Implementation strategies and outcomes in the delivery of HIV test services (HTS) in community pharmacies in Nigeria.
Community pharmacists
HIV test services
Implementation outcomes
Implementation strategies
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
26 Aug 2024
26 Aug 2024
Historique:
received:
10
06
2024
accepted:
09
08
2024
medline:
27
8
2024
pubmed:
27
8
2024
entrez:
26
8
2024
Statut:
epublish
Résumé
Studies have shown that training interventions fail when proper strategies are not in place for their implementation. The study described the implementation strategies used in the delivery of the HIV test services (HTS) and measured implementation outcomes in the delivery of the services. The study was conducted between August and November 2019 among 50 selected community pharmacies in Oyo State, Nigeria using a mixed-method quantitative and qualitative data survey design. The implementation strategies and activities used in the delivery of HTS in the pharmacies and during outreaches were described while both observational and survey methods were used to collect data. Implementation outcomes were measured and analysed in terms of penetration, adoption, acceptability, feasibility, fidelity, and appropriateness of the intervention. Penetration among respondents was 90%. Acceptability of the HTS was high (77.3%) among clients 20-49 years of age with 919 clients participating in the HIV screening. While 919 HIV tests were conducted, only 19 (2.1%) were positive. Adherence to the protocol of delivery of HTS (fidelity) indicated that all the respondents conducted rapid HIV testing, pre-testing counselling (43, 95.6%), post-testing counselling (40, 88.9%), and provision of confidential test results (39, 86.7%). Respondents' responsiveness indicated that 23 (51.1%%) of the respondents could use up to 80% and above of the test strips given within the period. Researchers' observations showed respondents' ability to perform the tests as intended with little challenges. Participants felt that rendering the services was an interesting experience, and fulfilling, and allowed them to improve on their professional deliverables and practice. It also showcased the relevance of pharmacists in rendering HTS, creating awareness of the menace of HIV/AIDS, and helping people to stop the spread. The study showed that HTS is acceptable, appropriate, feasible, and easy to adopt in community pharmacies and penetration was high. For sustainability, community pharmacists should be well remunerated, and need for an established policy to include this scope in community pharmacy practice.
Sections du résumé
BACKGROUND
BACKGROUND
Studies have shown that training interventions fail when proper strategies are not in place for their implementation. The study described the implementation strategies used in the delivery of the HIV test services (HTS) and measured implementation outcomes in the delivery of the services.
METHODS
METHODS
The study was conducted between August and November 2019 among 50 selected community pharmacies in Oyo State, Nigeria using a mixed-method quantitative and qualitative data survey design. The implementation strategies and activities used in the delivery of HTS in the pharmacies and during outreaches were described while both observational and survey methods were used to collect data. Implementation outcomes were measured and analysed in terms of penetration, adoption, acceptability, feasibility, fidelity, and appropriateness of the intervention.
RESULTS
RESULTS
Penetration among respondents was 90%. Acceptability of the HTS was high (77.3%) among clients 20-49 years of age with 919 clients participating in the HIV screening. While 919 HIV tests were conducted, only 19 (2.1%) were positive. Adherence to the protocol of delivery of HTS (fidelity) indicated that all the respondents conducted rapid HIV testing, pre-testing counselling (43, 95.6%), post-testing counselling (40, 88.9%), and provision of confidential test results (39, 86.7%). Respondents' responsiveness indicated that 23 (51.1%%) of the respondents could use up to 80% and above of the test strips given within the period. Researchers' observations showed respondents' ability to perform the tests as intended with little challenges. Participants felt that rendering the services was an interesting experience, and fulfilling, and allowed them to improve on their professional deliverables and practice. It also showcased the relevance of pharmacists in rendering HTS, creating awareness of the menace of HIV/AIDS, and helping people to stop the spread.
CONCLUSION
CONCLUSIONS
The study showed that HTS is acceptable, appropriate, feasible, and easy to adopt in community pharmacies and penetration was high. For sustainability, community pharmacists should be well remunerated, and need for an established policy to include this scope in community pharmacy practice.
Identifiants
pubmed: 39187789
doi: 10.1186/s12875-024-02568-1
pii: 10.1186/s12875-024-02568-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
315Informations de copyright
© 2024. The Author(s).
Références
UNAIDS. Summary of the Declaration of Commitment on HIV/AIDS. 2002 https://www.unaids.org/sites/default/files/sub_landing/files/jc668-keepingpromise_en.pdf (accessed on November 15, 2018).
WHO/UNAIDS Statement. WHO, UNAIDS statement on HIV testing services: new opportunities and ongoing challenges.2017. https://www.unaids.org/en/resources/presscentre/featurestories/2017/august/20170829_HIV-testing-services (accessed on November 15, 2018).
UNAIDS. 2025 AIDS Target. https://www.unaids.org/sites/default/files/2025-AIDS-Targets_en.pdf (accessed on December 20, 2022).
UNAIDS. The gap report 2014. Geneva: Joint United Nations Programme on HIV/AIDS. https://unaids-test.unaids.org/sites/default/files/unaids/contentassets/documents/unaidspublication/2014/UNAIDS_Gap_report_en.pdf (accessed on November 15, 2018).
Nigeria HIV, AIDS. accessed on November 18, and. https://www.unodc.org/nigeria/en/hiv-and-aids.html#:~:text=Nigeria%20ranks%20third%20among%20countries,in%20Nigeria%20as%20at%202018 (2023).
National Agency for the Control of AIDS (NACA). ‘National Strategic Framework on HIV and AIDS: 2017–2021’ [pdf]. https://naca.gov.ng/2013-national-hiv-validated-data-2-2/ (accessed on November 15, 2018).
UNAIDS Data. 2020. https://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf (accessed on December 20, 2022).
Diaz-Cruz ES, Thompson S, Hawkins M, Zengotita-Borges R, Jefferson K. Leveraging expertise from Community resources to improve the role of the pharmacist in HIV Testing and Counseling. Innov Pharm. 2021;12(4):10–24926. Published 2021 Sep 22. https://doi.org/10.24926/iip.v12i4.3918 .
doi: 10.24926/iip.v12i4.3918
pmcid: 9401364
WHO 2017. END HIV/AIDS BY 2030 https://iris.who.int/bitstream/handle/10665/259638/EndAIDS-eng.pdf?sequence=1&isAllowed=y#:~:text=Political%20commitment%20towards%20the%20HIV,HIV%2FAIDS%20epidemic%20by%202030
Ibrahim MIM. Chapter 18 - Assessment of Medication Dispensing and Extended Community Pharmacy Services, Editor(s): Mohamed Izham Mohamed Ibrahim, Albert I. Wertheimer, Zaheer-Ud-Din Babar, Social and Administrative Aspects of Pharmacy in Low- and Middle-Income Countries, Academic Press, 2018, Pages 295–309, ISBN 9780128112281, https://doi.org/10.1016/B978-0-12-811228-1.00018-2 . ( https://www.sciencedirect.com/science/article/pii/B978012 8112281000182).
American Pharmacists Association (APhA). 2013. Chain Community Pharmacy. https://aphanet.pharmacist.com/sites/default/files/files/Profile_06%20Chain%20pharmacy%20Final%20071713.pdf
Valliant SN, Burbage SC, Pathak S, Urick BY. Pharmacists as accessible health care providers: quantifying the opportunity. J Manag Care Spec Pharm. 2022;28(1):85–90. https://doi.org/10.18553/jmcp.2022.28.1.85 .
doi: 10.18553/jmcp.2022.28.1.85
pubmed: 34949110
Shirdel A, Pourreza A, Daemi A, Ahmadi B. Health-promoting services provided in pharmacies: a systematic review. J Educ Health Promot. 2021;10:234. https://doi.org/10.4103/jehp.jehp_1374_20 . Published 2021 Jun 30.
doi: 10.4103/jehp.jehp_1374_20
pubmed: 34395671
pmcid: 8318157
Goode JV, Owen J, Page A, Gatewood S. Community-based Pharmacy Practice Innovation and the role of the community-based pharmacist practitioner in the United States. Pharm (Basel). 2019;7(3):106. https://doi.org/10.3390/pharmacy7030106 . Published 2019 Aug 4.
doi: 10.3390/pharmacy7030106
Bamgboye AO, Hassan IA, Fatoye EO, Ozuluoha CC, Folami SO, Uwizeyimana T. Enhancing care transition performance of community pharmacies in Nigeria. Health Sci Rep. 2024;7(2):e1904. Published 2024 Feb 15. https://doi.org/10.1002/hsr2.1904
Ihekoronye MR, Osemene KP. Evaluation of the participation of community pharmacists in Primary Healthcare Services in Nigeria: a mixed-method survey. Int J Health Policy Manag. 2022;11(6):829–39. https://doi.org/10.34172/ijhpm.2020.224 . Published 2022 Jun 1.
doi: 10.34172/ijhpm.2020.224
pubmed: 33300774
Oladapo RK, Oyetola AB. Cabenuva
Oseni Y. and
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76. https://doi.org/10.1007/s10488-010-0319-7 .
doi: 10.1007/s10488-010-0319-7
pubmed: 20957426
Fernandez ME, Ten Hoor GA, van Lieshout S, et al. Implementation mapping: using intervention mapping to develop implementation strategies. Front Public Health. 2019;7:158. https://doi.org/10.3389/fpubh.2019.00158 . Published 2019 Jun 18.
doi: 10.3389/fpubh.2019.00158
pubmed: 31275915
pmcid: 6592155
Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17:75. https://doi.org/10.1186/s13012-022-01245-0 .
doi: 10.1186/s13012-022-01245-0
pubmed: 36309746
pmcid: 9617234
Consolidated Framework for Implementation. Research (CFIR) https://cfirguide.org/constructs/
Stiles PG, Boothroyd RA, Snyder K, Zong X. Service penetration by persons with severe mental illness: how should it be measured? J Behav Health Serv Res. 2002;29(2):198–207. https://doi.org/10.1007/BF02287706 .
doi: 10.1007/BF02287706
pubmed: 12032977
Rabin BA, Brownson RC, Haire-Joshu D, Kreuter MW, Weaver NL. A glossary for dissemination and implementation research in health. J Public Health Manag Pract. 2008;14(2):117–23. https://doi.org/10.1097/01.PHH.0000311888.06252.bb .
doi: 10.1097/01.PHH.0000311888.06252.bb
pubmed: 18287916
Rogers EM. Diffusion of innovations fourth ed. New York: Free; 1995.
Rye CB, Kimberly JR. The adoption of innovations by provider organizations in health care. Med Care Res Rev. 2007;64(3):235–78. https://doi.org/10.1177/1077558707299865 .
doi: 10.1177/1077558707299865
pubmed: 17507458
Davis F. User acceptance of information technology: system characteristics, user perceptions and behavioral impacts. Int J Man Mach Stud. 1993;38:475–87. https://doi.org/10.1006/imms.1993.1022 .
doi: 10.1006/imms.1993.1022
Dusenbury L, Brannigan R, Falco M, Hansen WB. A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res. 2003;18(2):237–56. https://doi.org/10.1093/her/18.2.237 .
doi: 10.1093/her/18.2.237
pubmed: 12729182
Mihalic S. The importance of implementation fidelity. Emotional Behav Disorders Youth. 2004;4(4):83–105. https://www.incredibleyears.com/wp-content/uploads/fidelity-importance.pdf .
Dane AV, Schneider BH. Program integrity in primary and early secondary prevention: are implementation effects out of control? Clin Psychol Rev. 1998;18(1):23–45. https://doi.org/10.1016/s0272-7358(97)00043-3 .
doi: 10.1016/s0272-7358(97)00043-3
pubmed: 9455622
Karsh BT. Beyond usability: designing effective technology implementation systems to promote patient safety. Qual Saf Health Care. 2004;13(5):388–94. https://doi.org/10.1136/qhc.13.5.388 .
doi: 10.1136/qhc.13.5.388
pubmed: 15465944
pmcid: 1743880
Nilsen P, Birken SA, Handbook on Implementation Science. Edw Elgar Publishing, 29 May 2020 - Business & Economics – 576 pages
Oseni YO, Erhun WO. Assessing community pharmacists’ involvement and clients’ opinion of HIV/AIDS services in community pharmacies in Nigeria: a cross-sectional survey. Int J STD AIDS. 2021;32(6):538–50. https://doi.org/10.1177/0956462420981527 .
doi: 10.1177/0956462420981527
pubmed: 33533299
Oseni YO, Erhun WO. Delivery of training in HIV/AIDS services among community pharmacists in Oyo State, Nigeria: an interventional study. Malays J Pharm Sci. 2023;21(2):13–28. https://doi.org/10.21315/mjps2023.21.2.2 .
doi: 10.21315/mjps2023.21.2.2
Peters, David, Tran, Nhan, Adam, Taghreed, Alliance for Health Policy and Systems Research & World Health Organization. (2013). Implementation research in health:a practical guide / edited by David Peters … et al]. World Health Organization. https://iris.who.int/handle/10665/91758 .
State O. Nigeria | Britannica. www.britannica.com. Archived from the original on 2023-04-05. Retrieved 2023-05-05. https://en.wikipedia.org/wiki/Oyo_State#cite_note-9
Oyo State Pacesetter State. About Oyo State. https://old.oyostate.gov.ng/about-oyo-state/
Pharmacists Council of Nigeria (PCN). 2018 Register. List of registered pharmacists and pharmaceutical premises as at December. Abuja; 2018.
Oseni YO, Afolabi MO. Knowledge and involvement of community pharmacists in health promotion activities in Oyo State, Nigeria. Nigerian J Pharm Sci. 2018;17(2):36–47.
Hiner CA, Mandel BG, Weaver MR, Bruce D, McLaughlin R, Anderson J. Effectiveness of a training-of-trainers model in a HIV counseling and testing program in the Caribbean Region. Hum Resour Health 7:11. Published 2009 Feb 17. https://doi.org/10.1186/1478-4491-7-11
Weidle P PJ, Lecher S, Botts LW, Jones L, Spach DH, Alvarez J, Jones R, Thomas V. HIV testing in community pharmacies and retail clinics: a model to expand access to screening for HIV infection. J Am Pharm Assoc (2003). 2014;54(5):486–92. https://doi.org/10.1331/JAPhA.2014.14045 .
doi: 10.1331/JAPhA.2014.14045
pubmed: 25216878
Darin KM, Klepser ME, Klepser DE, Klepser SA, Reeves A, Young M, Scarsi KK. Pharmacist-provided rapid HIV testing in two community pharmacies. J Am Pharm Assoc (2003). 2015;55(1):81–8. https://doi.org/10.1331/JAPhA.2015.14070 .
doi: 10.1331/JAPhA.2015.14070
pubmed: 25415222
Klepser DG, Klepser ME, Peters PJ, Hoover KW, Weidle PJ. Implementation and evaluation of a collaborative, pharmacy-based Hepatitis C and HIV Screening Program. Prev Chronic Dis. 2022;19:E83. https://doi.org/10.5888/pcd19.220129 . Published 2022 Dec 8.
doi: 10.5888/pcd19.220129
pubmed: 36480802
pmcid: 9746706
Kherghehpoush S, McKeirnan KC. The role of community pharmacies in the HIV and HCV care continuum. ERCSP. 2023;9:100215. https://doi.org/10.1016/j.rcsop.2022.100215 .
doi: 10.1016/j.rcsop.2022.100215
Ryder PT, Meyerson BE, Coy KC, von Hippel CD. Pharmacists’ perspectives on HIV testing in community pharmacies. J Am Pharm Assoc (2003). 2013; 53(6):595–600. https://doi.org/10.1331/JAPhA.2013.12240
Figueira I, Teixeira I, Rodrigues AT, Gama A, Dias S. Point-of-care HIV and hepatitis screening in community pharmacies: a quantitative and qualitative study. Int J Clin Pharm. 2022;44(5):1158–68. https://doi.org/10.1007/s11096-022-01444-1 .
doi: 10.1007/s11096-022-01444-1
pubmed: 36098836
pmcid: 9469055
Melbourne School of Population and Global Health. 3.2 What are implementation outcomes? https://mspgh.unimelb.edu.au/centres-institutes/nossal-institute-for-global-health/implementation-science/how/step-3-evaluating/implementation-outcomes (accessed on December 15, 2023).
Dearing JW, Cox JG. Diffusion of innovations theory, principles, and practice. Health Affairs (Millwood). 2018;37(2):183–90. https://doi.org/10.1377/hlthaff.2017.1104 .
doi: 10.1377/hlthaff.2017.1104
Ntakarutimana A, Kagwiza JN, Bushaija E, Tumusiime DK, Ekane N, Schuller KA. Insights from the implementation and adoption of Community-Based Health interventions. J Health Soc Behav. 2021;15(1):61–75. https://doi.org/10.5590/JSBHS.2021.15.1.04 .
doi: 10.5590/JSBHS.2021.15.1.04
Kelly DV, Kielly J, Hughes C, et al. Expanding access to HIV testing through Canadian community pharmacies: findings from the APPROACH study. BMC Public Health. 2020;20(1):639. https://doi.org/10.1186/s12889-020-08719-0 . Published 2020 May 7.
doi: 10.1186/s12889-020-08719-0
pubmed: 32380978
pmcid: 7203868
World Health Organization (WHO). ‘Community pharmacy’ In: The Role of the Pharmacist in the Health Care System, WHO/PHARM/94.569. http://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.2.html#Jh2995e.1.6.2 (accessed on August15, 2015).
CDC, Implementing. accessed on November 15, HIV Testing in Nonclinical Settings: A Guide For HIV Testing Providers. https://www.cdc.gov/hiv/pdf/testing/CDC_HIV_Implementing_HIV_Testing_in_Nonclinical_Settings.pdf (2018).
CDC. (2020) HIV testing in retail pharmacies. https://www.cdc.gov/hiv/effective-interventions/diagnose/hiv-testing-in-retail-pharmacies?Sort=Title%3A%3Aasc&Intervention%20Name=HIV%20Testing%20in%20Retail%20Pharmacies (accessed on November 15, 2018).
Oseni YO, Afolabi MO. Development and evaluation of health promotion training programme for community pharmacists in Oyo State, Nigeria. Pedagogy Health Promot. 2020;6(4):296–304. https://doi.org/10.1177/2373379920918614 .
doi: 10.1177/2373379920918614
Kamps C. Practice spotlight: community pharmacy practice. Pract Spotlight. 2014;52(2):15–6. https://www.michiganpharmacists.org/Portals/0/patients/communitypharmacy.pdf .
Eddy E, Emmeline P, Alexander M. Community Pharmacists and Technicians: Impacting Public Health One Service at a Time. Pharmacy Times July 28, 2023. https://www.pharmacytimes.com/view/community-pharmacists-and-technicians-impacting-public-health-one-service-at-a-time
International Pharmaceutical Federation. World Health Organisation (FIP/WHO). The Role of the Pharmacist in the fight against The HIV-AIDS Pandemic. https://www.fip.org/file/1563 (accessed on December 15, 2018).
International Pharmaceutical Federation (FIP). 2004 FIP statement of policy point of care testing in pharmacies. https://www.fip.org/file/1500 (accessed on December 15, 2018).
UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2014. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf .
WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. Geneva, Switzerland: WHO; 2016.
UNAIDS. (2017) ‘Ending AIDS: Progress towards the 90-90-90 targets’ https://www.unaids.org/en/resources/documents/2017/20170720_Global_AIDS_update_2017
International Pharmaceutical Federation FIP. (2022) HIV prevention, screening and management, A handbook for pharmacists. https://www.fip.org/file/5342
Adje DU, Oparah AC, Williams FE, Ezeagwuna OO. Assessment of point of care testing services in community pharmacies in Delta State, Nigeria. J Sci Pract Pharm. 2016;3(1):115–20. https://doi.org/10.47227/jsppharm/v3i1.6 .
doi: 10.47227/jsppharm/v3i1.6
Walker R, Edwards C, editors. (2003) Clinical Pharmacy and Therapeutics (3rd Edition) London: Churchill Livingstone. Pape. 937.
Ayorinde AA, Porteous T, Sharma P. Screening for major diseases in community pharmacies: a systematic review. Int J Pharm Pract. 2013;21(6):349–61. https://doi.org/10.1111/ijpp.12041 .
doi: 10.1111/ijpp.12041
pubmed: 23683090
Beardsell S, Coyle A. A review of research on the nature and quality of HIV testing services: a proposal for process-based studies. Soc Sci Med. 1996;42(5):733–43. https://doi.org/10.1016/0277-9536(95)00145-x .
doi: 10.1016/0277-9536(95)00145-x
pubmed: 8685741
Kauffman Y, Nair V, Herist K, Thomas V, Weidle PJ. HIV medication therapy management services in community pharmacies. J Am Pharm Assoc (2003). 2012;52(6):e287–91. https://doi.org/10.1331/JAPhA.2012.12063 .
doi: 10.1331/JAPhA.2012.12063
pubmed: 23229993
McCree DH, Byrd KK, Johnston M, Gaines M, Weidle PJ. Roles for pharmacists in the ending the HIV Epidemic: a plan for America Initiative. Public Health Rep. 2020;135(5):547–54. https://doi.org/10.1177/0033354920941184 .
doi: 10.1177/0033354920941184
pubmed: 32780671
pmcid: 7485061