Abstract
IntroductionAdolescent HIV prevention and treatment is a high priority for youth healthcare in sub-Saharan Africa.MethodsThis study employed concept mapping to identify factors that impact the implementation of HIV prevention and intervention programs for adolescents in sub-Saharan Africa. Key stakeholders including researchers, policymakers, and non-governmental organization (NGO) personnel constituting membership of the NIH-sponsored Adolescent HIV Prevention and Treatment Implementation Science Alliance responded to the question: “In your experience, what factors have facilitated or hindered implementation of evidence-based HIV prevention or treatment for adolescents in sub-Saharan Africa?” Participants generated statements in response to the focus question, sorted them into thematically relevant groups, and rated each statement on its importance and changeability.ResultsThrough data analyses and participant feedback, 15 distinct themes were derived. “Workforce/Workflow” and “HIV Stigma and Adolescent Development” were rated highest for importance, and “Threshold Conditions for Treatment” and “Structure of Implementation Efforts” were rated most changeable.ConclusionsUnderstanding implementation science determinants and mechanisms can facilitate the uptake of successful implementation and sustainment strategies for the prevention and treatment of HIV in a given context. We placed determinants and mechanisms within the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to provide greater contextual integration with broader theories in implementation science. Implementers across multiple disciplines can use these findings to improve the scale-up of evidence-based practices for adolescent HIV prevention and treatment in sub-Saharan Africa. Implementation approaches that consider the determinants and mechanisms identified in this study and integrated in implementation frameworks will likely have utility for other health conditions and contexts.
Highlights
Adolescent Human immunodeficiency virus (HIV) prevention and treatment is a high priority for youth healthcare in sub-Saharan Africa
Understanding implementation science determinants and mechanisms can facilitate the uptake of successful implementation and sustainment strategies for the prevention and treatment of HIV in a given context
Implementers across multiple disciplines can use these findings to improve the scale-up of evidence-based practices for adolescent HIV prevention and treatment in sub-Saharan Africa
Summary
Adolescent HIV prevention and treatment is a high priority for youth healthcare in sub-Saharan Africa. Implementation and sustainment of evidence-based practices (EBPs) is a challenge, even for established and relatively well-funded healthcare systems in high-income countries. Implementation of EBPs in low- and middleincome countries presents challenges that may be common across settings (e.g., poor healthcare financing and limited human resources), but unique with respect to the disease being addressed, the country or region of implementation, and the target population. The challenges of implementing EBPs for adolescent HIV prevention and treatment are not unique; the benefits of proven interventions have not been fully realized because of enduring barriers to uptake, replication, and scale-up in many settings. An IS approach to substantial advancements is to have deliberate and strategic efforts to facilitate collaboration, communication, and relationship-building among the generators and users of research evidence
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