Fostering successful and sustainable collaborations to advance implementation science: the adolescent HIV prevention and treatment implementation science alliance

Abstract

Introduction HIV continues to devastate the adolescent population in sub‐Saharan Africa (SSA). The complex array of interpersonal, social, structural and system‐level obstacles specific to adolescents have slowed progress in prevention and treatment of HIV in this population. The field of implementation science holds promise for addressing these challenges. Discussion There is growing consensus that enhanced interactions between researchers and users of scientific evidence are important and necessary to tackle enduring barriers to implementation. In 2017, the Fogarty International Center launched the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) to promote communication and catalyse collaboration among implementation scientists and implementers to enhance the cross‐fertilization of insights as research advances and the implementation environment evolves. This network has identified key implementation science questions for adolescent HIV, assessed how members’ research is addressing them, and is currently conducting a concept mapping exercise to more systematically identify implementation research priorities. In addition, AHSA pinpointed common challenges to addressing these questions and discussed their collective capacity to conduct implementation science using the shared learning approach of the network. Specifically, AHISA addresses challenges related to capacity building, developing mentorship, engaging stakeholders, and involving adolescents through support for training efforts and funding region‐/country‐specific networks that respond to local issues and increase implementation science capacity across SSA. Conclusions Innovative platforms, like AHISA, that foster collaborations between implementation science researchers, policymakers and community participants to prioritizes research needs and identify and address implementation challenges can speed the translation of effective HIV interventions to benefit adolescent health.

HIV and mental health among young people in low-resource contexts in Southeast Asia: A qualitative investigation

“…social-structural conditions, such as policies, institutional practices, and resource allocation) (Auerbach et al, 2011) in healthcare, family, school, and peer domains; these correspond to WHO-identified priority research areas for adolescent health in LMIC (Nagata et al, 2016). In accordance with framework analysis, we undertook five steps: 1) familiarised ourselves with the transcripts through immersion in the data, reading and re-reading transcripts and writing memos; 2) generated a thematic framework in successive team meetings, based on both a priori themes guided by EST and participant narratives; 3) indexed the data to the themes through deductive and inductive coding of transcripts; 4) charted the data by organising coded text in accordance with the themes; and 5) mapped and interpreted the data, involving analysis of key characteristics with the aim of generating strategies and recommendations that reflected the experiences, thoughts, and priorities of participants (Ritchie & Spencer, 1994;Srivastava & Thomson, 2009). We implemented extensive member checking through a consultative, knowledge exchange process (Madill & Sullivan, 2018): draft findings and interpretations were shared with young people, KIs, NGO/IGO staff, and experts in each country through in-person forums and written reports, and their feedback integrated into data analysis and interpretation.…”

“…This qualitative exploration with young people in Indonesia, the Philippines, Thailand, and Vietnam reveals pervasive social-structural challenges and unmet needs around HIV and mental health in the context of under-resourced and fragmented health and mental health systems, and multiple and intersecting forms of stigma and discrimination. We identified gaps in youth-friendly HIV and SRH services, and a lack of trained health and mental health professionals, as described in other LMIC settings; these coalesce in scarce implementation of evidence-informed programmes, which leaves large numbers of young people without access to quality care for HIV or mental health issues (Saxena et al, 2007;Sturke et al, 2020). Intersectional stigma based on sexuality, gender identity, HIV, and mental health creates barriers to HIV, SRH, and mental health awareness, service access, and utilisation (Huang et al, 2020;Logie et al, 2016;Pantelic et al, 2020), which further disrupt HIV prevention and care continua for AYKP and YPLHIV.…”

“…Social and environmental risk factors in LMICs, including poverty, community violence, and substance use (Lund et al, 2018;Pedersen et al, 2019), impact children and youth via the family environment. Risk factors for HIV and poor mental health, such as aggressive family environments, family violence (Repetti et al, 2002) and parental rejection, are overrepresented among AYKP (Newman et al, 2018;Newman & Fantus, 2015;Sturke et al, 2020). Strategic interventions were reported in limited programmes that aimed to promote protective factors by engaging family support for adolescent HIV testing, counselling, and retention in care; these were sponsored by NGOs and, to a limited extent, government ministries in each country.…”

“…Inchoate collaborations between Ministries of Education and Health reported in each country provided opportunities for intervention packages in schools that integrate early recognition and care for HIV, and mental and neuropsychiatric issues, for adolescents, then mainstreaming them through primary healthcare and communitylevel services. Establishing referral pathways from schools to bridge segmented health, child protection, and community systems, increasing awareness of locally available programmes and services for young people, and promoting government involvement (Kasedde et al, 2014) and resource allocation for young people's health and education (Sturke et al, 2020) are strategic responses to increase the effectiveness of the educational sector in early intervention for HIV, SRH, and mental health issues.…”

“…Depression, anxiety, and post-traumatic stress disorder are correlated with HIV acquisition risk, including among young people; and young people living with HIV (YPLHIV) are at increased risk for mental health and neuropsychiatric conditions (Chibanda et al, 2016;Koegler & Kennedy, 2018;Sikkema et al, 2015). Young people in LMIC have increased vulnerability to mental illness and associated mortality owing to higher rates of HIV and adverse social determinants of health, such as poverty, food insecurity, community violence, and low access to mental health care (Lund et al, 2018;Patel et al, 2008)-challenges compounded for AYKP (Sturke et al, 2020). Positive associations between syndemic (co-occurring) psychosocial factors-such as depression, suicidality, and substance use-and HIV risk, incidence, and prevalence have been identified among young MSM in Thailand (Guadamuz et al, 2014) and Vietnam (Biello et al, 2014).…”