PDF(Pubmed)
Abstract：
OBJECTIVE: To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya.
METHODS: Cluster randomized trial and mystery shopper evaluation.
METHODS: Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or \"mystery shoppers\" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP.
RESULTS: Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P < 0.001).
CONCLUSIONS: SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.
METHODS: Cluster randomized trial and mystery shopper evaluation.
METHODS: Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or \"mystery shoppers\" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP.
RESULTS: Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P < 0.001).
CONCLUSIONS: SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.
摘要：
目的：评估在肯尼亚为青少年女孩和年轻妇女（AGYW）提供的标准化患者行为者（SP）培训干预措施的有效性。
方法：集群随机试验和神秘购物者评估。
方法：将24个妇幼保健和计划生育机构中的12个随机进行SP培训。干预设施的提供者参加了为期两天的青少年健康培训，PrEP指南,价值观澄清，和沟通技巧，其次是角色扮演和向训练有素的演员介绍情况。控制设施接受了标准的国家培训。主要结果是护理质量，由未公布的SP(USP)或“神秘购物者”对干预部门视而不见的评估。质量在两个领域进行衡量：指南依从性和沟通技巧。意图治疗分析比较了随机分组的干预后质量评分，聚集在设施上，并调整基线评分和USP。
结果：总体而言，232个提供者同意USP访问，94名提供者完成了培训。培训后,USP冒充AGYW在142次相遇中寻求PrEP（每个站点5-6次相遇）。干预点的平均质量评分为73.6%，对照点的平均质量评分为58.4%[校正平均差=15.3,95%置信区间(CI):9.4-21.1,p<0.001]。干预中心的平均指南依从性评分为57.2%，对照中心为36.2%（调整后的平均差异=21.0，95%CI：12.5-29.4，p<0.001）。干预点的平均沟通得分为90.0%，对照点的平均沟通得分为80.5%（调整后的平均差=9.5，95%CI：5.5-13.6，p<0.001）。
结论：SP培训显著提高了肯尼亚AGYW的PrEP护理质量。结合SP培训和未宣布的SP评估可以改善AGYW的PrEP吸收。
方法：集群随机试验和神秘购物者评估。
方法：将24个妇幼保健和计划生育机构中的12个随机进行SP培训。干预设施的提供者参加了为期两天的青少年健康培训，PrEP指南,价值观澄清，和沟通技巧，其次是角色扮演和向训练有素的演员介绍情况。控制设施接受了标准的国家培训。主要结果是护理质量，由未公布的SP(USP)或“神秘购物者”对干预部门视而不见的评估。质量在两个领域进行衡量：指南依从性和沟通技巧。意图治疗分析比较了随机分组的干预后质量评分，聚集在设施上，并调整基线评分和USP。
结果：总体而言，232个提供者同意USP访问，94名提供者完成了培训。培训后,USP冒充AGYW在142次相遇中寻求PrEP（每个站点5-6次相遇）。干预点的平均质量评分为73.6%，对照点的平均质量评分为58.4%[校正平均差=15.3,95%置信区间(CI):9.4-21.1,p<0.001]。干预中心的平均指南依从性评分为57.2%，对照中心为36.2%（调整后的平均差异=21.0，95%CI：12.5-29.4，p<0.001）。干预点的平均沟通得分为90.0%，对照点的平均沟通得分为80.5%（调整后的平均差=9.5，95%CI：5.5-13.6，p<0.001）。
结论：SP培训显著提高了肯尼亚AGYW的PrEP护理质量。结合SP培训和未宣布的SP评估可以改善AGYW的PrEP吸收。
