Harmonizing Implementation and Outcome Data Across HIV Prevention and Care Studies in Resource-Constrained Settings

Abstract

Harmonizing measures across studies can facilitate comparisons and strengthen the science, but procedures for establishing common data elements are rarely documented. We detail a rigorous, 2-year process to harmonize measures across the Prevention And Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC 3 H) consortium, consisting of eight federally-funded studies. We created a repository of measured constructs from each study, classified and selected constructs for harmonization, and identified survey instruments. Measures were harmonized for implementation science, HIV prevention and care, demographics and sexual behavior, mental health and substance use, and economic assessment. Importantly, we present our harmonized implementation science constructs. A common set of implementation science constructs have yet to be recommended in the literature for low-to-middle-income countries despite increasing recognition of their importance to delivering and scaling up effective interventions. Drawing on RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) and the Implementation Outcomes Framework, items were harmonized for staff/administrators and study participants to measure reach, adoption, implementation, maintenance, feasibility, acceptability, appropriateness, and fidelity. The process undertaken to harmonize measures and the codified set of implementation science measures developed by our consortium can inform future data harmonization efforts, critical to strengthening the replication and generalizability of findings while facilitating collaborative research—especially in resource-limited settings. We conclude with recommendations for research consortia, namely ensuring representation from all study teams and research priorities; adopting a flexible, transparent, and systematic approach; strengthening the literature on implementation science harmonization; and being responsive to life events (e.g., COVID-19). Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00042-7.

Positive attitudes toward adoption of a multi-component intervention strategy aimed at improving HIV outcomes among adolescents and young people in Nampula, Mozambique: perspectives of HIV care providers

“…In this study, the RE-AIM framework guided the evaluation of the pre-implementation phase of the CombinADO strategies [ 41 ]. The survey measures were formulated from quantitative items adapted from existing, validated measures recommended by the PATC 3 H IS working group for assessing three RE-AIM constructs: adoption, implementation, and maintenance [ 24 , 42 – 44 ]. Survey data were collected to understand stakeholder attitudes toward adoption, initial willingness to implement, and perspectives on maintenance of the study strategies before intervention packages were implemented at sites.…”

“…Stakeholder attitudes toward the adoption of the CombinADO strategies were assessed using an Attitudes towards intervention subscale previously developed in the Antiretroviral Treatment Access Study (ARTAS), which aimed to evaluate the adoption of an evidence-based HIV linkage-to-care intervention among AIDS directors in the United States [ 24 , 44 ]. In this study, the attitude towards the adoption endpoint is derived as a continuous composite score based on 9 of the 17 original subscale items assessed among stakeholders in implementing sites.…”