Exploring the Impact of Organizational Readiness and Inner Setting on Implementation of HIV Programming in South African Health Clinics

探索组织准备情况和内部环境对南非卫生诊所实施艾滋病规划的影响

• 批准号: 10245282
• 负责人: Sheri Ann Lippman
• 金额: $ 22.13万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-21 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10245282
• 关键词: AIDS prevention; Address; Affect; Area; Behavior Therapy; Belief; Caring; Characteristics; Clinic; Clinical; Clinical Data; Cluster randomized trial; Collaborations; Communities; Complex; Consolidated Framework for Implementation Research; Consultations; Country; Data Collection; Databases; Development; Disease Management; Elements; Ensure; Environment; Evidence based intervention; Feedback; Future; Guidelines; HIV; Health; Health care facility; Health system; Human Resources; Incidence; Institutes; Intervention; Interview; Investments; Lead; Light; Measures; Monitor; Organizational Culture; Patients; Performance; Pharmaceutical Preparations; Policies; Postdoctoral Fellow; Primary Health Care; Process; Protocols documentation; Provider; Readiness; Research; Research Personnel; Resources; Self Efficacy; Services; Shapes; Site; South Africa; South African; Specific qualifier value; Translating; Translations; United States National Institutes of Health; Variant; Work; aging population; antiretroviral therapy; base; burden of illness; care delivery; clinical care; clinical practice; cognitive interview; contextual factors; efficacious intervention; evidence base; experience; implementation determinants; implementation framework; implementation science; improved; innovation; meetings; member; multidisciplinary; organizational readiness; primary care setting; programs; skills; success; theories; tool; uptake

PROJECT SUMMARY/ABSTRACT In South Africa there are more people on treatment for HIV than ever before, placing a growing burden on health systems. While strategies for effective disease management exist for those who engage in care for HIV, the challenge of implementing best-practice at scale in the context of increasingly complex care remains. Implementation science (IS) seeks to bridge the gap between research and practice to ensure that efficacious interventions translate into effective implementation at scale. The theory of Organizational Readiness for Change (ORC) is an IS theory that posits that organizational members' shared resolve to implement a change (change commitment) and shared belief in their collective capability to do so (change efficacy) impacts successful program uptake. The Consolidated Framework for Implementation Research (CFIR), an IS framework, specifies elements in the facility inner setting that affect change commitment and efficacy. We propose to adapt scales assessing of ORC and of CFIR inner setting to the South African context to better measure the factors that should be addressed for successful translation of evidence-based interventions into clinical practice, specifically focusing on HIV, in order to close the gap towards optimized delivery of health programs in high disease burden settings. Specifically, we will use cognitive interviewing and expert consultations to culturally adapt measures of organizational readiness for implementing change (ORIC) and inner setting (CFIR) that have been developed in Western contexts (Aim 1). We will then implement the refined measures with 168 providers and 14 clinic managers in 14 South African primary care facilities in KwaZulu Natal (KZN), South Africa (Aim 2). We will assess which elements of ORC and CFIR are associated with successful implementation of a) new HIV treatment initiation and ART guidelines, and b) national decongestion programming for expedited care and medication dispensing for stable HIV patients. Results will be shared in a feedback process with experts, providers and clinic managers to validate findings. This developmental, exploratory R21 leverages an experienced research site, an established collaboration, and a multidisciplinary team of South African and US investigators to address the NIH priority of advancing research on factors associated with the successful implementation of evidence-based interventions and guidelines. This proposal can lead to targeted interventions advancing HIV program implementation and integrated care in primary care settings in high disease burden areas where scaled programming is vital.

项目概要/摘要 在南非，接受艾滋病毒治疗的人数比以往任何时候都多，这给人们带来了越来越大的负担 卫生系统。虽然针对艾滋病毒护理人员存在有效的疾病管理策略， 在日益复杂的护理背景下大规模实施最佳实践的挑战仍然存在。 实施科学（IS）旨在弥合研究与实践之间的差距，以确保有效 干预措施转化为大规模的有效实施。组织准备理论 变革 (ORC) 是一种 IS 理论，它假定组织成员实施变革的共同决心 （变革承诺）和对其集体能力的共同信念（变革效力）影响 成功的计划吸收。实施研究综合框架 (CFIR)，一个 IS 框架，指定设施内部环境中影响变革承诺和功效的要素。我们 建议根据南非的情况调整 ORC 和 CFIR 内部环境的量表评估，以更好地 衡量将循证干预措施成功转化为应解决的因素 临床实践，特别关注艾滋病毒，以缩小优化卫生服务的差距 高疾病负担环境中的计划。具体来说，我们将使用认知访谈和专家 进行磋商，以在文化上调整实施变革的组织准备措施（ORIC）和 在西方背景下发展起来的内部环境（CFIR）（目标 1）。然后我们将实施细化的 夸祖鲁 14 个南非初级保健机构的 168 名提供者和 14 名诊所经理采取了措施 南非纳塔尔 (KZN)（目标 2）。我们将评估 ORC 和 CFIR 的哪些元素与 成功实施 a) 新的艾滋病毒治疗启动和 ART 指南，以及 b) 全国缓解拥堵 为稳定的艾滋病毒患者提供快速护理和药物配发的规划。结果将在 与专家、提供者和诊所经理进行反馈流程以验证结果。这种发展， 探索性 R21 利用经验丰富的研究基地、既定的合作和多学科 南非和美国研究人员组成的团队致力于解决 NIH 推进因素研究的优先事项 与成功实施循证干预措施和指南有关。这个提议 可以导致有针对性的干预措施，推进艾滋病毒项目的实施和初级保健中的综合护理 在疾病负担高的地区，大规模规划至关重要。