PDF(Pubmed)
Abstract：
BACKGROUND: There is a lack of consensus about how to prioritize potential implementation strategies for HIV pre-exposure prophylaxis (PrEP) delivery. We compared several prioritization methods for their agreement and pragmatism in practice in a resource-limited setting.
METHODS: We engaged diverse stakeholders with clinical PrEP delivery and PrEP decision-making experience across 55 facilities in Kenya to prioritize 16 PrEP delivery strategies. We compared four strategy prioritization methods: (1) \"past experience surveys\" with experienced practitioners reflecting on implementation experience (N = 182); (2 and 3) \"pre- and post-small-group ranking\" surveys before and after group discussion (N = 44 and 40); (4) \"go-zone\" quadrant plots of perceived effectiveness vs feasibility. Kendall\'s correlation analysis was used to compare strategy prioritization using the four methods. Additionally, participants were requested to group strategies into three bundles with up to four strategies/bundle by phone and online survey.
RESULTS: The strategy ranking correlation was strongest between the pre- and post-small-group rankings (Tau: 0.648; p < 0.001). There was moderate correlation between go-zone plots and post-small-group rankings (Tau: 0.363; p = 0.079) and between past-experience surveys and post-small-group rankings (Tau: 0.385; p = 0.062). For strategy bundling, participants primarily chose bundles of strategies in the order in which they were listed, reflecting option ordering bias. Neither the phone nor online approach was effective in selecting strategy bundles. Participants agreed that the strategy ranking activities conducted during the workshop were useful in prioritizing a final set of strategies.
CONCLUSIONS: Both experienced and inexperienced stakeholder participants\' strategy rankings tended to prioritize strategies perceived as feasible. Small group discussions focused on feasibility and effectiveness revealed moderately different priorities than individual rankings. The strategy bundling approach, though less time- and resource-intensive, was not effective. Future research should further compare the relative effectiveness and pragmatism of methodologies to prioritize implementation strategies.
METHODS: We engaged diverse stakeholders with clinical PrEP delivery and PrEP decision-making experience across 55 facilities in Kenya to prioritize 16 PrEP delivery strategies. We compared four strategy prioritization methods: (1) \"past experience surveys\" with experienced practitioners reflecting on implementation experience (N = 182); (2 and 3) \"pre- and post-small-group ranking\" surveys before and after group discussion (N = 44 and 40); (4) \"go-zone\" quadrant plots of perceived effectiveness vs feasibility. Kendall\'s correlation analysis was used to compare strategy prioritization using the four methods. Additionally, participants were requested to group strategies into three bundles with up to four strategies/bundle by phone and online survey.
RESULTS: The strategy ranking correlation was strongest between the pre- and post-small-group rankings (Tau: 0.648; p < 0.001). There was moderate correlation between go-zone plots and post-small-group rankings (Tau: 0.363; p = 0.079) and between past-experience surveys and post-small-group rankings (Tau: 0.385; p = 0.062). For strategy bundling, participants primarily chose bundles of strategies in the order in which they were listed, reflecting option ordering bias. Neither the phone nor online approach was effective in selecting strategy bundles. Participants agreed that the strategy ranking activities conducted during the workshop were useful in prioritizing a final set of strategies.
CONCLUSIONS: Both experienced and inexperienced stakeholder participants\' strategy rankings tended to prioritize strategies perceived as feasible. Small group discussions focused on feasibility and effectiveness revealed moderately different priorities than individual rankings. The strategy bundling approach, though less time- and resource-intensive, was not effective. Future research should further compare the relative effectiveness and pragmatism of methodologies to prioritize implementation strategies.
摘要：
背景：关于如何优先考虑HIV暴露前预防（PrEP）交付的潜在实施策略，缺乏共识。在资源有限的情况下，我们比较了几种优先排序方法的一致性和实用主义。
方法：我们在肯尼亚的55家机构中与具有临床PrEP交付和PrEP决策经验的不同利益相关者合作，优先考虑16种PrEP交付策略。我们比较了四种策略优先级方法：（1）“过去的经验调查”与经验丰富的从业人员反思实施经验（N=182）；（2和3）小组讨论前后的“小组前和小组后排名”调查（N=44和40）；（4）感知有效性与可行性的“去区”象限图。使用Kendall的相关性分析来比较使用这四种方法的策略优先级。此外,参与者被要求通过电话和在线调查将策略分组为三个捆绑包,最多四个策略/捆绑包.
结果：在前和后小组排名之间，策略排名相关性最强（Tau：0.648；p<0.001）。去区地块与小组后排名之间存在中等相关性（Tau：0.363；p=0.079），过去的经验调查与小组后排名之间存在中等相关性（Tau：0.385；p=0.062）。对于策略捆绑，参与者主要按照列出的顺序选择捆绑的策略，反映期权排序偏差。电话和在线方法都不能有效地选择策略包。与会者一致认为，研讨会期间开展的战略排名活动有助于确定最后一套战略的优先次序。
结论：有经验和没有经验的利益相关者参与者的战略排名倾向于优先考虑被认为是可行的战略。小组讨论的重点是可行性和有效性，这表明优先事项与个人排名略有不同。战略捆绑方法，虽然时间和资源消耗较少，没有效果。未来的研究应进一步比较方法的相对有效性和实用主义，以优先考虑实施策略。
方法：我们在肯尼亚的55家机构中与具有临床PrEP交付和PrEP决策经验的不同利益相关者合作，优先考虑16种PrEP交付策略。我们比较了四种策略优先级方法：（1）“过去的经验调查”与经验丰富的从业人员反思实施经验（N=182）；（2和3）小组讨论前后的“小组前和小组后排名”调查（N=44和40）；（4）感知有效性与可行性的“去区”象限图。使用Kendall的相关性分析来比较使用这四种方法的策略优先级。此外,参与者被要求通过电话和在线调查将策略分组为三个捆绑包,最多四个策略/捆绑包.
结果：在前和后小组排名之间，策略排名相关性最强（Tau：0.648；p<0.001）。去区地块与小组后排名之间存在中等相关性（Tau：0.363；p=0.079），过去的经验调查与小组后排名之间存在中等相关性（Tau：0.385；p=0.062）。对于策略捆绑，参与者主要按照列出的顺序选择捆绑的策略，反映期权排序偏差。电话和在线方法都不能有效地选择策略包。与会者一致认为，研讨会期间开展的战略排名活动有助于确定最后一套战略的优先次序。
结论：有经验和没有经验的利益相关者参与者的战略排名倾向于优先考虑被认为是可行的战略。小组讨论的重点是可行性和有效性，这表明优先事项与个人排名略有不同。战略捆绑方法，虽然时间和资源消耗较少，没有效果。未来的研究应进一步比较方法的相对有效性和实用主义，以优先考虑实施策略。
