Barriers and facilitators to implementing advanced HIV disease diagnostic package at a district hospital; An exploratory study
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Date
2022-02-09
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Kamuzu University of Health Sciences
Abstract
Sequential exploratory mixed methods study design.
Problem: One third of the people beginning treatment for HIV present with advanced disease with
severe immune suppression (CD4<200), putting them at very high risk of opportunistic infections
(OIs) as well as death. Unfortunately, a good number of People Living with HIV (PLHIV) meeting
the WHO eligibility criteria are not screened for Advanced HIV Disease (AHD). Currently, data
on implementation bottlenecks are scarce. To derive an effective implementation strategy for
scaling up AHD screening coverage, there is need to identify barriers and facilitators to
implementation of AHD diagnostic services.
Aims and Objectives: To explore factors influencing effective implementation of WHO
recommended AHD Diagnostic package at Rumphi District Hospital.
Specific objectives:
• To determine the baseline uptake of AHD screening at Rumphi District Hospital between
June and December 2021.
• To explore the health facility barriers and facilitators to implementation of AHD diagnostic
tests at Rumphi District Hospital using the CFIR conceptual framework. To explore implementation strategies for optimizing AHD diagnostic test package.
Methodology: This is a sequential exploratory study that will employ both quatintative and
qualitative methods. A Consolidated Framework for Implementation Research (CFIR) will be
used to develop an interview guide that will be used for collecting qualitative data from health care
workers (HCWs) pertaining to barriers and facilitators to AHD diagnostic package at Rumphi
District Hospital. A NVivo software package will be used to organize interview transcripts in
preparation for thematic analysis. Quantitative baseline data will be extracted from quarterly
reports on AHD for the period of July, 2021 to December,2021 retrospectively. The data will be
analysed using STATA 15.0 statistical software and the results will be presented in tables,
histograms, and frequency distribution tables.Expected findings and dissemination of results: We expect to establish barriers and facilitators
from which implementation strategies would be derived. We hope that the identified strategies can be used to scale up utilization of AHD diagnostic services at Rumphi District Hospital and in other
settings in Malawi and beyond. Findings of the study will be shared with Ministry of Health,
College of Medicine Research and Ethics Committee (CoMREC), College of Medicine Research
Dissemination Forum and the Medicine Library. Findings will also be shared with funders of the
study. A manuscript will be prepared for publication.
Description
Sequential exploratory mixed methods study design.