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Kobrak P, Remien RH, Myers JE, Salcuni P, Edelstein Z, Tsoi B, Sandfort T. Motivations and Barriers to Routine HIV Testing Among Men Who Have Sex with Men in New York City. AIDS Behav 2022; 26:3563-3575. [PMID: 35536518 PMCID: PMC9550690 DOI: 10.1007/s10461-022-03679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/31/2022]
Abstract
In-depth qualitative interviews explored the experiences and understandings of men 18-39 years old who have sex with men that could facilitate or prevent HIV testing and routine HIV testing. For many men who tested frequently, testing and routine testing were motivated by awareness of the benefit of prompt treatment; public health and provider encouragement to test periodically; responsibility towards sexual partners; and wanting to share a recent HIV-negative test result when seeking sex online. For some men, any testing was impeded by anxiety around possible HIV diagnosis that made testing a stressful occasion that required time and energy to prepare for. This anxiety was often compounded by stigma related to sex between men, having condomless sex, or having HIV. Routine testing could be further stigmatized as some men felt judged by testing providers or partners if they asked for a test or said they tested frequently. We describe efforts to promote testing and routine testing by countering fear and stigma associated with HIV and testing.
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Affiliation(s)
- Paul Kobrak
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA.
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Paul Salcuni
- Relevant Healthcare Technologies, New York, NY, USA
| | - Zoe Edelstein
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA
| | - Benjamin Tsoi
- New York City Health Department, HIV Prevention Program, 42-09 28 Street, Long Island City, NY, 11101, USA
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Costa AB, Viscardi LH, Feijo M, Fontanari AMV. HIV Voluntary Counseling and Testing (VCT-HIV) effectiveness for sexual risk-reduction among key populations: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101612. [PMID: 36034408 PMCID: PMC9399159 DOI: 10.1016/j.eclinm.2022.101612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND HIV disproportionately affects people who inject drugs, transgender people, sex workers, men who have sex with men, and incarcerated people. Recognized as key populations (KP), these groups face increased impact of HIV infection and reduced access to health assistance. In 1990, the Center for Disease Control and Prevention organized technical guidance on HIV Voluntary Counseling and Testing (VCT-HIV), with subsequent trials comparing intervention methodologies, no longer recommending this strategy. However, KP needs have not been explicitly considered. METHODS We assessed VCT-HIV effectiveness for sexual risk-reduction among KP (PROSPERO 2020 CRD42020088816). We searched Pubmed, EMBASE, Global Health, Scopus, PsycINFO, and Web of Science for peer-reviewed, controlled trials from February, 2020, to April, 2022. We screened the references list and contacted the main authors, extracted data through Covidence, applied the Cochrane Risk-of-Bias tool, and performed the meta-analysis using Review Manager. FINDINGS We identified 17 eligible trials, including 10,916 participants and evaluated HIV risk behaviors. When compared to baseline, VCT-HIV reduced unsafe sex frequency (Z=5.40; p<0.00001, I²=0%). INTERPRETATION While our meta-analysis identified VCT-HIV as protective for sexual risk behaviors for among KP, the results are limited to MSM and PWID, demonstrating the paucity of data on the other KP. Also, it highlights the importance of applying a clear VCT-HIV guideline as well as properly training the counselors. FUNDING Research funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ/MS-DIAHV N° 24/2019), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.
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Affiliation(s)
- Angelo Brandelli Costa
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Henriques Viscardi
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Feijo
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Anna Martha Vaitses Fontanari
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Correspondence to: Medicine and Health Sciences Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul 90619-900, Brazil.
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Ngayo MO, Oluka M, Bulimo WD, Okalebo FA. Association between social psychological status and efavirenz and nevirapine plasma concentration among HIV patients in Kenya. Sci Rep 2021; 11:22071. [PMID: 34764325 PMCID: PMC8585942 DOI: 10.1038/s41598-021-01345-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/25/2021] [Indexed: 11/09/2022] Open
Abstract
HIV-related stigma, lack of disclosure and social support are still hindrances to HIV testing, care, and prevention. We assessed the association of these social-psychological statuses with nevirapine (NVP) and efavirenz (EFV) plasma concentrations among HIV patients in Kenya. Blood samples were obtained from 254 and 312 consenting HIV patients on NVP- and EFV-based first-line antiretroviral therapy (ART), respectively, and a detailed structured questionnaire was administered. The ARV plasma concentration was measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). There were 68.1% and 65.4% of the patients on NVP and EFV, respectively, who did not feel guilty for being HIV positive. The disclosure rates were approximately 96.1% and 94.6% of patients on NVP and EFV, respectively. Approximately 85% and 78.2% of patients on NVP and EFV, respectively, received social support as much as needed. There were 54.3% and 14.2% compared to 31.7% and 4.5% patients on NVP and EFV, respectively, with supratherapeutic and suboptimal plasma concentrations. Multivariate quantile regression analysis showed that feeling guilty for being HIV positive was associated with increased 954 ng/mL NVP plasma concentrations (95% CI 192.7 to 2156.6; p = 0.014) but not associated with EFV plasma concentrations (adjusted β = 347.7, 95% CI = - 153.4 to 848.7; p = 0.173). Feeling worthless for being HIV positive was associated with increased NVP plasma concentrations (adjusted β = 852, 95% CI = 64.3 to 1639.7; p = 0.034) and not with EFV plasma concentrations (adjusted β = - 143.3, 95% CI = - 759.2 to 472.5; p = 0.647). Being certain of telling the primary sexual partner about HIV-positive status was associated with increased EFV plasma concentrations (adjusted β 363, 95% CI, 97.9 to 628.1; p = 0.007) but not with NVP plasma concentrations (adjusted β = 341.5, 95% CI = - 1357 to 2040; p = 0.692). Disclosing HIV status to neighbors was associated with increased NVP plasma concentrations (adjusted β = 1731, 95% CI = 376 to 3086; p = 0.012) but not with EFV plasma concentrations (adjusted β = - 251, 95% CI = - 1714.1 to 1212.1; p = 0.736). Obtaining transportation to the hospital whenever needed was associated with a reduction in NVP plasma concentrations (adjusted β = - 1143.3, 95% CI = - 1914.3 to - 372.4; p = 0.004) but not with EFV plasma concentrations (adjusted β = - 6.6, 95% CI = - 377.8 to 364.7; p = 0.972). HIV stigma, lack disclosure and inadequate social support are still experienced by HIV-infected patients in Kenya. A significant proportion of patients receiving the NVP-based regimen had supra- and subtherapeutic plasma concentrations compared to EFV. Social-psychological factors negatively impact adherence and are associated with increased NVP plasma concentration compared to EFV.
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Affiliation(s)
- Musa Otieno Ngayo
- Centre of Microbiology Research, Kenya Medical Research Institute, Complex off Ngong Road Box, Nairobi, 19464-00202, Kenya. .,Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, Kenya.
| | - Margaret Oluka
- grid.10604.330000 0001 2019 0495Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, Kenya
| | - Wallace Dimbuson Bulimo
- grid.10604.330000 0001 2019 0495Department of Biochemistry, University of Nairobi, Nairobi, Kenya
| | - Faith Apolot Okalebo
- grid.10604.330000 0001 2019 0495Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, Kenya
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Abstract
HIV-prevention program planning, implementation, and evaluation began in the United States shortly after reports of a mysterious, apparently acquired, immune deficiency syndrome appeared in summer 1981. In San Francisco, New York City, and elsewhere, members of LGBT communities responded by providing accurate information, giving support, and raising money. During the first decade of the AIDS pandemic (1981–1990), social and behavioral scientists contributed by designing theory-based and practical interventions, combining interventions into programs, and measuring impact on behavior change and HIV incidence. In the second decade (1991–2000), federal, state, and local agencies and organizations played a more prominent role in establishing policies and procedures, funding research and programs, and determining the direction of intervention efforts. In the third decade (2001–2010), biomedical interventions were prioritized over behavioral interventions and have dominated attempts in the fourth decade (2011–2020) to integrate biomedical, behavioral, and structural interventions into coherent, efficient, and cost-effective programs to end AIDS.
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Gomes R. Participation of social movements in gay and lesbian health. CIENCIA & SAUDE COLETIVA 2021; 26:2291-2300. [PMID: 34231739 DOI: 10.1590/1413-81232021266.21972019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/15/2019] [Indexed: 11/22/2022] Open
Abstract
Since the beginning of the 20th century, social movements have developed isolated or aligned actions to promote the right of gays and lesbians to health. This article explores the participation of social movements in gay and lesbian health from the framing perspective on social movements. A literature search was performed and a frame analysis was conducted of the discussions found in the selected articles. This article therefore constitutes a bibliographic essay. With respect to outcomes, the literature reveals alignment between social rights and Aids activism, resonating in improved access to healthcare for gays and lesbians. We conclude that, although the participation of social movements in the struggle for the right of gays and lesbians to health started at the beginning of the last century, it cannot be said, now at the end of the second decade of the 21st century, that the outcomes were entirely solid. In short, we highlight that: (1) in some societies, the claims of social movements have been transformed into political agendas, while in others precarious concessions have been made in relation to gay and lesbian rights; and (2) non-acceptance of the right of gays and lesbians to sexuality still exists.
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Affiliation(s)
- Romeu Gomes
- Departamento de Ensino, Instituto Fernandes Figueiras, Fundação Oswaldo Cruz. Av. Rui Barbosa 716 4º andar, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Gilbert L, Goddard-Eckrich D, Chang M, Hunt T, Wu E, Johnson K, Richards S, Goodwin S, Tibbetts R, Metsch LR, El-Bassel N. Effectiveness of a Culturally Tailored HIV and Sexually Transmitted Infection Prevention Intervention for Black Women in Community Supervision Programs: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e215226. [PMID: 33835175 PMCID: PMC8035652 DOI: 10.1001/jamanetworkopen.2021.5226] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Concentrated epidemics of HIV and sexually transmitted infections (STIs) have persisted among Black women in community supervision programs (CSPs) in the United States. Accumulating research has highlighted the effectiveness of culturally tailored HIV/STI interventions for Black women; however, there is a dearth of such interventions for the large number of Black women in CSPs. OBJECTIVE To determine the effectiveness of a 5-session culturally tailored group-based intervention (Empowering African-American Women on the Road to Health [E-WORTH]) with individualized computerized modules and streamlined HIV testing in reducing STIs and condomless sex vs a 1-session streamlined HIV testing control condition. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from November 18, 2015, (first recruitment) to August 20, 2019 (last 12-month follow-up). Black women mandated to probation, parole, or alternative-to-incarceration programs in New York City who had a history of drug use were recruited and randomized to receive either E-WORTH or a streamlined HIV testing control condition. Both conditions were delivered by Black female staff at a large CSP. The analysis took an intention-to-treat approach. INTERVENTION E-WORTH included a 1-hour individual HIV testing and orientation session and 4 weekly 90-minute group sessions. The control condition included one 30-minute session of HIV testing and information. MAIN OUTCOMES AND MEASURES Primary outcomes were incidence of any STI (biologically assayed chlamydia, gonorrhea, and Trichomonas vaginalis) at the 12-month assessment and the number of condomless acts of vaginal or anal intercourse in the past 90 days during the 12-month period. RESULTS A total of 352 participants who identified as Black or African American were enrolled, including 79 (22.5%) who also identified as Latinx. The mean (SD) age was 32.4 (11.0) years. A total of 172 participants (48.9%) were assigned to the E-WORTH condition, and 180 (51.1%) were assigned to the control condition. Compared with control participants, participants assigned to the E-WORTH condition had 54% lower odds of testing positive for any STI at the 12-month follow-up (odds ratio, 0.46; 95% CI, 0.25-0.88; P = .01) and reported 38% fewer acts of condomless vaginal or anal intercourse during the 12-month period (incidence rate ratio, 0.62; 95% CI, 0.39-0.97; P = .04). CONCLUSIONS AND RELEVANCE The magnitudes of effects found across biological and behavioral outcomes in this randomized clinical trial indicate the feasibility and effectiveness of implementing E-WORTH in real-world CSPs. The findings lend further evidence to the promise of culturally tailored HIV/STI interventions for Black women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02391233.
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Affiliation(s)
- Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Mingway Chang
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | - Karen Johnson
- University of Alabama School of Social Work, Tuscaloosa
| | | | - Sharun Goodwin
- New York City Department of Probation, New York, New York
| | | | - Lisa R. Metsch
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, New York
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Dolcini MM, Davey-Rothwell MA, Singh RR, Catania JA, Gandelman AA, Narayanan V, Harris J, McKay VR. Use of effective training and quality assurance strategies is associated with high-fidelity EBI implementation in practice settings: a case analysis. Transl Behav Med 2021; 11:34-45. [PMID: 31773167 PMCID: PMC7877302 DOI: 10.1093/tbm/ibz158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.
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Affiliation(s)
- M Margaret Dolcini
- Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, San Francisco, CA, USA
| | - Melissa A Davey-Rothwell
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, San Francisco, CA, USA
| | - Ryan R Singh
- Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, San Francisco, CA, USA
| | - Joseph A Catania
- Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, San Francisco, CA, USA
| | - Alice A Gandelman
- California STD/HIV Prevention Training Center, University of California, San Francisco, CA, USA
| | | | - Justin Harris
- Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, San Francisco, CA, USA
| | - Virginia R McKay
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, WA, USA
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8
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Burton CR, Williams L, Bucknall T, Fisher D, Hall B, Harris G, Jones P, Makin M, Mcbride A, Meacock R, Parkinson J, Rycroft-Malone J, Waring J. Theory and practical guidance for effective de-implementation of practices across health and care services: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background
Health-care systems across the globe are facing increased pressures to balance the efficient use of resources and at the same time provide high-quality care. There is greater requirement for services to be evidence based, but practices that are of limited clinical effectiveness or cost-effectiveness still occur.
Objectives
Our objectives included completing a concept analysis of de-implementation, surfacing decision-making processes associated with de-implementing through stakeholder engagement, and generating an evidence-based realist programme theory of ‘what works’ in de-implementation.
Design
A realist synthesis was conducted using an iterative stakeholder-driven four-stage approach. Phase 1 involved scoping the literature and conducting stakeholder interviews to develop the concept analysis and an initial programme theory. In Phase 2, systematic searches of the evidence were conducted to test and develop this theory, expressed in the form of contingent relationships. These are expressed as context–mechanism–outcomes to show how particular contexts or conditions trigger mechanisms to generate outcomes. Phase 3 consisted of validation and refinement of programme theories through stakeholder interviews. The final phase (i.e. Phase 4) formulated actionable recommendations for service leaders.
Participants
In total, 31 stakeholders (i.e. user/patient representatives, clinical managers, commissioners) took part in focus groups and telephone interviews.
Data sources
Using keywords identified during the scoping work and concept analysis, searches of bibliographic databases were conducted in May 2018. The databases searched were the Cochrane Library, Campbell Collaboration, MEDLINE (via EBSCOhost), the Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), the National Institute for Health Research Journals Library and the following databases via the ProQuest platform: Applied Social Sciences Index and Abstracts, Social Services Abstracts, International Bibliography of the Social Sciences, Social Sciences Database and Sociological Abstracts. Alerts were set up for the MEDLINE database from May 2018 to December 2018. Online sources were searched for grey literature and snowballing techniques were used to identify clusters of evidence.
Results
The concept analysis showed that de-implementation is associated with five main components in context and over time: (1) what is being de-implemented, (2) the issues driving de-implementation, (3) the action characterising de-implementation, (4) the extent that de-implementation is planned or opportunistic and (5) the consequences of de-implementation. Forty-two papers were synthesised to identify six context–mechanism–outcome configurations, which focused on issues ranging from individual behaviours to organisational procedures. Current systems can perpetuate habitual decision-making practices that include low-value treatments. Electronic health records can be designed to hide or remove low-value treatments from choice options, foregrounding best evidence. Professionals can be made aware of their decision-making strategies through increasing their attention to low-value practice behaviours. Uncertainty about diagnosis or patients’ expectations for certain treatments provide opportunities for ‘watchful waiting’ as an active strategy to reduce inappropriate investigations and prescribing. The emotional component of clinician–patient relationships can limit opportunities for de-implementation, requiring professional support through multimodal educational interventions. Sufficient alignment between policy, public and professional perspectives is required for de-implementation success.
Limitations
Some specific clinical issues (e.g. de-prescribing) dominate the de-implementation evidence base, which may limit the transferability of the synthesis findings. Any realist inquiry generates findings that are essentially cumulative and should be developed through further investigation that extends the range of sources into, for example, clinical research and further empirical studies.
Conclusions
This review contributes to our understanding of how de-implementation of low-value procedures and services can be improved within health-care services, through interventions that make professional decision-making more accountable and the prominence of a whole-system approach to de-implementation. Given the whole-system context of de-implementation, a range of different dissemination strategies will be required to engage with different stakeholders, in different ways, to change practice and policy in a timely manner.
Study registration
This study is registered as PROSPERO CRD42017081030.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Christopher R Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Lynne Williams
- School of Health Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia
| | - Denise Fisher
- School of Health Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Gill Harris
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Peter Jones
- School of Health Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Matthew Makin
- North Manchester Care Organisation, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Anne Mcbride
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Rachel Meacock
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - John Parkinson
- School of Psychology, College of Human Sciences, Bangor University, Bangor, UK
| | | | - Justin Waring
- School of Social Policy, University of Birmingham, Birmingham, UK
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Lenton E, Johnson J, Brown G. Upscaling HIV and hepatitis C testing in primary healthcare settings: stigma-sensitive practice. Aust J Prim Health 2021; 27:255-258. [PMID: 34154704 DOI: 10.1071/py20176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/05/2021] [Indexed: 11/23/2022]
Abstract
Increasing testing for viral hepatitis and HIV is central to meeting World Health Organization and Australian targets to eliminate blood-borne viruses as public health priorities by 2030. In this paper we draw on findings and recommendations from a Victorian consultation with 40 health and community practitioners engaged with blood-borne virus testing. The consultation focused on identifying what constitutes best practice in pre- and post-testing discussion in the current era of highly effective treatments for HIV and hepatitis C. Overall, the consultation found that the pre- and post-test discussion remains an important feature of testing, but, given that stigma continues to impact the lives of people affected by these viruses, sensitivity to this issue needs to inform how these discussions take place. We describe how primary healthcare settings can support the goal of upscaling HIV and hepatitis C testing in a way that delivers safe and stigma-free testing encounters. We offer the notion of 'stigma-sensitive practice' as a term to describe this approach to pre- and post-test discussions.
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Affiliation(s)
- Emily Lenton
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Vic., Australia; and Corresponding author.
| | - Jen Johnson
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Vic., Australia
| | - Graham Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Vic., Australia; and Present address: Centre for Social Impact UNSW, 704, Level 7, Science Engineering Building, UNSW Sydney, NSW 2052, Australia
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10
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McKay VR, Tetteh EK, Reid MJ, Ingaiza LM. Better Service by Doing Less: Introducing De-implementation Research in HIV. Curr HIV/AIDS Rep 2020; 17:431-437. [PMID: 32794070 PMCID: PMC7492471 DOI: 10.1007/s11904-020-00517-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The course of HIV research has led to a multitude of interventions to prevent and treat HIV. With the arrival of more effective interventions comes the need to end, or de-implement, less effective interventions. PURPOSE OF REVIEW: To describe the state of de-implementation research in HIV and provide a rationale for expanded research in this area. RECENT FINDINGS: Existing studies have identified a set of HIV-specific interventions appropriate for de-implementing and described the persistence of interventions that should be ended. However, to our knowledge, strategies to successfully promote appropriate de-implementation of HIV-specific interventions have not been examined. De-implementing interventions that are no longer needed is an opportunity to improve the quality and effectiveness of HIV services. Opportunities to expand this field of research abound.
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Affiliation(s)
- Virginia R McKay
- The Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
| | - Emmanuel K Tetteh
- The Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Miranda J Reid
- The Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Lucy M Ingaiza
- The Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
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11
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Beauchemin M, Cohn E, Shelton RC. Implementation of Clinical Practice Guidelines in the Health Care Setting: A Concept Analysis. ANS Adv Nurs Sci 2020; 42:307-324. [PMID: 30839334 PMCID: PMC6717691 DOI: 10.1097/ans.0000000000000263] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The literature is replete with clinical practice guidelines (CPGs) and evidence supporting them. Translating guidelines into practice, however, is often challenging. We conducted a concept analysis to define the concept of "implementation of CPGs in health care settings." We utilized Walker and Avant's methodology to define the concept of "implementation of CPGs in health care settings." This included a focused review of the literature, defining the relevant attributes, defining implementation, case examples, and antecedents and potential consequences from implementation of CPGs in health care settings. The concept "implementation" is complex, with numerous frameworks, facilitators, and barriers to implementation described in the literature. The existing literature supports our definition of implementation of CPGs in a health care setting as a process of changing practice in health care while utilizing the best level of evidence that is available in the published literature. These include 7 attributes necessary for effective implementation. Implementation of CPGs in health care settings requires an ongoing iterative process that considers these attributes and is inclusive to administrators, clinicians, and patients to ensure guidelines are understood, accepted, implemented, and evaluated for continued adoption of best practices. Ongoing efforts inclusive at all steps of implementation across multiple levels are needed to effectively change practice.
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Affiliation(s)
| | - Elizabeth Cohn
- Hunter College, The Graduate Center, City University of New York, New York, 10016
| | - Rachel C. Shelton
- Mailman School of Public Health, Columbia University, New York, NY 10032
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McKay VR, Combs TB, Dolcini MM, Brownson RC. The de-implementation and persistence of low-value HIV prevention interventions in the United States: a cross-sectional study. Implement Sci Commun 2020; 1:60. [PMID: 32885215 PMCID: PMC7427853 DOI: 10.1186/s43058-020-00040-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As more effective or efficient interventions emerge out of scientific advancement to address a particular public health issue, it may be appropriate to de-implement low-value interventions, or interventions that are less effective or efficient. Furthermore, factors that contribute to appropriate de-implementation are not well identified. We examined the extent to which low-value interventions were de-implemented among public health organizations providing HIV prevention services, as well as explored socio-economic, organizational, and intervention characteristics associated with de-implementation. METHODS We conducted an online cross-sectional survey from the fall of 2017 to the spring of 2019 with organizations (N = 188) providing HIV prevention services in the USA. Organizations were recruited from the Center for Disease Control and Prevention's (CDC) website gettested.org from 20 metropolitan statistical areas with the highest HIV incidence. An organization was eligible to participate if the organization had provided at least one of the HIV prevention interventions identified as inefficient by the CDC in the last ten years, and one administrator familiar with HIV prevention programming at the organization was recruited to respond. Complete responses were analyzed to describe intervention de-implementation and identify organizational and intervention characteristics associated with de-implementation using logistic regression. RESULTS Organizations reported 359 instances of implementing low-value interventions. Out of the low-value interventions implemented, approximately 57% were group, 34% were individual, and 5% were community interventions. Of interventions implemented, 46% had been de-implemented. Although we examined a number of intervention and organizational factors thought to be associated with de-implementation, the only factor statistically associated with de-implementation was organization size, with larger organizations-those with 50+ FTEs-being 3.1 times more likely to de-implement than smaller organizations (95% CI 1.3-7.5). CONCLUSIONS While low-value interventions are frequently de-implemented among HIV prevention organizations, many persisted representing substantial inefficiency in HIV prevention service delivery. Further exploration is needed to understand why organizations may opt to continue low-value interventions and the factors that lead to de-implementation.
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Affiliation(s)
- Virginia R. McKay
- Center for Public Health Systems Science, The Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Todd B. Combs
- Center for Public Health Systems Science, The Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - M. Margaret Dolcini
- Hallie E. Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR USA
| | - Ross C. Brownson
- Prevention Research Center, The Brown School, Washington University in St. Louis, St. Louis, MO USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO USA
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Prusaczyk B, Swindle T, Curran G. Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes. Implement Sci Commun 2020; 1:43. [PMID: 32885200 PMCID: PMC7427870 DOI: 10.1186/s43058-020-00035-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Increasingly, scholars argue that de-implementation is a distinct concept from implementation; factors contributing to stopping a current practice might be distinct from those that encourage adoption of a new one. One such distinction is related to de-implementation outcomes. We offer preliminary analysis and guidance on de-implementation outcomes, including how they may differ from or overlap with implementation outcomes, how they may be conceptualized and measured, and how they could be measured in different settings such as clinical care vs. community programs. CONCEPTUALIZATION OF OUTCOMES We conceptualize each of the outcomes from Proctor and colleagues' taxonomy of implementation outcomes for de-implementation research. First, we suggest key considerations for researchers assessing de-implementation outcomes, such as considering how the cultural or historical significance to the practice may impact de-implementation success and, as others have stated, the importance of the patient in driving healthcare overuse. Second, we conceptualize de-implementation outcomes, paying attention to a number of factors such as the importance of measuring outcomes not only of the targeted practice but of the de-implementation process as well. Also, the degree to which a practice should be de-implemented must be distinguished, as well as if there are thresholds that certain outcomes must reach before action is taken. We include a number of examples across all outcomes, both from clinical and community settings, to demonstrate the importance of these considerations. We also discuss how the concepts of health disparities, cultural or community relevance, and altruism impact the assessment of de-implementation outcomes. CONCLUSION We conceptualized existing implementation outcomes within the context of de-implementation, noted where there are similarities and differences to implementation research, and recommended a clear distinction between the target for de-implementation and the strategies used to promote de-implementation. This critical analysis can serve as a building block for others working to understand de-implementation processes and de-implement practices in real-world settings.
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Affiliation(s)
- Beth Prusaczyk
- Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, St. Louis, MO 63110 USA
| | - Taren Swindle
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 77205 USA
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 77205 USA
- Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA
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Allen P, Jacob RR, Parks RG, Mazzucca S, Hu H, Robinson M, Dobbins M, Dekker D, Padek M, Brownson RC. Perspectives on program mis-implementation among U.S. local public health departments. BMC Health Serv Res 2020; 20:258. [PMID: 32228688 PMCID: PMC7106610 DOI: 10.1186/s12913-020-05141-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments. METHODS The national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert). RESULTS Thirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio = 0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%). CONCLUSIONS Organizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.
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Affiliation(s)
- Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA.
| | - Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Renee G Parks
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Hengrui Hu
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Mackenzie Robinson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, Ontario, L8P 0A1, Canada
| | - Debra Dekker
- National Association of County and City Health Officials (NACCHO), 1201 Eye Street, NW, 4th Floor, Washington, DC, 20005, USA
| | - Margaret Padek
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, 4921 Parkview Place, St. Louis, MO, 63110, USA
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15
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Barbosu CM, Radulescu A, Manciuc C, Muir E, Levandowski BA, Dye T. Attitudes, practices, and priority of HIV screening and testing among clinical providers in Transylvania and Moldavia, Romania. BMC Health Serv Res 2019; 19:970. [PMID: 31842851 PMCID: PMC6916152 DOI: 10.1186/s12913-019-4823-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
Abstract Screening and linkage to care are core, foundational strategies for HIV transmission prevention and for identifying People Living with HIV (PLHIV). In Romania – with an atypical experience in the HIV/AIDS epidemic – providing care for HIV+ patients identified early is a priority, though screening and testing can pose a challenge in some areas. Methods A survey of 125 clinical providers to explore important dimensions of HIV/ AIDS clinical care was conducted in Transylvania and Moldavia, where clinicians identified poor/ latent screening as a major problem in providing timely care and in preventing the spread of disease. We analyzed determinants of offering HIV screening/testing to patients using Pearson Chi-square analysis and logistic regression. Logistic regression generated Odds Ratios (OR) to reflect the magnitude of association between the relevant variables, with 95% confidence interval (95% CI) indicating statistical range. Results In total, 40.8% of providers did not provide HIV screening/testing to at least one segment of the population. Hospital-based providers were significantly more likely to offer HIV screening/testing to all segments than were non-hospital-based providers (58.1% v. 35.5%, respectively; p < .05). Providers located within institutions with screening/testing policies were more likely to offer such services to their patients (p < .05). Overall, 94.4% of providers indicated interest in more training around HIV screening/testing. Discussion Reaching Romanian and global goals for reducing HIV require more timely screening and action based on positive status. Romanian clinicians are interested in expanding HIV screening/testing and are interested in participating in training that helps them feel more prepared to undertake this work.
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Affiliation(s)
- Cabiria M Barbosu
- University of Rochester School of Medicine and Dentistry, Rochester, New York, 1464, USA
| | - Amanda Radulescu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carmen Manciuc
- "Gr.T.Popa" University of Medicine and Pharmacy Iași, Iasi, Romania
| | - Erin Muir
- University of Rochester School of Medicine and Dentistry, Rochester, New York, 1464, USA
| | - Brooke A Levandowski
- University of Rochester School of Medicine and Dentistry, Rochester, New York, 1464, USA
| | - Timothy Dye
- University of Rochester School of Medicine and Dentistry, Rochester, New York, 1464, USA.
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Prevalence of spontaneous, induced labour or planned caesarean section and factors associated with caesarean section in low-risk women in southern Brazil. Midwifery 2019; 79:102530. [PMID: 31479799 DOI: 10.1016/j.midw.2019.102530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study aimed to examine the prevalence of spontaneous labour, induced labour and planned caesarean section in low-risk women; to identify the contribution of each group to the overall caesarean section rate; and to estimate factors associated with caesarean section in low-risk women according to spontaneous labour, induced labour and planned caesarean section. DESIGN Cross-sectional hospital-based study of postpartum women and newborns, using data from the survey Birth in Brazil, Southern region. In the sample of 2,668 low-risk women, a descriptive analysis was undertaken and a Multinomial Logistic Regression model was applied to verify associations among caesarean section and spontaneous labour, induced labour and planned caesarean section in comparison with vaginal birth. MEASUREMENTS AND FINDINGS The results showed the prevalence of spontaneous labour (48.0%), induced labour (14.0%) and planned caesarean sections (38.0%); these frequencies contributed to an overall caesarean section rate of 50.5%. Obstetric characteristics like previous vaginal birth or previous caesarean section were differentially associated with caesarean section, independently of the labour. Caesarean section without labour was significantly associated with age ≥ 35 years (ORadj 5.45 95%CI 3.16-9.39), economic class A and B (ORadj 3.10 95%CI 1.92-4.99), pregnancy between 37 and 38 weeks (ORadj 1.65 95%CI 1.22-2.24), same obstetrician in prenatal and childbirth (ORadj 13.83 95%CI 8.85-21.61) and private payment source at birth (ORadj 11.50 95%CI 6.64-19.93). KEY CONCLUSION For low-risk women in Southern Brazil, the results identify high planned caesarean section rates, not associated with socioeconomic, obstetric, institutional or prenatal factors that justify these rates.
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Pinto RM, Witte SS, Filippone PL, Choi CJ, Wall M. Policy Interventions Shaping HIV Prevention: Providers' Active Role in the HIV Continuum of Care. HEALTH EDUCATION & BEHAVIOR 2018; 45:714-722. [PMID: 29547342 DOI: 10.1177/1090198118760681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The U.S. Centers for Disease Control and Prevention (CDC) Diffusion of Effective Behavioral Interventions project has disseminated HIV behavioral interventions (EBIs) across the United States since the 1990s. In 2011, the CDC launched the High-Impact HIV Prevention (HIP) project, providing EBIs plus high-impact services (HIV testing, primary care, and support services). Providers (nurses, social workers, educators) are unable to consistently make linkages; thus, numerous at-risk individuals are not benefitting from HIP. Research on providers' roles in the HIV Continuum of Care-linking clients to HIV testing, primary care, and support services-is lacking. This article helps fill this gap with evidence that providers exposed to EBIs, whose agencies offer EBIs, more frequently link clients to high-impact services. This is based on diffusion of innovations theory, where individuals in social networks influence one another's adoption of innovations. We hypothesize that providers are exposed to EBIs via training, reading and hearing about EBIs, and/or discussing EBIs with colleagues. We used cross-sectional data from 379 providers from 36 agencies in New York City. We used multilevel ordinal logistic regression models to test associations between provider exposure to EBIs (agency provides EBIs) and frequency of linkages to high-impact services. Providers exposed to greater numbers of EBIs more frequently link clients to HIV, hepatitis C (HEP-C), and sexually transmitted infections testing; to primary care; and to drug treatment and mental health services. Providers link clients most frequently to primary care and HIV testing and least frequently to HEP-C testing and syringe exchange. Findings suggest a dose effect, with exposure to more EBIs resulting in more linkages. Findings show a staged, evidence-based prevention approach that includes exposure to EBIs, leading to providers linking clients to high-impact services. There needs to be emphasis on inspiring providers to engage with high-impact services at the elevated levels needed to end the epidemic.
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Affiliation(s)
| | | | | | - C Jean Choi
- 3 New York State Psychiatric Institute, New York, NY, USA
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18
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McKay VR, Morshed AB, Brownson RC, Proctor EK, Prusaczyk B. Letting Go: Conceptualizing Intervention De-implementation in Public Health and Social Service Settings. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 62:189-202. [PMID: 29971792 PMCID: PMC6175194 DOI: 10.1002/ajcp.12258] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The discontinuation of interventions that should be stopped, or de-implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de-implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de-implemented. We identify three criteria for identifying interventions appropriate for de-implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well-documented examples illustrate each of the criteria. We describe de-implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de-implementation research as a supplement. Finally, we conclude with a discussion of de-implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de-implementation research, especially identifying interventions appropriate for de-implementation in a systematic manner; and highlight special ethical considerations to advance the field of de-implementation research.
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Affiliation(s)
- Virginia R. McKay
- Center for Public Health Systems ScienceBrown SchoolWashington University in St. LouisSt. LouisMOUSA
- Institute of Clinical and Translational ScienceWashington University School of Medicine in St. LouisSt. LouisMOUSA
| | - Alexandra B. Morshed
- Prevention Research Center in St. LouisBrown SchoolWashington University in St. LouisSt. LouisMOUSA
| | - Ross C. Brownson
- Prevention Research Center in St. LouisBrown SchoolWashington University in St. LouisSt. LouisMOUSA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer CenterWashington University School of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Enola K. Proctor
- Institute of Clinical and Translational ScienceWashington University School of Medicine in St. LouisSt. LouisMOUSA
- Center for Mental Health Services ResearchGeorge Warren Brown School of Social WorkWashington University in St. LouisSt. LouisMOUSA
- Institute for Public HealthWashington University in St. LouisSt. LouisMOUSA
| | - Beth Prusaczyk
- Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Center for Clinical Quality and Implementation ResearchVanderbilt University Medical CenterNashvilleTNUSA
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McKay VR, Hoffer LD, Combs TB, Margaret Dolcini M. The dynamic influence of human resources on evidence-based intervention sustainability and population outcomes: an agent-based modeling approach. Implement Sci 2018; 13:77. [PMID: 29866135 PMCID: PMC5987464 DOI: 10.1186/s13012-018-0767-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/21/2018] [Indexed: 11/27/2022] Open
Abstract
Background Sustaining evidence-based interventions (EBIs) is an ongoing challenge for dissemination and implementation science in public health and social services. Characterizing the relationship among human resource capacity within an agency and subsequent population outcomes is an important step to improving our understanding of how EBIs are sustained. Although human resource capacity and population outcomes are theoretically related, examining them over time within real-world experiments is difficult. Simulation approaches, especially agent-based models, offer advantages that complement existing methods. Methods We used an agent-based model to examine the relationships among human resources, EBI delivery, and population outcomes by simulating provision of an EBI through a hypothetical agency and its staff. We used data from existing studies examining a widely implemented HIV prevention intervention to inform simulation design, calibration, and validity. Once we developed a baseline model, we used the model as a simulated laboratory by systematically varying three human resource variables: the number of staff positions, the staff turnover rate, and timing in training. We tracked the subsequent influence on EBI delivery and the level of population risk over time to describe the overall and dynamic relationships among these variables. Results Higher overall levels of human resource capacity at an agency (more positions) led to more extensive EBI delivery over time and lowered population risk earlier in time. In simulations representing the typical human resource investments, substantial influences on population risk were visible after approximately 2 years and peaked around 4 years. Conclusions Human resources, especially staff positions, have an important impact on EBI sustainability and ultimately population health. A minimum level of human resources based on the context (e.g., size of the initial population and characteristics of the EBI) is likely needed for an EBI to have a meaningful impact on population outcomes. Furthermore, this model demonstrates how ABMs may be leveraged to inform research design and assess the impact of EBI sustainability in practice. Electronic supplementary material The online version of this article (10.1186/s13012-018-0767-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginia R McKay
- Center for Public Health Systems Research in the Warren G. Brown School of Social Work, Washington University in St. Louis, Campus Box1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Lee D Hoffer
- Department of Anthropology, Case Western Reserve University, Mather Memorial Room 238 11220, Bellflower Road, Cleveland, OH, 44106-7125, USA
| | - Todd B Combs
- Center for Public Health Systems Research in the Warren G. Brown School of Social Work, Washington University in St. Louis, Campus Box1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - M Margaret Dolcini
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Hallie E. Ford Center for Health Children and Families, 2631 SW Campus Way, Corvallis, OR, 97331, USA
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HIV Testing in Men who have Sex with Men: A Follow-up Review of the Qualitative Literature since 2010. AIDS Behav 2018; 22:593-605. [PMID: 28331992 DOI: 10.1007/s10461-017-1752-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The landscape of HIV testing has changed significantly in recent years following the rise in importance of the 'treatment as prevention' strategy and advancements in new HIV testing and prevention technologies. This review provides a synthesis of qualitative research findings published since 2010 on preferences and practices of men who have sex with men (MSM) surrounding HIV testing in high-income settings. MSM are one of the hardest groups to reach with standard or conventional HIV testing approaches. To develop innovative testing strategies for this particular group, a good understanding of their concerns, barriers and facilitators of accessing HIV testing is needed. This updated review provides valuable information for improving existing programs and designing new testing services for MSM.
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Kazanjian P. UNAIDS 90-90-90 Campaign to End the AIDS Epidemic in Historic Perspective. Milbank Q 2018; 95:408-439. [PMID: 28589602 DOI: 10.1111/1468-0009.12265] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Powel Kazanjian
- Division of Infectious Diseases, University of Michigan Medical School
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Bayer R, Philbin M, Remien RH. The End of Written Informed Consent for HIV Testing: Not With a Bang but a Whimper. Am J Public Health 2017; 107:1259-1265. [PMID: 28640673 PMCID: PMC5508137 DOI: 10.2105/ajph.2017.303819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/04/2022]
Abstract
In 2014, only two states in the United States still mandated specific written informed consent for HIV testing and, after years of controversy, New York ended this requirement, leaving only Nebraska. New York's shift to opt-out testing meant that a singular feature of what had characterized the exceptionalism surrounding HIV testing was eliminated. We trace the history of debates on written informed consent nationally and in New York State. Over the years of dispute from when HIV testing was initiated in 1985 to 2014, the evidence about the benefits and burdens of written informed consent changed. Just as important was the transformation of the political configuration of HIV advocacy and funding, both nationwide and in New York State. What had for years been the subject of furious debate over what a rational and ethical screening policy required came to an end without the slightest public protest. (Am J Public Health. 2017;107:1259-1265. doi:10.2105/AJPH.2017.303819).
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Affiliation(s)
- Ronald Bayer
- Ronald Bayer is with the Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, NY. Morgan Philbin is with the Department of Sociomedical Sciences, Mailman School of Public Health. Robert H. Remien is with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columba University Medical Center, New York
| | - Morgan Philbin
- Ronald Bayer is with the Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, NY. Morgan Philbin is with the Department of Sociomedical Sciences, Mailman School of Public Health. Robert H. Remien is with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columba University Medical Center, New York
| | - Robert H Remien
- Ronald Bayer is with the Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, NY. Morgan Philbin is with the Department of Sociomedical Sciences, Mailman School of Public Health. Robert H. Remien is with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columba University Medical Center, New York
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Williams I, Harlock J, Robert G, Mannion R, Brearley S, Hall K. Decommissioning health care: identifying best practice through primary and secondary research – a prospective mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05220] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundDecommissioning – defined as the planned process of removing, reducing or replacing health-care services – is an important component of current reforms in the NHS. However, the evidence base on which to guide policy and practice in this area is weak.AimThis study aims to formulate theoretically grounded, evidence-informed guidance to support best practice in effective decommissioning of NHS services.DesignThe overall approach is a sequential, multimethod research design. The study involves (1) a literature synthesis summarising what is known about decommissioning, an international expert Delphi study, 12 interviews with national/regional bodies and seven narrative vignettes from NHS leaders; (2) a survey of Clinical Commissioning Groups (CCGs) in England (n = 56/211, 27%); (3) longitudinal, prospective case studies of four purposively sampled decommissioning projects comprising 59 semistructured interviews, 18 non-participant observations and documentary analysis; and (4) research with citizens, patient/service user representatives, carers, third-sector organisations and local community groups, including three focus groups (30 participants) and a second Delphi study (26 participants). The study took place over the period 2013–16.SettingThe English NHS.ResultsThere is a lack of robust evidence to guide decommissioning, but among experts there is a high level of consensus for the following good-practice principles: establish a strong leadership team, engage clinical leaders from an early stage and establish a clear rationale for change. The most common type of CCG decommissioning activity was ‘relocation or replacement of a service from an acute to a community setting’ (28% of all activities) and the majority of responding CCGs (77%) were planning to decommission services. Case studies demonstrate the need to (1) draw on evidence, reviews and policies to frame the problem; (2) build alliances in order to legitimise decommissioning as a solution; (3) seek wider acceptance, including among patients and community groups, of decommissioning; and (4) devise implementation plans that recognise the additional challenges of removal and replacement. Citizens, patient/service user representatives, carers, third-sector organisations and local community groups were more likely to believe that decommissioning is driven by financial and political concerns than by considerations of service quality and efficiency, and to distrust and/or resent decision-makers. Overall, the study suggests that failure rates in decommissioning are likely to be higher than in other forms of service change, suggesting the need for tailored design and implementation approaches.LimitationsThere were few opportunities for patient and public engagement in early phases of the research; however, this was mitigated by the addition of work package 4. We were unable to track outcomes of decommissioning activities within the time scales of the project and the survey response rate was lower than anticipated.ConclusionsDecommissioning is shaped by change management and implementation, evidence and information, and relationships and politics. We propose an expanded understanding, encompassing organisational and political factors, of how avoidance of loss affects the delivery of decommissioning programmes. Future work should explore the relationships between contexts, mechanisms and outcomes in decommissioning, develop the understanding of how loss affects decisions and explore the long-term impact of decommissioning and its impact on patient care and outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jenny Harlock
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, London, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Sally Brearley
- Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, London, UK
| | - Kelly Hall
- Department of Social Policy and Social Work, University of Birmingham, Birmingham, UK
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