ABSTRACT
BACKGROUND: Rapidly linking newly diagnosed HIV patients to antiretroviral treatment (ART) is the best practice for achieving optimal treatment outcomes, including viral suppression. However, rapid ART implementation varies throughout the United States, highlighting the importance of identifying rapid ART implementation determinants in US HIV epicenters, such as Miami-Dade County (MDC). METHODS: Clinic focus groups (N = 4 clinics) and patient interviews (N = 31 recently diagnosed patients) systematically and qualitatively assessed rapid ART implementation determinants in MDC. Independent coders analyzed focus groups and interviews using a directed content analysis approach guided by the Consolidated Framework for Implementation Research. RESULTS: For clinic stakeholders, key rapid ART implementation determinants included the following: complexity and adaptability (innovation characteristics); networks between clinics and patient needs rooted in structural inequities (outer setting); leadership and available resources (inner setting); staff/provider flexibility (characteristics of individuals); and appointing patient navigators and champions (process). For patients, key determinants included complexity and relative advantage of rapid treatment (innovation characteristics); patient needs and clinic networks (outer setting); provider knowledge and skills (inner setting); provider warmth and affirmation (characteristics of individuals); and need for improved outreach (process). CONCLUSIONS: Multilevel factors impact clinic implementation and patient demand for rapid ART in MDC. Informed by these factors, we identified potential implementation strategies to enhance rapid ART implementation throughout MDC. These implementation strategies can be tested in an implementation trial, enhancing the toolkit of strategies to ensure that evidence-based tools, particularly rapid ART, are readily available to the most impacted communities.
Subject(s)
HIV Infections , Ambulatory Care Facilities , Anti-Retroviral Agents/therapeutic use , Focus Groups , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Leadership , United StatesABSTRACT
Os autores analisam a questäo da avaliaçäo dos serviços de saúdem em particular, os relacionados com o sistema de saúde mental. Concluem pela necessidade de ampliar os horizontes da avaliçäo do sistema de saúde, envolvendo no processo todos os segmentos da comunidade que possam contribuir para o progresso do setor
Subject(s)
Mental Health Services , Outcome and Process Assessment, Health Care , Quality of Health Care , Brazil , Health Policy/trends , Delivery of Health CareABSTRACT
Os autores analisam a questao da avaliacao dos servicos de saude, em particular, os relacionados com o sistema de saude mental. Concluem pela necessidade de ampliar os horizontes da avaliacao do sistema de saude, envolvendo no processo todos os segmentos da comunidade que possam contribuir para o progresso do setor.