steps in a visit (HIV testing, risk screening, and PrEP counseling) (PrEP fidelity), and client PrEP knowledge, client satisfaction, and waiting time and service time (a priori outcomes); post hoc, we compared the proportion offered PrEP (PrEP offer) and completing HIV testing. We measured provider perceptions of the acceptability and appropriateness of the implementation strategies.ResultsWe observed significant improvements in PrEP penetration, PrEP offer, satisfaction, and knowledge (p < 0.05) and improvements in fidelity that trended towards significance (p = 0.057). PrEP penetration increased 5 percentage points (p = 0.008), PrEP fidelity increased 8 percentage points (p = 0.057), and PrEP offer increased 4 percentage points (p = 0.003) in intervention vs. comparison facilities. Client PrEP knowledge increased by 1.7 out of 6 total points (p < 0.001) and client satisfaction increased by 0.7 out of 24 total points (p = 0.003) in intervention vs. comparison facilities. We observed no changes in ...

العلاقة: https://www.frontiersin.org/articles/10.3389/frph.2023.1205503/fullTest; https://doaj.org/toc/2673-3153Test; https://doaj.org/article/dd1e5e54d5524ff3b6831243fa17e514Test

الإتاحة: https://doi.org/10.3389/frph.2023.1205503Test
https://doaj.org/article/dd1e5e54d5524ff3b6831243fa17e514Test

المؤلفون: Sarah Hicks, Ben Odhiambo, Felix Abuna, Julia C. Dettinger, Nancy Ngumbau, Laurén Gómez, Joseph Sila, George Oketch, Enock Sifuna, Bryan J. Weiner, Grace John-Stewart, John Kinuthia, Anjuli D. Wagner

المصدر: Implementation Science Communications, Vol 4, Iss 1, Pp 1-12 (2023)

مصطلحات موضوعية: HIV infections/prevention and control, Humans, Pregnancy and postpartum, Strategy prioritization, Nominal group technique, Medicine (General), R5-920

الوصف: Background There is a higher risk for HIV acquisition during pregnancy and postpartum. Pre-exposure prophylaxis (PrEP) is recommended during this period for those at high risk of infection; integrated delivery in maternal and child health (MCH) clinics is feasible and acceptable but requires implementation optimization. Methods The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged stakeholders to prioritize determinants of PrEP delivery (using Likert scores) and prioritize PrEP delivery implementation strategies. Using a sequential explanatory mixed methods design, we conducted quantitative surveys with healthcare workers at 55 facilities in Western Kenya and a stakeholder workshop (including nurses, pharmacists, counselors, and county and national policymakers), yielding visual plots of stakeholders’ perceived feasibility and effectiveness of the strategies. A stepwise elimination process was used to identify seven strategies for empirical testing. Facilitator debriefing reports from the workshop were used to qualitatively assess the decision-making process. Results Among 146 healthcare workers, the strongest reported barriers to PrEP delivery were insufficient providers and inadequate training, insufficient space, and high volume of patients. Sixteen strategies were assessed, 14 of which were included in the final analysis. Among rankings from 182 healthcare workers and 44 PrEP policymakers and implementers, seven strategies were eliminated based on low post-workshop ranking scores (bottom 50th percentile) or being perceived as low feasibility or low effectiveness for at least 50% of the workshop groups. The top seven strategies included delivering PrEP within MCH clinics instead of pharmacies, fast-tracking PrEP clients to reduce waiting time, delivering PrEP-related health talks in waiting bays, task shifting PrEP counseling, task shifting PrEP risk assessments, training different providers to deliver PrEP, and retraining providers on PrEP delivery. All top ...

العلاقة: https://doi.org/10.1186/s43058-023-00481-9Test; https://doaj.org/toc/2662-2211Test; https://doaj.org/article/107918de1ebb4e1180f96a43b44a0af9Test

الإتاحة: https://doi.org/10.1186/s43058-023-00481-9Test
https://doaj.org/article/107918de1ebb4e1180f96a43b44a0af9Test

المؤلفون: Sarah Hicks, Felix Abuna, Ben Odhiambo, Julia C. Dettinger, Nancy Ngumbau, Laurén Gómez, Joseph Sila, George Oketch, Enock Sifuna, Bryan J. Weiner, Grace C. John-Stewart, John Kinuthia, Anjuli D. Wagner

المصدر: Implementation Science Communications, Vol 4, Iss 1, Pp 1-16 (2023)

مصطلحات موضوعية: Implementation strategy, Implementation determinants, Prioritization, Nominal group technique, Medicine (General), R5-920

الوصف: Background There is a lack of consensus about how to prioritize potential implementation strategies for HIV pre-exposure prophylaxis (PrEP) delivery. We compared several prioritization methods for their agreement and pragmatism in practice in a resource-limited setting. Methods We engaged diverse stakeholders with clinical PrEP delivery and PrEP decision-making experience across 55 facilities in Kenya to prioritize 16 PrEP delivery strategies. We compared four strategy prioritization methods: (1) “past experience surveys” with experienced practitioners reflecting on implementation experience (N = 182); (2 and 3) “pre- and post-small-group ranking” surveys before and after group discussion (N = 44 and 40); (4) “go-zone” quadrant plots of perceived effectiveness vs feasibility. Kendall’s correlation analysis was used to compare strategy prioritization using the four methods. Additionally, participants were requested to group strategies into three bundles with up to four strategies/bundle by phone and online survey. Results The strategy ranking correlation was strongest between the pre- and post-small-group rankings (Tau: 0.648; p < 0.001). There was moderate correlation between go-zone plots and post-small-group rankings (Tau: 0.363; p = 0.079) and between past-experience surveys and post-small-group rankings (Tau: 0.385; p = 0.062). For strategy bundling, participants primarily chose bundles of strategies in the order in which they were listed, reflecting option ordering bias. Neither the phone nor online approach was effective in selecting strategy bundles. Participants agreed that the strategy ranking activities conducted during the workshop were useful in prioritizing a final set of strategies. Conclusions Both experienced and inexperienced stakeholder participants’ strategy rankings tended to prioritize strategies perceived as feasible. Small group discussions focused on feasibility and effectiveness revealed moderately different priorities than individual rankings. The strategy bundling approach, ...

العلاقة: https://doi.org/10.1186/s43058-023-00457-9Test; https://doaj.org/toc/2662-2211Test; https://doaj.org/article/4fa9adfdb4ca4ca7808f11003a4bb029Test

الإتاحة: https://doi.org/10.1186/s43058-023-00457-9Test
https://doaj.org/article/4fa9adfdb4ca4ca7808f11003a4bb029Test