Implementation science and the Health Resources and Services Administration’s Ryan White HIV/AIDS Program’s work towards ending the HIV epidemic in the United States

Psihopaidas, Demetrios; Cohen, Stacy M.; West, Tanchica; Avery, Latham; Dempsey, Antigone; Brown, Kim; Heath, Corliss D.; Cajina, Adan; Phillips, Harold; Young, S. K.; Stubbs-Smith, April; Cheever, Laura W.

doi:10.1371/journal.pmed.1003128

Cited by 20 publications

(28 citation statements)

References 34 publications

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“…Having found in the Mapping Project a limited capacity for some HIV organizations to perform research and evaluation, such as that which might be needed to explore IS determinants, our model leverages the resources of these organizations by offering a menu of “emerging” stigma reduction interventions from which to choose given their local context. By elevating emerging interventions used in practice, we are in accordance with a recently published IS framework by the Health Resources and Services Administration that acknowledges that IS is an essential field across the HIV care continuum and expressly highlighted the importance of emerging practices as those that have “demonstrated real-world validity and effectiveness but have insufficient published evidence.” 16…”

Section: Discussionmentioning

confidence: 99%

Reducing Intersecting Stigmas in HIV Service Organizations: An Implementation Science Model

Rodriguez‐Hart

Mackson

Bélanger

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Discussionmentioning

confidence: 99%

Reducing Intersecting Stigmas in HIV Service Organizations: An Implementation Science Model

Rodriguez‐Hart

Mackson

Bélanger

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…In contrast to traditional QI approaches in which projects are implemented and evaluated at individual sites over a period of months, QICs feature more frequent performance measurement and smaller-scale tests of changes, enabling sites to test multiple interventions and share experiences with other participating facilities over an accelerated period of time. The accumulation of evidence-informed [ 33 ] interventions and performance improvements are significantly accelerated through QICs, leading to the compilation of a “change package” for use in scale-up activities. Since an overarching aim of NAMPROPA was to promote QI capacity-building, no facilities were assigned to serve as controls.…”

Section: Methodsmentioning

confidence: 99%

Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach

et al. 2022

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Background Hypertension (HTN) is highly prevalent among people with HIV (PWH) in Namibia, but screening and treatment for HTN are not routinely offered as part of HIV care delivery. We report the implementation of a quality improvement collaborative (QIC) to accelerate integration of HTN and HIV care within public-sector health facilities in Namibia. Methods Twenty-four facilities participated in the QIC with the aim of increasing HTN screening and treatment among adult PWH (>15 years). HTN was defined according to national treatment guidelines (i.e., systolic blood pressure >140 and/or diastolic blood pressure >90 across three measurements and at least two occasions), and decisions regarding initiation of treatment were made by physicians only. Teams from participating hospitals used quality improvement methods, monthly measurement of performance indicators, and small-scale tests of change to implement contextually tailored interventions. Coaching of sites was performed on a monthly basis by clinical officers with expertise in QI and HIV, and sites were convened as part of learning sessions to facilitate diffusion of effective interventions. Results Between March 2017 and March 2018, hypertension screening occurred as part of 183,043 (86%) clinical encounters at participating facilities. Among 1,759 PWH newly diagnosed with HTN, 992 (56%) were initiated on first-line treatment. Rates of treatment initiation were higher in facilities with an on-site physician (61%) compared to those without one (51%). During the QIC, facility teams identified fourteen interventions to improve HTN screening and treatment. Among barriers to implementation, teams pointed to malfunctions of blood pressure machines and stock outs of antihypertensive medications as common challenges. Conclusions Implementation of a QIC provided a structured approach for integrating HTN and HIV services across 24 high-volume facilities in Namibia. As rates of HTN treatment remained low despite ongoing facility-level changes, policy-level interventions—such as task sharing and supply chain strengthening—should be pursued to further improve delivery of HTN care among PWH beyond initial screening.

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“…Jurisdictions across the country are charged with developing community-engagement plans and implementing evidenced-based and/or promising interventions in order to improve HCC outcomes within highly HIV-impacted jurisdictions [ 7 , 8 , 9 , 10 ]. Implementation research is a useful approach that can be utilized to better understand the strengths and limitations of implementation strategies that are being used to improve access to HIV services, how they can be improved in real time, their mechanism of change, and within which context they operate to improve HCC outcomes for PLWH [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Examining the Implementation of Conditional Financial Incentives Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to Improve HIV Outcomes among Persons Living with HIV (PLWH) in Louisiana

Chrestman

Patel

Lass³

et al. 2022

IJERPH

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Economic strengthening interventions are needed to support HIV outcomes among persons living with HIV (PLWH). The Baton Rouge Positive Pathway Study (BRPPS), a mixed method implementation science study, was conducted to assess key RE-AIM components tied to the provision of conditional financial incentives among PLWH in Baton Rouge, Louisiana. Seven hundred and eighty-one (781) PLWH enrolled at four HIV clinic sites were included in the final analyses. Participants completed an initial baseline survey, viral load test, and were contacted at 6 and 12 months (±1 month) post-enrollment for follow-up labs to monitor viral load levels. Participants received up to USD140 in conditional financial incentives. The primary analyses assessed whether participation in the BRPPS was associated with an increase in the proportion of participants who were: (a) engaged in care, (b) retained in care and (c) virally suppressed at baseline to 6 and 12 months post-baseline. We constructed a longitudinal regression model where participant-level outcomes at times t0 (baseline) and t1 (6- or 12-month follow-up) were modeled as a function of time. A secondary analysis was conducted using single-level regression to examine which baseline characteristics were associated with the outcomes of interest at 12-month follow-up. Cost analyses were also conducted with three of the participating clinics. Most participants identified as Black/African American (89%). Fewer than half of participants reported that they were unemployed or made less than USD5000 annually (43%). Over time, the proportion of participants engaged in care and retained in care significantly increased (70% to 93% and 32% to 64%, p < 0.00). However, the proportion of virally suppressed participants decreased over time (59% to 34%, p < 0.00). Implementation costs across the three sites ranged from USD17,198.05 to USD396,910.00 and were associated with between 0.37 and 1.34 HIV transmissions averted at each site. Study findings provide promising evidence to suggest that conditional financial incentives could help support engagement and retention in HIV care for a high need and at risk for falling out of HIV care population.

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Implementation science and the Health Resources and Services Administration’s Ryan White HIV/AIDS Program’s work towards ending the HIV epidemic in the United States

Abstract: • Implementation science has emerged as an essential field for HIV treatment and prevention, promising to maximize the impact of effective intervention strategies to prevent transmission of the virus and to link and retain people with HIV in care.

Cited by 20 publications

References 34 publications

Reducing Intersecting Stigmas in HIV Service Organizations: An Implementation Science Model

Reducing Intersecting Stigmas in HIV Service Organizations: An Implementation Science Model

Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach

Examining the Implementation of Conditional Financial Incentives Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to Improve HIV Outcomes among Persons Living with HIV (PLWH) in Louisiana

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