Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya
Abstract Background Children and adolescents living with HIV have poorer rates of HIV testing, treatment, and virologic suppression than adults. Strategies that use a systems approach to optimize these multiple, linked steps simultaneously are critical to close these gaps. Methods The Systems Analys...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-022-00304-3 |
| _version_ | 1818198133441560576 |
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| author | Kristin Beima-Sofie Anjuli D. Wagner Caroline Soi Wenjia Liu Deanna Tollefson Irene N. Njuguna Emily Ogutu Douglas Gaitho Nancy Mburu Geoffrey Oluoch Peter Mwaura Peter Cherutich Laura Oyiengo Grace C. John-Stewart Ruth Nduati Kenneth Sherr Sarah Gimbel |
| author_facet | Kristin Beima-Sofie Anjuli D. Wagner Caroline Soi Wenjia Liu Deanna Tollefson Irene N. Njuguna Emily Ogutu Douglas Gaitho Nancy Mburu Geoffrey Oluoch Peter Mwaura Peter Cherutich Laura Oyiengo Grace C. John-Stewart Ruth Nduati Kenneth Sherr Sarah Gimbel |
| author_sort | Kristin Beima-Sofie |
| collection | DOAJ |
| description | Abstract Background Children and adolescents living with HIV have poorer rates of HIV testing, treatment, and virologic suppression than adults. Strategies that use a systems approach to optimize these multiple, linked steps simultaneously are critical to close these gaps. Methods The Systems Analysis and Improvement Approach (SAIA) was adapted and piloted for the pediatric and adolescent HIV care and treatment cascade (SAIA-PEDS) at 6 facilities in Kenya. SAIA-PEDS includes three tools: continuous quality improvement (CQI), flow mapping, and pediatric cascade analysis (PedCAT). A predominately qualitative evaluation utilizing focus group discussions (N = 6) and in-depth interviews (N = 19) was conducted with healthcare workers after implementation to identify determinants of implementation. Data collection and analysis were grounded in the Consolidated Framework for Implementation Research (CFIR). Results Overall, the adapted SAIA-PEDS strategy was acceptable, and the three tools complemented one another and provided a relative advantage over existing processes. The flow mapping and CQI tools were compatible with existing workflows and resonated with team priorities and goals while providing a structure for group problem solving that transcended a single department’s focus. The PedCAT was overly complex, making it difficult to use. Leadership and hierarchy were complex determinants. All teams reported supportive leadership, with some describing in detail how their leadership was engaged and enthusiastic about the SAIA-PEDS process, by providing recognition, time, and resources. Hierarchy was similarly complex: in some facilities, leadership stifled rapid innovation by insisting on approving each change, while at other facilities, leadership had strong and supportive oversight of processes, checking on the progress frequently and empowering teams to test innovative ideas. Conclusion CQI and flow mapping were core components of SAIA-PEDS, with high acceptability and consistent use, but the PedCAT was too complex. Leadership and hierarchy had a nuanced role in implementation. Future SAIA-PEDS testing should address PedCAT complexity and further explore the modifiability of leadership engagement to maximize implementation. |
| first_indexed | 2024-12-12T02:01:01Z |
| format | Article |
| id | doaj.art-53602cf5e62d430ca9db0304b079a603 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-12T02:01:01Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-53602cf5e62d430ca9db0304b079a6032022-12-22T00:42:11ZengBMCImplementation Science Communications2662-22112022-07-013111310.1186/s43058-022-00304-3Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in KenyaKristin Beima-Sofie0Anjuli D. Wagner1Caroline Soi2Wenjia Liu3Deanna Tollefson4Irene N. Njuguna5Emily Ogutu6Douglas Gaitho7Nancy Mburu8Geoffrey Oluoch9Peter Mwaura10Peter Cherutich11Laura Oyiengo12Grace C. John-Stewart13Ruth Nduati14Kenneth Sherr15Sarah Gimbel16Department of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Child, Family & Population Health Nursing, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonGangarosa Department of Environmental Health, Emory UniversityNetwork of AIDS Researchers in Eastern and Southern AfricaNetwork of AIDS Researchers in Eastern and Southern AfricaNetwork of AIDS Researchers in Eastern and Southern AfricaNetwork of AIDS Researchers in Eastern and Southern AfricaMinistry of HealthMinistry of HealthDepartment of Global Health, University of WashingtonNetwork of AIDS Researchers in Eastern and Southern AfricaDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonAbstract Background Children and adolescents living with HIV have poorer rates of HIV testing, treatment, and virologic suppression than adults. Strategies that use a systems approach to optimize these multiple, linked steps simultaneously are critical to close these gaps. Methods The Systems Analysis and Improvement Approach (SAIA) was adapted and piloted for the pediatric and adolescent HIV care and treatment cascade (SAIA-PEDS) at 6 facilities in Kenya. SAIA-PEDS includes three tools: continuous quality improvement (CQI), flow mapping, and pediatric cascade analysis (PedCAT). A predominately qualitative evaluation utilizing focus group discussions (N = 6) and in-depth interviews (N = 19) was conducted with healthcare workers after implementation to identify determinants of implementation. Data collection and analysis were grounded in the Consolidated Framework for Implementation Research (CFIR). Results Overall, the adapted SAIA-PEDS strategy was acceptable, and the three tools complemented one another and provided a relative advantage over existing processes. The flow mapping and CQI tools were compatible with existing workflows and resonated with team priorities and goals while providing a structure for group problem solving that transcended a single department’s focus. The PedCAT was overly complex, making it difficult to use. Leadership and hierarchy were complex determinants. All teams reported supportive leadership, with some describing in detail how their leadership was engaged and enthusiastic about the SAIA-PEDS process, by providing recognition, time, and resources. Hierarchy was similarly complex: in some facilities, leadership stifled rapid innovation by insisting on approving each change, while at other facilities, leadership had strong and supportive oversight of processes, checking on the progress frequently and empowering teams to test innovative ideas. Conclusion CQI and flow mapping were core components of SAIA-PEDS, with high acceptability and consistent use, but the PedCAT was too complex. Leadership and hierarchy had a nuanced role in implementation. Future SAIA-PEDS testing should address PedCAT complexity and further explore the modifiability of leadership engagement to maximize implementation.https://doi.org/10.1186/s43058-022-00304-3Consolidated framework for implementation research (CFIR)Implementation determinantsPediatricAdolescentHIVHealth systems |
| spellingShingle | Kristin Beima-Sofie Anjuli D. Wagner Caroline Soi Wenjia Liu Deanna Tollefson Irene N. Njuguna Emily Ogutu Douglas Gaitho Nancy Mburu Geoffrey Oluoch Peter Mwaura Peter Cherutich Laura Oyiengo Grace C. John-Stewart Ruth Nduati Kenneth Sherr Sarah Gimbel Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya Implementation Science Communications Consolidated framework for implementation research (CFIR) Implementation determinants Pediatric Adolescent HIV Health systems |
| title | Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya |
| title_full | Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya |
| title_fullStr | Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya |
| title_full_unstemmed | Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya |
| title_short | Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya |
| title_sort | providing a beam of light to see the gaps determinants of implementation of the systems analysis and improvement approach applied to the pediatric and adolescent hiv cascade in kenya |
| topic | Consolidated framework for implementation research (CFIR) Implementation determinants Pediatric Adolescent HIV Health systems |
| url | https://doi.org/10.1186/s43058-022-00304-3 |
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