How might improved estimates of HIV programme outcomes influence practice? A formative study of evidence, dissemination and response

Mukamba, Njekwa, Beres, Laura K., Mwamba, Chanda, Law, Jeanna Wallenta, Topp, Stephanie M., Simbeza, Sandra, Sikombe, Kombatende, Padian, Nancy, Holmes, Charles B., Geng, Elvin H., and Sikazwe, Izukanji (2020) How might improved estimates of HIV programme outcomes influence practice? A formative study of evidence, dissemination and response. Health Research Policy and Systems, 18. 121.

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Abstract

Background While HIV programmes have started millions of persons on life-saving antiretroviral therapy in Africa, longitudinal health information systems are frail and, therefore, data about long-term survival is often inaccurate or unknown to HIV programmes. The 'Better Information for Health in Zambia' (BetterInfo) Study - a regional sampling-based survey to assess retention and mortality in HIV programmes in Zambia - found both retention and mortality to be higher than prevailing estimates from national surveillance systems. We sought to understand how Zambian health decision-makers at different health system levels would respond to these new data, with a view to informing research translation. Methods We interviewed 25 purposefully sampled health decision-makers from community, facility, district, provincial and national levels. During the interviews, we shared retention and mortality estimates from both routine programme surveillance and those generated by the study. Transcripts were analysed for inductive and deductive themes, the latter drawing on Weiss's framework that policy-makers interpret and apply evidence as 'warning', 'guidance', 'reconceptualisation' or 'mobilisation of support'. Findings All decision-makers found study findings relevant and important. Decision-makers viewed the underestimates of mortality to be a warning about the veracity and informativeness of routine data systems. Decision-makers felt guided by the findings to improve data monitoring and, acknowledging limitations of routine data, utilised episodic patient tracing to support improved data accuracy. Findings catalysed renewed motivation and mobilisation by national level decision-makers for differentiated models of HIV care to improve patient outcomes and also improved data management systems to better capture patient outcomes. Inductive analysis highlighted a programmatic application data interpretation, in which study findings can influence facility and patient-level decision-making, quality of care and routine data management. Conclusions New epidemiological data on patient outcomes were widely seen as informative and relevant and can potentially catalyse health system action such as using evaluations to supplement electronic medical record data to improve HIV programmes. Formative evidence suggests that targeting research dissemination at different levels of the health system will elicit different responses. Researchers supporting the translation of evidence to action should leverage all relevant levels of the health system to facilitate both policy and programmatic action.

Item ID: 64954
Item Type: Article (Research - C1)
ISSN: 1478-4505
Keywords: HIV outcomes, dissemination, health decision-making, implementation science
Copyright Information: © The Author(s). 2020. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Funders: Bill and Melinda Gates Foundation (BMGF), National Institute of Allergy and Infectious Disease (NIAID)
Projects and Grants: BMGF OPP1105071, NIAID P30 AI027763, NIAID K24 AI134413
Date Deposited: 04 Nov 2020 07:47
FoR Codes: 44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 20%
42 HEALTH SCIENCES > 4203 Health services and systems > 420308 Health informatics and information systems @ 30%
42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified @ 50%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 50%
92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 50%
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