Identifying factors associated with successful implementation and uptake of an evidence-based voluntary medical male circumcision program in Zambia: The Spear and Shield 2 Program

Violeta J. Rodriguez, Antonio Chahine, Aileen De La Rosa, Tae Kyoung Lee, Nicholas V. Cristofari, Deborah L. Jones, Robert Zulu, Ndashi Chitalu, Stephen M. Weiss

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Voluntary medical male circumcision has been shown to provide a 50%-70% reduction in the risk of HIV infection without contributing to behavioral disinhibition of safer sexual practices. This study examined the interim implementation and dissemination data of Spear and Shield 2, an HIV risk-reduction program in Zambia. The purpose of this interim review was to identify contextual challenges to implementation and implement midcourse corrections associated with sustainability of program delivery. Using a mixed-methods design, quantitative evaluations of organizational functioning, barriers to implementation, burnout, and organizational readiness, as well as qualitative data utilizing the Consolidated Framework for Implementation Research (CFIR), were examined to evaluate program implementation. Participants were 184 health care providers from 46 clinics in Zambia. Successful implementation was associated with better community and leader support, and employee readiness and motivation. Quantitative assessments were not related to implementation and provided a limited picture of implementation outcomes. Results suggest that the qualitative data underlying the CFIR constructs provided a nuanced, contextual assessment of implementation, and dissemination outcomes. The CFIR may be valuable in informing the implementation of evidence-based interventions in other parts of Zambia.

Original languageEnglish (US)
Pages (from-to)970-977
Number of pages8
JournalTranslational behavioral medicine
Volume10
Issue number4
DOIs
StatePublished - Aug 1 2020
Externally publishedYes

Keywords

  • HIV prevention
  • Implementation science
  • Male circumcision
  • Mixed methods

ASJC Scopus subject areas

  • Applied Psychology
  • Behavioral Neuroscience

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