Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia

Wood, Sarah; Meanley, Steven; Bonett, Stephen; Torres, Mary Evelyn; Watson, Dovie L; Williams, Javontae; Brady, Kathleen A.; Bauermeister, José A.

doi:10.1097/qai.0000000000002969

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…Increasingly, implementation science (IS) is being used to aid in the planning and successful delivery of complex evidence-based interventions and their adoption among PWID in the US and abroad. Prior MOUD and harm reduction research has examined implementation facilitators and barriers within the organizational healthcare and social service systems [24][25][26][27][28][29][30][31][32], workforce capacity [33], financing, and policy contexts [34,35]. In the context of HIV and substance use, IS frameworks and methods have been leveraged in the US to articulate organization and patient perspectives of harm reduction interventions for PWID with HIV [36], improve the success of HIV prevention interventions by accounting for the unique injection contexts on HIV risk behaviors among PWID [37], and help to expand harm reduction interventions via pharmacy services directed to PWID [38].…”

Section: Introductionmentioning

confidence: 99%

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Smith,

Perez-Brumer,

Nicholls

et al. 2024

Implementation Sci

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Background HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. Methods We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. Results Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. Conclusions Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. Trial registration ClincalTrials.gov, Registration Number: NCT04804072. Registered 18 February 2021.

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Section: Introductionmentioning

confidence: 99%

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Smith,

Perez-Brumer,

Nicholls

et al. 2024

Implementation Sci

View full text Add to dashboard Cite

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Factors influencing implementation of a care coordination intervention for cancer survivors with multiple comorbidities in a safety-net system: an application of the Implementation Research Logic Model

Rodriguez,

Lee,

Higashi

et al. 2023

Implementation Sci

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Background Under- and uninsured cancer survivors have significant medical, social, and economic complexity. For these survivors, effective care coordination between oncology and primary care teams is critical for high-quality, comprehensive care. While evidence-based interventions exist to improve coordination between healthcare teams, testing implementation of these interventions for cancer survivors seen in real-world safety-net settings has been limited. This study aimed to (1) identify factors influencing implementation of a multicomponent care coordination intervention (nurse coordinator plus patient registry) focused on cancer survivors with multiple comorbidities in an integrated safety-net system and (2) identify mechanisms through which the factors impacted implementation outcomes. Methods We conducted semi-structured interviews (patients, providers, and system leaders), structured observations of primary care and oncology operations, and document analysis during intervention implementation between 2016 and 2020. The practice change model (PCM) guided data collection to identify barriers and facilitators of implementation; the PCM, Consolidated Framework for Implementation Research, and Implementation Research Logic Model guided four immersion/crystallization data analysis and synthesis cycles to identify mechanisms and assess outcomes. Implementation outcomes included appropriateness, acceptability, adoption, and penetration. Results The intervention was appropriate and acceptable to primary care and oncology teams based on reported patient needs and resources and the strength of the evidence supporting intervention components. Active and sustained partnership with system leaders facilitated these outcomes. There was limited adoption and penetration early in implementation because the study was narrowly focused on just breast and colorectal cancer patients. This created barriers to real-world practice where patients with all cancer types receive care. Over time, flexibility intentionally designed into intervention implementation facilitated adoption and penetration. Regular feedback from system partners and rapid cycles of implementation and evaluation led to real-time adaptations increasing adoption and penetration. Discussion Evidence-based interventions to coordinate care for underserved cancer survivors across oncology and primary care teams can be implemented successfully when system leaders are actively engaged and with flexibility in implementation embedded intentionally to continuously facilitate adoption and penetration across the health system.

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Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia

Cited by 2 publications

References 16 publications

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Factors influencing implementation of a care coordination intervention for cancer survivors with multiple comorbidities in a safety-net system: an application of the Implementation Research Logic Model

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