دورية أكاديمية
Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an implementation science framework.
| العنوان: | Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an implementation science framework. |
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| المؤلفون: | Vanhamel J; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Reyniers T; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Vuylsteke B; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Callens S; Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium., Nöstlinger C; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Huis In 't Veld D; Department of General Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium., Kenyon C; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium., Van Praet J; Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium., Libois A; Department of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium., Vincent A; Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Brussels, Belgium., Demeester R; HIV Reference Centre, University Hospital of Charleroi, Charleroi, Belgium., Henrard S; HIV Reference Centre and Internal Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium., Messiaen P; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.; Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Hasselt, Belgium., Allard SD; Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium., Rotsaert A; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Kielmann K; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. |
| المصدر: | Journal of the International AIDS Society [J Int AIDS Soc] 2024 Jul; Vol. 27 Suppl 1, pp. e26260. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: John Wiley & Sons, Inc Country of Publication: Switzerland NLM ID: 101478566 Publication Model: Print Cited Medium: Internet ISSN: 1758-2652 (Electronic) Linking ISSN: 17582652 NLM ISO Abbreviation: J Int AIDS Soc Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2017- : Hoboken, NJ : John Wiley & Sons, Inc Original Publication: [London] : BioMed Central |
| مواضيع طبية MeSH: | Pre-Exposure Prophylaxis*/methods , HIV Infections*/drug therapy , HIV Infections*/prevention & control , Implementation Science*, Humans ; Belgium ; Male ; Female ; Interviews as Topic ; Anti-HIV Agents/therapeutic use ; Qualitative Research ; Health Personnel ; Adult ; Delivery of Health Care ; Ambulatory Care Facilities |
| مستخلص: | Introduction: In Belgium, oral HIV pre-exposure prophylaxis (PrEP) is primarily provided in specialized clinical settings. Optimal implementation of PrEP services can help to substantially reduce HIV transmission. However, insights into implementation processes, and their complex interactions with local context, are limited. This study examined factors that influence providers' adaptive responses in the implementation of PrEP services in Belgian HIV clinics. Methods: We conducted a qualitative multiple case study on PrEP care implementation in eight HIV clinics. Thirty-six semi-structured interviews were conducted between January 2021 and May 2022 with a purposive sample of PrEP care providers (e.g. physicians, nurses, psychologists), supplemented by 50 hours of observations of healthcare settings and clinical interactions. Field notes from observations and verbatim interview transcripts were thematically analysed guided by a refined iteration of extended Normalisation Process Theory. Results: Implementing PrEP care in a centralized service delivery system required considerable adaptive capacity of providers to balance the increasing workload with an adequate response to PrEP users' individual care needs. As a result, clinic structures were re-organized to allow for more efficient PrEP care processes, compatible with other clinic-level priorities. Providers adapted clinical and policy norms on PrEP care (e.g. related to PrEP prescribing practices and which providers can deliver PrEP services), to flexibly tailor care to individual clients' situations. Interprofessional relationships were reconfigured in line with organizational and clinical adaptations; these included task-shifting from physicians to nurses, leading them to become increasingly trained and specialized in PrEP care. As nurse involvement grew, they adopted a crucial role in responding to PrEP users' non-medical needs (e.g. providing psychosocial support). Moreover, clinicians' growing collaboration with sexologists and psychologists, and interactions with PrEP users' family physician, became crucial in addressing complex psychosocial needs of PrEP clients, while also alleviating the burden of care on busy HIV clinics. Conclusions: Our study in Belgian HIV clinics reveals that the implementation of PrEP care presents a complex-multifaceted-undertaking that requires substantial adaptive work to ensure seamless integration within existing health services. To optimize integration in different settings, policies and guidelines governing PrEP care implementation should allow for sufficient flexibility and tailoring according to respective local health systems. (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.) |
| References: | AIDS Behav. 2018 Nov;22(11):3681-3691. (PMID: 29872999) AIDS Behav. 2023 Nov;27(11):3755-3766. (PMID: 37351685) BMC Health Serv Res. 2019 Dec 5;19(1):938. (PMID: 31806010) Int J Health Policy Manag. 2017 Apr 04;6(8):431-435. (PMID: 28812842) Health Policy Plan. 2014 Dec;29 Suppl 3:iii51-69. (PMID: 25435536) Front Med (Lausanne). 2022 Mar 30;9:828695. (PMID: 35433734) Sex Health. 2022 Aug;19(4):329-335. (PMID: 35922116) PLoS Med. 2011 Aug;8(8):e1001073. (PMID: 21857809) Sex Health. 2018 Nov;15(6):522-527. (PMID: 30476461) JAMA Intern Med. 2020 Jan 1;180(1):126-130. (PMID: 31738380) AIDS. 2016 Jul 31;30(12):1973-83. (PMID: 27149090) J Prim Prev. 2013 Jun;34(3):147-61. (PMID: 23605294) Curr Opin HIV AIDS. 2022 Jul 1;17(4):173-178. (PMID: 35762370) Infection. 2016 Apr;44(2):151-8. (PMID: 26471511) JMIR Public Health Surveill. 2022 Jun 7;8(6):e37479. (PMID: 35486813) Front Public Health. 2018 Jul 06;6:188. (PMID: 30035106) J Acquir Immune Defic Syndr. 2022 Jul 1;90(S1):S235-S246. (PMID: 35703776) AIDS Behav. 2014 Sep;18(9):1712-21. (PMID: 24965676) Health Serv Res. 1999 Dec;34(5 Pt 2):1189-208. (PMID: 10591279) J Int AIDS Soc. 2023 Feb;26(2):e26055. (PMID: 36739603) AIDS Behav. 2024 Feb;28(2):393-407. (PMID: 38038778) AIDS Behav. 2022 May;26(5):1377-1392. (PMID: 34669062) Sex Health. 2022 Aug;19(4):346-356. (PMID: 35995430) Health Res Policy Syst. 2014 Apr 17;12:19. (PMID: 24739525) Health Policy Plan. 2021 Apr 21;36(3):249-259. (PMID: 33582787) PLoS One. 2015 May 15;10(5):e0126144. (PMID: 25978632) Sex Health. 2023 Aug;20(4):282-295. (PMID: 37603534) Implement Sci. 2022 Oct 29;17(1):75. (PMID: 36309746) AIDS Behav. 2023 Jul;27(7):2089-2102. (PMID: 36459263) Health Policy Plan. 2020 Oct 1;35(8):1084-1109. (PMID: 32529253) Lancet HIV. 2022 May;9(5):e363-e366. (PMID: 35358418) J Assoc Nurses AIDS Care. 2019 May-Jun;30(3):301-311. (PMID: 31008817) BMJ Open. 2020 Jun 16;10(6):e035272. (PMID: 32554739) Curr HIV/AIDS Rep. 2021 Dec;18(6):500-507. (PMID: 34708316) Am J Prev Med. 2016 Oct;51(4 Suppl 2):S124-31. (PMID: 27371105) Health Policy Plan. 2017 Nov 1;32(suppl_4):iv67-iv81. (PMID: 29194544) BMC Med. 2010 Oct 20;8:63. (PMID: 20961442) BMC Health Serv Res. 2020 Jul 31;20(1):704. (PMID: 32736626) Lancet HIV. 2020 Oct;7(10):e711-e720. (PMID: 33010243) Sex Health. 2018 Nov;15(6):595-597. (PMID: 30257752) PLoS One. 2022 Apr 5;17(4):e0266280. (PMID: 35381024) Clin Infect Dis. 2020 Dec 15;71(12):3152-3153. (PMID: 32097454) J Int AIDS Soc. 2023 Jul;26 Suppl 1:e26114. (PMID: 37408458) J Int AIDS Soc. 2021 Sep;24(9):e25799. (PMID: 34496148) Implement Sci. 2013 Feb 13;8:18. (PMID: 23406398) Implement Sci. 2016 Oct 19;11(1):141. (PMID: 27756414) |
| معلومات مُعتمدة: | S004919N Flemish Research Foundation as part of a Strategic Basic Research project (FWO-SBO) |
| فهرسة مساهمة: | Keywords: HIV; delivery of healthcare; implementation science; pre‐exposure prophylaxis; public health systems research; qualitative research |
| المشرفين على المادة: | 0 (Anti-HIV Agents) |
| تواريخ الأحداث: | Date Created: 20240705 Date Completed: 20240705 Latest Revision: 20240707 |
| رمز التحديث: | 20240707 |
| مُعرف محوري في PubMed: | PMC11224588 |
| DOI: | 10.1002/jia2.26260 |
| PMID: | 38965986 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1758-2652 |
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| DOI: | 10.1002/jia2.26260 |