Dataset Information

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 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.

SUBMITTER: Beima-Sofie K

PROVIDER: S-EPMC9287987 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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.

Beima-Sofie Kristin K Wagner Anjuli D AD Soi Caroline C Liu Wenjia W Tollefson Deanna D Njuguna Irene N IN Ogutu Emily E Gaitho Douglas D Mburu Nancy N Oluoch Geoffrey G Mwaura Peter P Cherutich Peter P Oyiengo Laura L John-Stewart Grace C GC Nduati Ruth R Sherr Kenneth K Gimbel Sarah S

Implementation science communications 20220716 1

<h4>Background</h4>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.<h4>Methods</h4>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: c ...[more]

PMID: 35842734

Similar Datasets

Project description:BackgroundAdolescent fertility in Kenya is vital in the development and execution of reproductive health policies and programs. One of the specific objectives of the Kenyan Adolescent Sexual Reproductive Health (ASRH) policy developed in 2015 is to decrease early and unintended pregnancies in an attempt to reduce adolescent fertility. We aimed to establish determinants of adolescent fertility in Kenya.MethodsThe Kenya Demographic and Health Survey (KDHS) 2014 data set was utilized. Adolescent's number of children ever born was the dependent variable. The Chi-square test was utilized to determine the relationship between dependent and independent variables. A Proportional-odds model was performed to establish determinants of adolescent fertility at a 5% significance level.ResultsOver 40% of the adolescent girls who had sex below 17 years had given birth i.e, current age 15-17 years (40.9%) and <15 years (44.9%) had given birth. In addition, 70.7% of the married adolescents had given birth compared to 8.1% of the unmarried adolescents. Moreover, 65.1% of the adolescents who were using contraceptives had given birth compared to only 9% of the adolescents who were not using a contraceptive. Approximately 29.4% of the adolescents who had no education had given birth compared to 9.1% who had attained secondary education. Age at first sex (18-19 years: OR: 0.221, 95% CI: 0.124-0.392; 15-17 years: OR: 0.530, 95% CI: 0.379-0.742), current age (18-19 years: OR: 4.727, 95% CI: 3.318-6.733), current marital status (Not married: OR:0.212, 95% CI: 0.150-4.780), and current contraceptive use (Using: OR 3.138, 95% CI: 2.257-4.362) were associated with adolescent fertility.ConclusionThe study established that age at first sex, current age, marital status, and contraceptive use are the main determinants of adolescent childbearing. The stated determinants should be targeted by the government to control the adolescent birth rate in Kenya. Consequently, delaying the age at first sex, discouraging adolescent marriage, and increasing secondary school enrollment among adolescent girls are recommended strategies to control adolescent fertility in Kenya.

Project description:Microelectrode material and cell culture medium have significant roles in the signal-to-noise ratio and cell well-being in in vitro electrophysiological studies. Here, we report an ion beam assisted e-beam deposition (IBAD) based process as an alternative titanium nitride (TiN) deposition method for sputtering in the fabrication of state-of-the-art TiN microelectrode arrays (MEAs). The effects of evaporation and nitrogen flow rates were evaluated while developing the IBAD TiN deposition process. Moreover, the produced IBAD TiN microelectrodes were characterized by impedance, charge transfer capacity (CTC) and noise measurements for electrical properties, AFM and SEM for topological imaging, and EDS for material composition. The impedance (at 1 kHz) of brand new 30 μm IBAD TiN microelectrodes was found to be double but still below 100 kΩ compared with commercial reference MEAs with sputtered TiN microelectrodes of the same size. On the contrary, the noise level of IBAD TiN MEAs was lower compared with that of commercial sputtered TiN MEAs in equal conditions. In CTC IBAD TiN electrodes (3.3 mC/cm2) also outperformed the sputtered counterparts (2.0 mC/cm2). To verify the suitability of IBAD TiN microelectrodes for cell measurements, human pluripotent stem cell (hPSC)-derived neuronal networks were cultured on IBAD TiN MEAs and commercial sputtered TiN MEAs in two different media: neural differentiation medium (NDM) and BrainPhys (BPH). The effect of cell culture media to hPSC derived neuronal networks was evaluated to gain more stable and more active networks. Higher spontaneous activity levels were measured from the neuronal networks cultured in BPH compared with those in NDM in both MEA types. However, BPH caused more problems in cell survival in long-term cultures by inducing neuronal network retraction and clump formation after 1-2 weeks. In addition, BPH was found to corrode the Si3N4 insulator layer more than NDM medium. The developed IBAD TiN process gives MEA manufacturers more choices to choose which method to use to deposit TiN electrodes and the medium evaluation results remind that not only electrode material but also insulator layer and cell culturing medium have crucial role in successful long term MEA measurements.

Project description:BackgroundHypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade.ObjectiveThis scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade.MethodsThe method of this scoping review has been guided by the framework by Arksey and O'Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management.ResultsA total of 128 studies were included, with 42.2% (54/128) conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care, 63 (49.2%) focused on diabetes care, and only 18 (14.1%) reported on the care of both diseases. The majority (96/128, 75.0%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4% vs 52/128, 40.6%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings.ConclusionsThis review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes.

Dataset Information

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.

Background

Methods

Results

Conclusion

Publications

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.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets