Mixed methods implementation research to understand success of intensive combination approach to roll back the epidemic in Nigerian adolescents) (iCARE Nigeria) HIV testing uptake and linkage to care among young men focusing on young men who have sex with men in Ibadan

AIDS Research and Therapy

Research

Adedotun Adetunji¹  Lisa R. Hirschhorn²  Aima A. Ahonkhai³  Olutosin A. Awolude⁴  Amy K. Johnson⁵  Lisa M. Kuhns⁵  Robert Garofalo⁶  Bibilola Oladeji⁷  Olayinka Omigbodun⁸  Ogochukwu Okonkwor⁹  Babafemi Taiwo⁹  Kehinde M. Kuti^1,10  Jude Onumabor^1,11 

[1] Department of Family Medicine, University College Hospital, Ibadan, Nigeria;Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, 14-013, 60611, Chicago, IL, USA;Feinberg School of Medicine, Ryan Family Center for Global Primary Care, Robert J Havey Institute of Global Health, Northwestern University, Chicago, USA;Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA;Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA;Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria;Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria;Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA;Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA;Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria;Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria;Centre for Child and Adolescent Mental Health, College of Medicine,, Ibadan University, Ibadan, Nigeria;Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, IL, USA;Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria;Staff Medical Services Department, University College Hospital, Ibadan, Nigeria;Initiative for the Advancement of Improved Health and Development, I-AIHD, Ibadan, Nigeria;

关键词: HIV;    Nigeria;    Implementation science;    Men who have sex with men;    HIV testing;   

DOI  :  10.1186/s12981-023-00574-4

 received in 2022-12-26, accepted in 2023-10-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHIV seroprevalence in Nigeria is increasing among men who have sex with men (MSM) from 14% to 2007 to 23% in 2014, threatening progress towards ending the epidemic in the country. Expanding access to HIV testing and linkage to care for key populations, like young MSM (YMSM), is critical to end the HIV epidemic in Nigeria. The Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents (iCARE Nigeria) pilot intervention successfully implemented a combination of evidence-based interventions utilizing peer navigators and popular social media apps and platforms to reach young men at risk for HIV exposure, including YMSM. We conducted sequential mixed methods explanatory implementation research to expand on the previously reported effectiveness and implementation outcomes and to explore the determinants and strategies which contributed to primary study results.MethodsWe conducted key informant interviews and focus group discussions with 2 peer navigators and 3 study staff at the end of the pilot. We used directed content analysis to understand the quantitative results from the pilot. Using the Implementation Research Logic Model, we were able to identify and map strategies through mechanisms of action from barriers addressed to the reported implementation outcomes including feasibility, acceptability fidelity and adoption.ResultsWe found that iCARE Nigeria’s pilot intervention implementers reported high feasibility, acceptability fidelity and adoption were associated with implementation of strategies which addressed many challenging contextual factors, including social stigma, online social networking, legal barriers surrounding MSM behavior, and the COVID-19 pandemic. These strategies included integration of stakeholders’ interests, selection of experienced peer navigators including from the targeted population, training and supportive supervision using an implementation guide, ensuring safety (COVID and legal) and identification of clinics serving the targeted population.ConclusionMixed methods using implementation research frameworks provided insights into the strategies and barriers and facilitators they addressed which may explain the success of the pilot. These results can inform strategies needed to scale-up the intervention to youth including YMSM in other areas in Nigeria and the region.Trial registration ISRCTN: ISRCTN94590823, https://doi.org/10.1186/ISRCTN94590823

【 授权许可】

CC BY   
© The Author(s) 2023

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Fig. 4