背景:在低收入和中等收入国家(LMICs),受到艾滋病毒流行的不成比例的影响,管理有限的资源,需要优化实施策略,以提高艾滋病毒应对的效率。评估迄今为止的战略使用情况可以确定研究差距,并为未来的实施工作提供信息。我们进行了系统评价,以描述旨在改善HIV治疗服务提供和结果的已发布实施策略的特征和分布。
方法:我们搜索了PubMed,Embase,2014年1月1日至2021年8月27日期间发表的英文研究和CINAHL以及筛选摘要和全文,这些研究描述了艾滋病毒干预的实施情况,并报告了至少一个艾滋病毒护理级联结果,从HIV检测到病毒抑制。实施策略是归纳性地指定的,以演员的独特组合为特征,行动和行动目标,并根据现有的实施策略分类进行了总结。本研究中包括的所有策略都经过独立审查,以确保准确性和一致性。
结果:我们确定了44,126份摘要,并审查了1504份全文手稿。在485项纳入的研究中,83%在撒哈拉以南非洲进行;其余在东南亚和西太平洋进行(12%),美洲(8%)。总共确定了7253种独特的实施策略,包括改变卫生服务提供(48%)和提供能力建设和支持战略(34%)。医疗保健提供者和研究人员领导了59%和28%的策略,分别。艾滋病毒感染者及其社区(62%)和医疗保健提供者(38%)是共同的战略目标。试图改变治理的策略,很少报告财务安排和实施过程。
结论:我们确定了一系列已发表的针对HIV级联结果的实施策略,尽管存在一些关键差距。我们可能需要扩大实施战略的应用,以确保所有利益攸关方有意义地参与,以支持跨地理区域和目标人群的公平实施努力,并优化实施结果。
结论:迄今为止,一些卫生服务提供、能力建设和支持战略最为常用。未来的研究和实施可能会纳入更多样化的战略,并详细报告其使用情况,以告知全球改进的艾滋病毒应对措施。
BACKGROUND: In low- and middle-income countries (LMICs), which are disproportionately affected by the HIV epidemic and manage limited resources, optimized implementation strategies are needed to enhance the efficiency of the HIV response. Assessing strategy usage to date could identify research gaps and inform future implementation efforts. We conducted a systematic review to describe the features and distributions of published implementation strategies attempting to improve HIV treatment service delivery and outcomes.
METHODS: We searched PubMed, Embase, and CINAHL and screened abstracts and full texts published between 1 January 2014 and 27 August 2021, for English-language studies conducted in LMICs that described the implementation of HIV intervention and reported at least one HIV care cascade outcome, ranging from HIV testing to viral suppression. Implementation strategies were inductively specified, characterized by unique combinations of actor, action and action target, and summarized based on existing implementation strategy taxonomies. All strategies included in this study were independently reviewed to ensure accuracy and consistency.
RESULTS: We identified 44,126 abstracts and reviewed 1504 full-text manuscripts. Among 485 included studies, 83% were conducted in sub-Saharan Africa; the rest were conducted in South-East Asia and Western Pacific (12%), and the Americas (8%). A total of 7253 unique implementation strategies were identified, including changing health service delivery (48%) and providing capacity building and support strategies (34%). Healthcare providers and researchers led 59% and 28% of the strategies, respectively. People living with HIV and their communities (62%) and healthcare providers (38%) were common strategy targets. Strategies attempting to change governance, financial arrangements and implementation processes were rarely reported.
CONCLUSIONS: We identified a range of published implementation strategies that addressed HIV cascade outcomes, though some key gaps exist. We may need to expand the application of implementation strategies to ensure that all stakeholders are meaningfully involved to support equitable implementation efforts across the geographic regions and target populations, and to optimize implementation outcomes.
CONCLUSIONS: Some health service delivery and capacity building and support strategies have been most commonly used to date. Future research and implementation may incorporate a more diverse range of strategies and detailed reporting on their usage to inform improved HIV responses globally.