Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in...
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Transcript of Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in...
Jessie Mbwambo, Jessie Mbwambo, Muhimbili Muhimbili National Hospital (MNH) and National Hospital (MNH) and
Muhimbili University of Health and Muhimbili University of Health and Allied Sciences (MUHAS)Allied Sciences (MUHAS)
What is Implementation Sciences
What is the value of Implementation Science
Background to the Injection Drug Use in the region
Implementation science for injection drug users—The case study of a methadone treatment program
Research questions for Implementation Sciences for Injection Drug Users
Presentation format
IS is the study of approaches to translate
effective interventions into health care policy and practice.
IS draws from a variety of different research disciplines including epidemiology, biostatistics, anthropology, sociology, health policy, health economics, management sciences, mathematical modeling, community engagement and ethics.
Using these methodologies with HIV programs, IS identifies, develops and measures the impact of innovative strategies to improve HIV service delivery, thereby strengthening the global AIDS response.
Definition of Implementation Sciences
(IS)
Framework for IS
IS Framework 1
To begin addressing IS questions, a clear understanding of the gaps in HIV for KP programs must be developed.
Establish and strengthen M&E and surveillance systems that facilitate identification of bottlenecks, gaps and missed opportunities in KP program delivery .
IS Framework 2
Effective translation of evidence into practice via relationships and activities between communities that facilitate the delivery of health services and health interventions
Deciding where change(s) must be targeted
among the components of health care system and what are the best approaches for inducing change, whether organizational, social or individual levels.
Formulating new approaches where teams should consider the context of the linkages, interactions, relationships and behaviors of the components of the system of health care under investigation .
Development of strategies and approaches that can be translated to other settings allowing for local adaptation as appropriate.
IS Framework#2
IS Framework 3
Engaging researchers who have experience in developing studies to answer IS questions critical
Research personelle to be familiar to using multiple methodologies to answer questions
Using cost data and analysis of data to understand the relative efficiency of different approaches by measuring and comparing the costs and consequences of different strategies.
IS Framework 4
Success of IS initiatives is when research findings are used to improve programs and tailor policies when lessons have been learned.
IS initiatives should include a plan for how to achieve this with understanding that the approach will change along the way.
Considerations of how to address a programmatic gap or measure that impact the new strategy
Approaches used to accomplish these
goals will vary from situation to situation.
understanding what ways the results from a particular initiative should be utilized – including polices at a national, regional or global level is critical
strategic planning within service delivery systems (i.e., clinics or hospitals) or program strategies among community-based organizations – should also be understood.
IS framework 4……….
Value of Implementation
Science
Globally 151 countries have reported presence of Injection Drug Use
15.9 million people inject drugs 3million of those are HIV infected No population estimates in many
countries of SSA HIV reported in many small scale studies In Tanzania using snow ball format rates
between 42-51% among PWID Constellation of multiple risky
behaviours possibly crossing into general reported in Kenya, cannot be different elsewhere
Injecting drug users and HIV
Program entitled “Reducing
HIV/AIDS transmission in people who inject drugs their sexual and injecting networks in Dar es Salaam, Tanzania”
Started 2009 through Cooperative Agreement to MUHAS from CDC with funding from the PEPFAR
Prevention of HIV among PWIDS in Dar es
Salaam
TAPP at the forefront of efforts in sub-Saharan Africa to address HIV transmission among people who inject drugs and their social networks.
Used a combination approach to HIV prevention for PWIDs TAPP created an outreach program with
Tanzanian non-governmental organizations (NGOs) that uses a variety of community-based, clinical and state level interventions to address different levels of vulnerability
Prevention#2
Injection drug users programing at MUHAS
Used program data to raise
questions: TB screening and diagnosis: Active Case Finding for
Tuberculosis among People Who Inject Drugs on Methadone Treatment in Dar es Salaam, Tanzania
Where do we loose women in the cascade to MAT: Understanding Barriers to Methadone Assisted Therapy Among Female Heroin Users in Dar es Salaam, Tanzania
Who are the defaulters when using methadone: Methadone Dose, Age and History of Abuse Impact Clients’ Risk of Defaulting from Methadone Treatment in Dar es Salaam, Tanzania
Identify programmatic gaps
Inequities in health care delivery: Methadone
Treatment for HIV Prevention-Feasibility, Retention and Predictors of Defaulting in Dar es Salaam, Tanzania: A Retrospective Cohort Study
What is the quality of life of those on methadone: Quality of life among people who inject drugs attending Muhimbili Methadone Clinic in Dar-es-Salaam
How to maximize utilization at MAT to prevent HIV: Providing Medication Assisted Treatment (MAT) as an HIV Prevention Intervention: Programmatic Strategies to Maximize Service Utilization in Dar es Salaam, Tanzania
Identifying program gaps 2
TB screening and diagnosis: Use
GeneXpert gives real time results can even work with low quantity of microbes in sputum and results within short time
Where do we loose women in the cascade to MAT: Night time community out reach work and economic empowerment
Who are the defaulters when using methadone: Young people give “older peers” as treatment supporters; people on low doses have doses increased
Developing and implementing strategies
IS 3: Measuring effectiveness
and efficiency Young program not yet there
IS 4: Utilizing information Young program not yet there
IS 3 and IS 4
Research Gaps
Integrated Bio Behavioural Surveys (IBBS) needed to have a denominator for the 50% needed for interventions done to make it possible for turning the tide of the HIV epidemic among PWIDs
What cadres and quantities of human resource for health are required for implementing comprehensive services for PWIDs
Evaluation of interventions as is outlined a main option Pre and post test utilization designs (depends on
corrections of previous observations) Mental and social outcomes for PWIDS in and not
in treatment