Abstract
Voluntary medical male circumcision (VMMC) uptake in Africa could prevent 3.4 million HIV infections across a 10 year span. In Zambia, however, ~80 per cent of uncircumcised men report no interest in undergoing VMMC. The Spear & Shield (S&S) intervention has been shown to be more effective than control or observation of only conditions at increasing the number of VMMCs. This study identified predictors of S&S implementation success or failure to create an "early warning" system to enable remedial action during implementation. Participants were n = 48 staff members from 12 community health facilities conducting the S&S program in Lusaka Province, Zambia. Quantitative assessments included demographics, provider attitudes, barriers to research uptake, staff burnout, and organizational readiness. Qualitative interviews were also conducted and quantified for analysis using the Consolidated Framework for Implementation Research (CFIR). Two-thirds (66%) of staff were women with a mean age of 37.67 years (SD = 7.51). Quantitatively, staff performance (p = .033) and decreased levels of staff burnout (p = .025) were associated with S&S implementation success. Qualitatively, constructs such as improved planning, executing, and self-reflection and evaluation were associated with S&S implementation success (p = .005). Identifying these factors facilitated remedial action across health facilities. This study illustrates the utility of the CFIR to guide program decision making in VMMC implementation in the Zambian context. Early identification of challenges to implementation may enable remedial action to enhance the likelihood of program sustainability. Effective monitoring strategies for HIV prevention interventions may thus enhance dissemination, implementation, and sustainability goals to bridge research and practice.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 907-916 |
| Number of pages | 10 |
| Journal | Translational Behavioral Medicine |
| Volume | 8 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 21 2018 |
Fingerprint
ASJC Scopus subject areas
- Applied Psychology
- Behavioral Neuroscience
Cite this
Increasing acceptability and uptake of voluntary male medical circumcision in Zambia : implementing and disseminating an evidence-based intervention. / Jones, Deborah; Rodriguez, Violeta J.; Butts, Stefani A.; Arheart, Kris; Zulu, Robert; Chitalu, Ndashi; Weiss, Stephen M.
In: Translational Behavioral Medicine, Vol. 8, No. 6, 21.11.2018, p. 907-916.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Increasing acceptability and uptake of voluntary male medical circumcision in Zambia
T2 - implementing and disseminating an evidence-based intervention
AU - Jones, Deborah
AU - Rodriguez, Violeta J.
AU - Butts, Stefani A.
AU - Arheart, Kris
AU - Zulu, Robert
AU - Chitalu, Ndashi
AU - Weiss, Stephen M
PY - 2018/11/21
Y1 - 2018/11/21
N2 - Voluntary medical male circumcision (VMMC) uptake in Africa could prevent 3.4 million HIV infections across a 10 year span. In Zambia, however, ~80 per cent of uncircumcised men report no interest in undergoing VMMC. The Spear & Shield (S&S) intervention has been shown to be more effective than control or observation of only conditions at increasing the number of VMMCs. This study identified predictors of S&S implementation success or failure to create an "early warning" system to enable remedial action during implementation. Participants were n = 48 staff members from 12 community health facilities conducting the S&S program in Lusaka Province, Zambia. Quantitative assessments included demographics, provider attitudes, barriers to research uptake, staff burnout, and organizational readiness. Qualitative interviews were also conducted and quantified for analysis using the Consolidated Framework for Implementation Research (CFIR). Two-thirds (66%) of staff were women with a mean age of 37.67 years (SD = 7.51). Quantitatively, staff performance (p = .033) and decreased levels of staff burnout (p = .025) were associated with S&S implementation success. Qualitatively, constructs such as improved planning, executing, and self-reflection and evaluation were associated with S&S implementation success (p = .005). Identifying these factors facilitated remedial action across health facilities. This study illustrates the utility of the CFIR to guide program decision making in VMMC implementation in the Zambian context. Early identification of challenges to implementation may enable remedial action to enhance the likelihood of program sustainability. Effective monitoring strategies for HIV prevention interventions may thus enhance dissemination, implementation, and sustainability goals to bridge research and practice.
AB - Voluntary medical male circumcision (VMMC) uptake in Africa could prevent 3.4 million HIV infections across a 10 year span. In Zambia, however, ~80 per cent of uncircumcised men report no interest in undergoing VMMC. The Spear & Shield (S&S) intervention has been shown to be more effective than control or observation of only conditions at increasing the number of VMMCs. This study identified predictors of S&S implementation success or failure to create an "early warning" system to enable remedial action during implementation. Participants were n = 48 staff members from 12 community health facilities conducting the S&S program in Lusaka Province, Zambia. Quantitative assessments included demographics, provider attitudes, barriers to research uptake, staff burnout, and organizational readiness. Qualitative interviews were also conducted and quantified for analysis using the Consolidated Framework for Implementation Research (CFIR). Two-thirds (66%) of staff were women with a mean age of 37.67 years (SD = 7.51). Quantitatively, staff performance (p = .033) and decreased levels of staff burnout (p = .025) were associated with S&S implementation success. Qualitatively, constructs such as improved planning, executing, and self-reflection and evaluation were associated with S&S implementation success (p = .005). Identifying these factors facilitated remedial action across health facilities. This study illustrates the utility of the CFIR to guide program decision making in VMMC implementation in the Zambian context. Early identification of challenges to implementation may enable remedial action to enhance the likelihood of program sustainability. Effective monitoring strategies for HIV prevention interventions may thus enhance dissemination, implementation, and sustainability goals to bridge research and practice.
UR - http://www.scopus.com/inward/record.url?scp=85057165173&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85057165173&partnerID=8YFLogxK
U2 - 10.1093/tbm/iby078
DO - 10.1093/tbm/iby078
M3 - Article
C2 - 30010980
AN - SCOPUS:85057165173
VL - 8
SP - 907
EP - 916
JO - Translational Behavioral Medicine
JF - Translational Behavioral Medicine
SN - 1869-6716
IS - 6
ER -