Implementation and evaluation of a large-scale postpartum family planning program in Rwanda

卢旺达大规模产后计划生育方案的实施和评估

基本信息

批准号：
10211298
负责人：
Kristin Marie Wall
金额：
$ 59.27万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10211298
关键词：
Academic advising Address Adoption Africa Area Birth Intervals Breast Feeding Capital Chicago Child Cities Client Client satisfaction Clinic Communities Community Health Aides Consolidated Framework for Implementation Research Contraceptive Usage Contraceptive methods Cost Savings Cost utility Counseling Country Couples Data Decision Making Diffusion Effectiveness Evaluation Family Planning Family Planning Programs Goals Government Health Health care facility Implant Intervention Interview Intrauterine Devices Maintenance Maternal Health Maternal Mortality Measures Methods Modeling Morbidity - disease rate National Institute of Child Health and Human Development Neonatal Mortality Newborn Infant Nurses Outcome Patients Play Postpartum Period Postpartum Women Pregnancy Pregnant Women Prevention Professional counselor Provider Randomized Research Rwanda Savings Services Testing Woman Women&apos s Health Work World Health Organization Zambia abortion acceptability and feasibility base comparison intervention cost cost effective cost effectiveness cost estimate design effectiveness evaluation effectiveness implementation study experience implementation cost implementation framework implementation process improved incremental cost-effectiveness innovation low and middle-income countries mortality neonatal health novel organizational readiness programs promoter randomized trial reversible contraceptive side effect social standard of care theories tool unintended pregnancy uptake

项目摘要

PROJECT SUMMARY In 2017-2018, we worked closely with the Rwanda Ministry of Health (MOH) to develop and pilot test a theory- based, multi-level intervention targeting postpartum family planning (PPFP) supply and demand in 5 government health facilities in Kigali, the capital. This innovative PPFP intervention is known as `C4' because it is informed by Clients, Clinic providers, Champions, and Community Health Workers. Long-acting reversible contraceptives (LARC), the intrauterine device (PPIUD) and implant, are fundamental to PPFP programs. LARCs are highly effective and are the only reversible methods that may be safely used in early postpartum period by breastfeeding women. During our pilot, LARC uptake among postpartum women increased significantly (172% for PP implant, 2,687% for PPIUD), PPFP feasibility and acceptability were high among providers and clients, and side-effects were rare. We now propose to use an implementation science framework to evaluate the effectiveness of different PPFP demand creation strategies and test the hypothesis that C4 is adaptable to large-scale implementation, cost-effective, and sustainable. In a Type 2 effectiveness- implementation hybrid study, we will evaluate facility organizational readiness prior to implementing C4 in a clinic randomized trial in 12 high-volume health facilities in Kigali, Rwanda (Aim 1). Adaptability and sustainability within government facilities is a critical aspect of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver C4 PPFP counseling to over 21,000 women/couples during the project period. We will then evaluate C4 effectiveness and implementation processes using RE-AIM (Aim 2). We hypothesize that C4 will significantly increase the number of stakeholders engaged, PPFP providers and promoters, couples/clients receiving information about PPFP (reach), and LARC uptake (effectiveness) comparing intervention versus standard of care. We expect PPFP client satisfaction will be high and side-effects will be rare. The independent effectiveness of each demand creation strategy on LARC uptake will be estimated. We assess measures of C4 adoption, implementation, and maintenance at the patient-, provider- and stakeholder-level to assess C4 sustainability. Finally, we will evaluate C4 cost-effectiveness and develop a national costed implementation plan to guide Rwandan MOH decision-making for nationwide roll-out of PPFP services (Aim 3). We hypothesize that C4 will be cost-saving relative to standard of care. C4 represents an important contribution to the Rwanda Family Planning 2020 goals and the MOH are enthusiastic to see our successful pilot efforts expanded to a larger number of facilities for greater and sustained impact. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have high unmet need for PPFP.

项目概要 2017-2018 年，我们与卢旺达卫生部 (MOH) 密切合作，开发并试点测试了以下理论：针对产后计划生育 (PPFP) 供需的多层次干预 5 首都基加利的政府医疗机构。这种创新的 PPFP 干预措施被称为“C4”，因为它由客户、诊所提供者、倡导者和社区卫生工作者告知。长效可逆避孕药具 (LARC)、宫内节育器 (PPIUD) 和植入物是 PPFP 计划的基础。 LARC 非常有效，是唯一可以在产后早期安全使用的可逆方法哺乳期妇女。在我们的试点期间，产后妇女对 LARC 的使用有所增加显着（PP 种植体为 172%，PPIUD 为 2,687%），PPFP 的可行性和可接受性很高提供者和客户，并且副作用很少见。我们现在建议使用实施科学框架评估不同 PPFP 需求创造策略的有效性并检验 C4 的假设适应大规模实施、成本效益高、可持续。在 2 类有效性中—— 实施混合研究，我们将在实施 C4 之前评估设施组织准备情况在卢旺达基加利 12 个大容量卫生机构进行的临床随机试验（目标 1）。适应性和政府设施内的可持续性是我们提案的一个重要方面，卫生部和其他地方利益相关者将从一开始就参与其中。我们预计为超过 21,000 人提供 C4 PPFP 咨询项目期间的妇女/夫妇。然后我们将评估 C4 的有效性和实施情况使用 RE-AIM（目标 2）进行处理。我们假设 C4 将显着增加参与的利益相关者、PPFP 提供者和推动者、接收有关 PPFP 信息的夫妇/客户（达到）和 LARC 吸收（有效性）比较干预与标准护理。我们预计 PPFP 客户满意度会很高，副作用也会很少。每个需求的独立有效性将估计 LARC 吸收的创建策略。我们评估 C4 采用、实施和实施的措施在患者、提供者和利益相关者层面进行维护，以评估 C4 的可持续性。最后，我们将评估 C4 成本效益并制定国家成本实施计划以指导卢旺达卫生部制定在全国范围内推广 PPFP 服务的决策（目标 3）。我们假设 C4 将节省成本相对于护理标准。 C4 代表了对卢旺达 2020 年计划生育的重要贡献目标和卫生部很高兴看到我们成功的试点工作扩展到更多的设施以获得更大和持续的影响。我们的 PPFP 实施模型旨在可复制和可扩展该地区其他国家同样对 PPFP 的需求未得到满足。