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Client experiences with “Dynamic Choice Prevention,” a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa 动态选择预防 "是东非农村地区以患者为中心灵活开展艾滋病预防工作的一种模式，其客户经验。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-17 DOI: 10.1002/jia2.26336
Carol S. Camlin, Titus Arunga, Jason Johnson-Peretz, Cecilia Akatukwasa, Fredrick Atwine, Angeline Onyango, Lawrence Owino, Moses R. Kamya, Maya L. Petersen, Gabriel Chamie, Elijah Kakande, Jane Kabami, Laura B. Balzer, Diane V. Havlir, James Ayieko

Introduction

Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients’ experiences of this “dynamic choice prevention model” (DCP) and highlight pathways of action to inform HIV prevention delivery models.

Methods

In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.

Results

Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners’ behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.

Conclusions

Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities—but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients

导言：确定提供艾滋病预防服务的最佳方法以满足高危人群的需求是当务之急，特别是考虑到生物医学艾滋病预防方案的工具包在不断扩大。一项正在东非农村社区进行的研究通过以患者为中心的结构化艾滋病预防服务模式，评估了对产品、检测模式和护理服务地点选择的接受程度。在这项定性研究中，我们试图了解客户对这种 "动态选择预防模式"（DCP）的体验，并强调行动路径，为艾滋病预防服务模式提供信息：从 2021 年 11 月到 2022 年 3 月，我们有目的性地抽取了 n = 56 名 DCP 试验参与者（横跨门诊部、产前诊所和社区环境）和 n = 21 名医疗服务提供者（总人数 n = 77），对他们进行了深入的半结构式访谈。一个由七人组成的跨地区团队对记录誊本数据进行了翻译和归纳编码。我们采用框架分析法来确定新出现的主题：结果：接受艾滋病暴露前预防疗法（PrEP）的个人报告称，他们感到如释重负，从对感染艾滋病的恐惧中解脱出来，并对能够不顾伴侣的行为而采取行动感到满意。夫妻双方利用该研究提供的一系列方法说服伴侣接受检测并选择 PrEP。暴露后预防（PEP）的使用并不普遍，尽管妇女欢迎在受到性胁迫或性侵犯时使用这种方法。参与者讨论了在熟悉使用方法并确定持续风险后从 PEP 转为 PrEP 的问题。参与者认为自己受到了医疗服务提供者的尊重，信任他们，并对能够直接与他们联系以获得电话支持表示感谢。阻碍采取预防措施的因素包括：耻辱感、对预防方法的经验和知识有限、亲密伴侣关系和家庭中的性别和代际权力动态，以及产品本身导致的对预防方法的负面看法。参与者预计，长效注射 PrEP 可以解决他们在药片大小、每日药片负担和意外披露可能性方面的难题：不同的偏好和接受预防的障碍需要选择不同的艾滋病预防方案、地点和提供方式--但此外，灵活、称职和友好的护理服务对于促进接受也至关重要。帮助客户感受到自己的价值，解决他们的独特需求和挑战，使他们能够优先考虑自己的健康。
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引用次数: 0
Academic accountability to local communities and society through Programme Science: a case study from the HPV self-sampling programme HOPE in Peru 通过 "计划科学 "对当地社区和社会承担学术责任：秘鲁人乳头瘤病毒（HPV）自采样计划 HOPE 的案例研究。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26297
Patricia Jannet Garcia, Carlos Santos, Marina Chiappe, María Valderrama, Cesar Paul Carcamo

Introduction

Health challenges in the 21st century underscore the need for adaptable and innovative approaches in public health. Academic institutions can and should contribute much more effectively to generate and translate scientific knowledge that will result in better programmes to improve societal health. Academic accountability to local communities and society requires universities to actively engage with local communities, understanding the context, their needs, and leveraging their knowledge and local experience. The Programme Science initiative provides a framework to optimize the scale, quality and impact of public health programmes, by integrating diverse approaches during the iterative cycle of research and practice within the strategic planning, programme implementation and programme management and evaluation. We illustrate how the Programme Science framework could be a useful tool for academic institutions to accomplish accountability to local communities and society through the experience of Project HOPE in Peru.

Discussion

Project HOPE applied the Programme Science framework to introduce HPV self-sampling into a women's health programme in Peru. Collaboration with local authorities and community members was pivotal in all phases of the project, ensuring interventions aligned with community needs and addressing social determinants of health. The HOPE Ladies—community women trained and empowered to promote and provide the HPV kits—crafted the messages used through the study and developed strategies to reach individuals and provided support to women's journey through health centres. By engaging communities in co-creating knowledge and addressing health inequities, academic institutions can generate contextually relevant and socially just scientific knowledge. The active participation of community women in Project HOPE was instrumental in improving service utilization and addressing barriers to self-sampling.

Conclusions

The Programme Science approach offers a pathway for academic institutions to enhance their accountability to communities and society at large. By embedding researchers within public health programmes and prioritizing community engagement, academic institutions can ensure that research findings directly inform policy improvements and programmatic decisions. However, achieving this requires a realignment of research agendas and recognition of the value of community engagement. Establishing Programme Science networks involving academia, government and funding entities can further reinforce academic accountability and en

导言：21 世纪的健康挑战凸显了在公共卫生领域采取适应性强的创新方法的必要性。学术机构可以而且应该更有效地促进科学知识的产生和转化，从而制定出更好的计划来改善社会健康。学术界要对当地社区和社会负责，就要求大学积极参与当地社区的活动，了解当地社区的背景和需求，并利用其知识和当地经验。计划科学倡议提供了一个框架，通过在战略规划、计划实施和计划管理与评估的研究与实践迭代周期中整合各种方法，优化公共卫生计划的规模、质量和影响。我们通过秘鲁 "希望工程 "的经验，说明计划科学框架如何成为学术机构对当地社区和社会负责的有用工具：讨论："希望工程 "应用 "计划科学 "框架，将人乳头瘤病毒（HPV）自我采样引入秘鲁的一项妇女健康计划。在项目的各个阶段，与地方当局和社区成员的合作都至关重要，确保干预措施符合社区需求，并解决健康的社会决定因素。HOPE Ladies--接受过培训并被授权推广和提供 HPV 套件的社区妇女--通过研究起草了所使用的信息，制定了接触个人的策略，并为妇女通过保健中心的旅程提供支持。通过让社区参与共同创造知识和解决健康方面的不平等问题，学术机构可以创造出符合实际情况和社会公正的科学知识。社区妇女对 "希望工程 "的积极参与有助于提高服务利用率和消除自我采样的障碍：计划科学方法为学术机构加强对社区和整个社会的责任提供了一条途径。通过将研究人员纳入公共卫生计划并优先考虑社区参与，学术机构可以确保研究成果直接为政策改进和计划决策提供信息。然而，要做到这一点，需要重新调整研究议程，并认识到社区参与的价值。建立由学术界、政府和资助实体参与的计划科学网络，可以进一步加强学术问责，提高公共卫生计划的影响力。
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引用次数: 0
Applying the Effective Programme Coverage framework to assess gaps in HIV prevention programmes for female sex workers and men who have sex with men in Nairobi, Kenya: findings from an expanded Polling Booth Survey 应用有效方案覆盖框架评估肯尼亚内罗毕女性性工作者和男男性行为者艾滋病毒预防方案的差距：扩大投票站调查的结果。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26240
Parinita Bhattacharjee, Leigh McClarty, Shajy Isac, Joshua Kimani, Faran Emmanuel, Rhoda Kabuti, Antony Kinyua, Bernadette Kina Kombo, Collins Owek, Helgar Musyoki, Anthony Kiplagat, Peter Arimi, Souradet Yuh-Nan Shaw, Monica Gandhi, Siobhan Malone, James Blanchard, Geoff Garnett, Marissa L. Becker

Introduction

Measuring the coverage of HIV prevention services for key populations (KPs) has consistently been a challenge for national HIV programmes. The current frameworks and measurement methods lack emphasis on effective coverage, occur infrequently, lack timeliness and limit the participation of KPs. The Effective Programme Coverage framework, which utilizes a programme science approach, provides an opportunity to assess gaps in various coverage domains and explore the underlying reasons for these gaps, in order to develop targeted solutions. We have demonstrated the application of this framework in partnership with the KP community in Nairobi, Kenya, using an expanded Polling Booth Survey (ePBS) method.

Methods

Data were collected between April and May 2023 among female sex workers (FSWs) and men who have sex with men (MSM) using (a) PBS, (b) bio-behavioural survey and (c) focus group discussions. Data collection and analysis involved both KP community and non-community researchers. Descriptive analysis was performed, and proportions were used to assess the programme coverage gaps. The data were weighted to account for the sampling design and unequal selection probabilities. Thematic analysis was conducted on the qualitative data.

Results

The condom programme for FSW and MSM had low availability (60.2% and 50.9%), contact (68.8% and 65.9%) and utilization (52.1% and 43.9%) coverages. The pre-exposure prophylaxis (PrEP) programme had very low utilization coverage for FSW and MSM (4.4% and 2.8%), while antiretroviral therapy utilization coverage was higher (86.6% and 87.7%). Reasons for coverage gaps included a low peer educator-to-peer ratio, longer distance to the clinics, shortage of free condoms supplied by the government, experienced and anticipated side effects related to PrEP, and stigma and discrimination experienced in the facilities.

Conclusions

The Effective Programme Coverage framework allows programmes to assess coverage gaps and develop solutions and a research agenda targeted at specific domains of coverage with large gaps. The ePBS method works well in collecting data to understand coverage gaps rapidly and allows for the engagement of the KP community.

导言：衡量艾滋病毒预防服务对重点人群（KPs）的覆盖率一直是国家艾滋病毒计划面临的挑战。目前的框架和衡量方法缺乏对有效覆盖率的重视，不经常出现，缺乏及时性，并限制了关键人群的参与。有效计划覆盖率框架采用计划科学的方法，提供了一个机会来评估各个覆盖领域的差距，并探索造成这些差距的根本原因，从而制定有针对性的解决方案。我们与肯尼亚内罗毕的 KP 社区合作，采用扩大投票站调查 (ePBS) 方法展示了这一框架的应用：方法：2023 年 4 月至 5 月期间，我们使用（a）投票站调查（PBS）、（b）生物行为调查和（c）焦点小组讨论，在女性性工作者（FSWs）和男男性行为者（MSM）中收集了数据。金伯利进程社区和非社区研究人员参与了数据收集和分析工作。对数据进行了描述性分析，并使用比例来评估计划覆盖范围的差距。考虑到抽样设计和不平等的选择概率，对数据进行了加权处理。对定性数据进行了专题分析：针对性工作者和男男性行为者的安全套计划的可用率（60.2% 和 50.9%）、接触率（68.8% 和 65.9%）和使用率（52.1% 和 43.9%）均较低。暴露前预防（PrEP）计划在女性同性恋者和男男性行为者中的使用覆盖率很低（4.4% 和 2.8%），而抗逆转录病毒疗法的使用覆盖率较高（86.6% 和 87.7%）。造成覆盖率差距的原因包括同伴教育者与同伴的比例较低、距离诊所较远、政府提供的免费安全套短缺、与 PrEP 相关的经验和预期副作用，以及在医疗机构中遭受的羞辱和歧视：有效计划覆盖范围框架允许计划评估覆盖范围的差距，并针对差距较大的特定覆盖范围制定解决方案和研究议程。ePBS 方法能很好地收集数据，迅速了解覆盖面的差距，并让 KP 社区参与进来。
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引用次数: 0
Community contexts and knowledge: accountability, leadership and meaningful involvement of communities in Programme Science 社区背景与知识：社区对计划科学的责任感、领导力和有意义的参与。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26281
Ruth Morgan Thomas, Andrew Spieldenner, Erika Castellanos, Judy Chang, Jules Kim

Introduction

A Programme Science approach that prioritizes populations who will benefit most and ensuring resources are allocated to programmes that meet the needs of those populations will bring an equity focus to research. Gay men and other men who have sex with men, people who use drugs, sex workers of all genders, and trans and gender-diverse people, defined by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) as key populations, have been disproportionately impacted since the start of the HIV pandemic. Through documenting community experiences from global key population-led networks, the authors explore the potential value and impact of community-led organizations and service delivery as critical components in effective HIV and Sexually Transmitted infections (STI) programmes.

Discussion

Through advocacy and research interventions, global key population networks have identified barriers against scaling up interventions for criminalized and marginalized communities, as well as highlighted solutions. The authors examine some of the current barriers to meaningful involvement of communities and the scaling up of community-led programmes that need to be addressed if Programme Science is to maintain an equity lens and the needs of key populations are to be met and highlight the need to make visible community engagement and participation in embedded research and Programme Science.

Conclusions

The Programme Science approach provides an important opportunity to understand practical issues that will increase effective coverage in the implementation of public health and other interventions, which will require the prioritizing of key populations and their priorities in HIV and STI programmes. It will require extensive time and work to build relationships, increase capacity and share power. Where this has already happened, it has resulted in positive outcomes, including better health outcomes, reduced stigma, increased agency for key populations, and built community-led organizations and responses.

导言：计划科学 "方法优先考虑受益最大的人群，并确保将资源分配给满足这些人群需求的计划，这将为研究工作带来公平的重点。男同性恋和其他男男性行为者、吸毒者、各种性别的性工作者以及变性人和性别多元化人群，被联合国艾滋病规划署（UNAIDS）和全球抗击艾滋病、结核病和疟疾基金（Global Fund）定义为关键人群，自艾滋病开始流行以来，他们受到了极大的影响。通过记录全球关键人群领导网络的社区经验，作者探讨了社区领导的组织和服务提供作为有效的艾滋病和性传播感染（STI）计划关键组成部分的潜在价值和影响：通过宣传和研究干预，全球关键人群网络发现了扩大对犯罪和边缘化社区干预的障碍，并强调了解决方案。作者研究了目前在社区有意义的参与和扩大社区主导计划方面存在的一些障碍，如果计划科学要保持公平视角并满足关键人群的需求，就需要解决这些障碍，并强调有必要使社区参与嵌入式研究和计划科学：计划科学方法为了解实际问题提供了一个重要机会，这些问题将增加公共卫生和其他干预措施实施的有效覆盖面，这将需要在艾滋病毒和性传播感染计划中优先考虑重点人群及其优先事项。这需要大量的时间和工作来建立关系、提高能力和分享权力。在已经这样做的地方，已经取得了积极的成果，包括更好的卫生成果、减少污名化、提高关键人群的能动性，以及建立社区主导的组织和应对措施。
{"title":"Community contexts and knowledge: accountability, leadership and meaningful involvement of communities in Programme Science","authors":"Ruth Morgan Thomas,&nbsp;Andrew Spieldenner,&nbsp;Erika Castellanos,&nbsp;Judy Chang,&nbsp;Jules Kim","doi":"10.1002/jia2.26281","DOIUrl":"10.1002/jia2.26281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A Programme Science approach that prioritizes populations who will benefit most and ensuring resources are allocated to programmes that meet the needs of those populations will bring an equity focus to research. Gay men and other men who have sex with men, people who use drugs, sex workers of all genders, and trans and gender-diverse people, defined by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) as key populations, have been disproportionately impacted since the start of the HIV pandemic. Through documenting community experiences from global key population-led networks, the authors explore the potential value and impact of community-led organizations and service delivery as critical components in effective HIV and Sexually Transmitted infections (STI) programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Through advocacy and research interventions, global key population networks have identified barriers against scaling up interventions for criminalized and marginalized communities, as well as highlighted solutions. The authors examine some of the current barriers to meaningful involvement of communities and the scaling up of community-led programmes that need to be addressed if Programme Science is to maintain an equity lens and the needs of key populations are to be met and highlight the need to make visible community engagement and participation in embedded research and Programme Science.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Programme Science approach provides an important opportunity to understand practical issues that will increase effective coverage in the implementation of public health and other interventions, which will require the prioritizing of key populations and their priorities in HIV and STI programmes. It will require extensive time and work to build relationships, increase capacity and share power. Where this has already happened, it has resulted in positive outcomes, including better health outcomes, reduced stigma, increased agency for key populations, and built community-led organizations and responses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Programme science in action: lessons from an observational study of HIV prevention programming for key populations in Lusaka, Zambia 行动中的计划科学：赞比亚卢萨卡重点人群艾滋病预防计划观察研究的经验教训。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26237
Izukanji Sikazwe, Maurice Musheke, Kanema Chiyenu, Benard Ngosa, Jake M. Pry, Chama Mulubwa, Martin Zimba, Martin Sakala, Mphatso Sakala, Paul Somwe, Goodwin Nyirenda, Theodora Savory, Carolyn Bolton-Moore, Michael E. Herce

Introduction

Optimizing uptake of pre-exposure prophylaxis (PrEP) for individuals at risk of HIV acquisition has been challenging despite clear scientific evidence and normative guidelines, particularly for key populations (KPs) such as men who have sex with men (MSM), female sex workers (FSWs), transgender (TG) people and persons who inject drugs (PWID). Applying an iterative Programme Science cycle, building on the effective programme coverage framework, we describe the approach used by the Centre for Infectious Disease Research in Zambia (CIDRZ) to scale up PrEP delivery and address inequities in PrEP access for KP in Lusaka, Zambia.

Methods

In 2019, CIDRZ partnered with 10 local KP civil society organizations (CSOs) and the Ministry of Health (MOH) to offer HIV services within KP-designated community safe spaces. KP CSO partners led KP mobilization, managed safe spaces and delivered peer support; MOH organized clinicians and clinical commodities; and CIDRZ provided technical oversight. In December 2021, we introduced a community-based intervention focused on PrEP delivery in venues where KP socialize. We collected routine programme data from September 2019 to June 2023 using programme-specific tools and the national electronic health record. We estimated the before-after effects of our intervention on PrEP uptake, continuation and equity for KP using descriptive statistics and interrupted time series regression, and used mixed-effects regression to estimate marginal probabilities of PrEP continuity.

Results

Most (25,658) of the 38,307 (67.0%) Key Population Investment Fund beneficiaries were reached with HIV prevention services at community-based venues. In total, 23,527 (61.4%) received HIV testing services, with 15,508 (65.9%) testing HIV negative and found PrEP eligible, and 15,241 (98.3%) initiating PrEP. Across all programme quarters and KP types, PrEP uptake was >90%. After introducing venue-based PrEP delivery, PrEP uptake (98.7% after vs. 96.5% before, p < 0.001) and the number of initiations (p = 0.014) increased significantly. The proportion of KP with ≥1 PrEP continuation visit within 6 months of initiation was unchanged post-intervention (46.7%, 95% confidence interval [CI]: 45.7%, 47.6%) versus pre-intervention (47.2%, 95% CI: 45.4%, 49.1%).

Conclusions

Applying Programme Science principles, we demonstrate how decentralizing HIV prevention services to KP venues and safe s

导言：尽管有明确的科学证据和规范性指南，但优化暴露前预防措施（PrEP）对艾滋病高危人群的吸收率一直是一项挑战，尤其是对男男性行为者（MSM）、女性性工作者（FSW）、变性人（TG）和注射毒品者（PWID）等关键人群而言。在有效计划覆盖框架的基础上，我们采用了迭代计划科学周期，介绍了赞比亚传染病研究中心（CIDRZ）为扩大 PrEP 的实施范围并解决赞比亚卢萨卡 KP 在获得 PrEP 方面的不平等而采用的方法：2019 年，CIDRZ 与当地 10 个 KP 民间社会组织 (CSO) 和卫生部 (MOH) 合作，在 KP 指定的社区安全空间内提供 HIV 服务。KP 民间社会组织合作伙伴领导 KP 的动员工作，管理安全空间并提供同伴支持；卫生部组织临床医生和临床商品；CIDRZ 提供技术监督。2021 年 12 月，我们推出了一项社区干预措施，重点是在金伯利进程社交场所提供 PrEP。从 2019 年 9 月到 2023 年 6 月，我们使用计划专用工具和国家电子健康记录收集了常规计划数据。我们使用描述性统计和间断时间序列回归估算了干预措施对 KP 的 PrEP 摄入、持续性和公平性的前后影响，并使用混合效应回归估算了 PrEP 持续性的边际概率：主要人口投资基金的 38,307 名受益者中，大部分（25,658 人）（67.0%）在社区场所接受了艾滋病预防服务。共有 23 527 人（61.4%）接受了艾滋病毒检测服务，其中 15 508 人（65.9%）艾滋病毒检测呈阴性，符合 PrEP 条件，15 241 人（98.3%）启动了 PrEP。在所有计划季度和 KP 类型中，PrEP 的接受率均超过 90%。在引入基于场所的 PrEP 服务后，PrEP 的摄取率（实施后为 98.7%，实施前为 96.5%，p 结论：我们运用 "计划科学 "原则，展示了如何通过与 KP 民间组织合作，将艾滋病预防服务下放到 KP 的场所和安全空间，从而成功地在传统的设施服务范围之外提供基于社区的 PrEP 服务。
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引用次数: 0
Using a Programme Science approach to substantially reduce the risk of HIV transmission and acquisition in sex transactions among female sex workers in Zimbabwe 采用 "计划科学 "方法，大幅降低津巴布韦女性性工作者在性交易中传播和感染艾滋病毒的风险。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26262
Frances M. Cowan, Sithembile Musemburi, Primrose Matambanadzo, Phillip Chida, Richard Steen, Rumbidzo Makandwa, Sungai T. Chabata, Albert Takura, Amber Sheets, Raymond Yekeye, Owen Mugurungi, Bernadette Hensen, Joanna Busza, James R. Hargreaves

Introduction

We used a Programme Science platform, to generate evidence to support the implementation of programmes for sex workers in Africa. Female sex workers are estimated to make up 1.6% (1.3%–1.8%) of the population of women aged 15−49 years in Zimbabwe. We highlight how programme science can be used to help distinguish between when, where and with whom programmes need to be implemented and discuss two case studies that exemplify implementing better (Case study 1 (1 June 2019−30 June 2021) Optimizing implementation of a risk differentiated microplanning intervention) and implementing differently (Case study 2 (1 October 2016−30 September 2022) Reorientating implementation of DREAMS for young women selling sex).

Methods

Zimbabwe's nationally scaled programme for sex workers was established in 2009 in partnership with sex workers to provide comprehensive services for sex workers and generate evidence for programme design, implementation and scale up. Since inception, comprehensive data have been collected from all sex workers seeking services. As the scope of service provision has expanded so has the scope of data collection and analysis. At enrolment, sex workers are assigned an alphanumeric unique identifier which links consultations within and across programme sites. We conduct descriptive analyses of the Key Population (KP) programme data to guide programme implementation and redesign, embedding programmatic qualitative enquiry as required.

Results

Two case studies describing different approaches to programme optimization are presented. In the first, an optimization exercise was used to strengthen programme implementation ensuring that the KP programme got back on track after SARS-COV-2. In the second, an in-depth review of research and programme data led to a re-orientation of the DREAMS programme to ensure that young women at the highest risk of HIV acquisition were enrolled and had access to DREAMS social support interventions in turn strengthening their uptake of HIV prevention.

Conclusions

Optimizing and sustaining HIV care and treatment programmes requires effective delivery with sufficient scale and intensity for population impact. Our programme science approach guided the scale up of the KP programme in Zimbabwe, providing evidence to support strategy, implementation and ongoing management, and importantly helping us distinguish between when we needed to just implement, implement better or im

简介我们利用 "计划科学 "平台，为非洲性工作者计划的实施提供证据支持。在津巴布韦，女性性工作者估计占 15-49 岁女性人口的 1.6%（1.3%-1.8%）。我们强调了如何利用计划科学来帮助区分计划实施的时间、地点和对象，并讨论了两个案例研究，分别说明了如何更好地实施计划（案例研究 1（2019 年 6 月 1 日至 2021 年 6 月 30 日）优化风险差异化微观计划干预措施的实施）和以不同方式实施计划（案例研究 2（2016 年 10 月 1 日至 2022 年 9 月 30 日）调整针对年轻卖春女性的 DREAMS 计划的实施方向）：津巴布韦的全国性性工作者计划于 2009 年与性工作者合作建立，旨在为性工作者提供全面服务，并为计划的设计、实施和推广提供证据。自该计划启动以来，已从所有寻求服务的性工作者那里收集了全面的数据。随着服务范围的扩大，数据收集和分析的范围也在扩大。在登记时，性工作者会被分配一个字母数字的唯一标识符，该标识符可将计划站点内部和站点之间的咨询联系起来。我们对关键人群（KP）计划数据进行描述性分析，以指导计划的实施和重新设计，并根据需要纳入计划定性调查：结果：本报告介绍了两个案例研究，描述了不同的计划优化方法。在第一个案例中，利用优化工作加强了计划的实施，确保了重点人群计划在第二次非典之后重新走上正轨。在第二项计划中，通过对研究和计划数据的深入审查，对 DREAMS 计划进行了重新定位，以确保感染艾滋病毒风险最高的年轻妇女能够加入该计划并获得 DREAMS 社会支持干预措施，从而加强她们对艾滋病毒预防措施的吸收：要优化和持续开展艾滋病护理和治疗计划，就必须有效地实施计划，并使其具有足够的规模和强度，从而对人群产生影响。我们的计划科学方法为津巴布韦扩大 KP 计划的规模提供了指导，为战略、实施和持续管理提供了证据支持，更重要的是帮助我们区分了何时需要实施、更好地实施或以不同的方式实施。
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引用次数: 0
A sub-national HIV epidemic appraisal in Kenya: a new approach for identifying priority geographies, populations and programmes for optimizing coverage for HIV prevention 肯尼亚国家以下一级艾滋病毒疫情评估：确定优先地域、人口和方案以优化艾滋病毒预防覆盖面的新方法。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26245
Ramesh Banadakoppa Manjappa, Parinita Bhattacharjee, Souradet Yuh-Nan Shaw, Joshua Gitonga, Japheth Kioko, Franklin Songok, Faran Emmanuel, Peter Arimi, Helgar Musyoki, Ruth Laibon Masha, James Blanchard

Introduction

The HIV Prevention 2025 Roadmap, developed by UNAIDS, recommends the adoption of a precision prevention approach focused on priority populations and geographies. With reduction in new HIV acquisitions in many countries, designing a differentiated HIV prevention response, using a Programme Science approach, based on the understanding of the epidemic and transmission dynamics at a sub-national level, is critical.

Methods

To support strategic planning, an epidemic appraisal at the sub-national level across 47 counties, with the 2019 population ranging from 0.14 million in Lamu to 4.40 million in Nairobi City, was conducted in Kenya using several existing data sources. Using 2021 Spectrum/EPP/Naomi model estimates of national and sub-national HIV incidence and prevalence, counties with high HIV incidence and prevalence were identified for geographic prioritization. The size of local key population (KP) networks and HIV prevalence in key and general populations were used to define epidemic typology and prioritize populations for HIV prevention programmes. Analysis of routine programme monitoring data for 2021 was used to assess coverage gaps in HIV prevention programmes, including prevention of vertical transmission, anti-retroviral therapy, KP programmes, adolescent girls and young women programme, and voluntary male medical circumcision programme.

Results

Ten counties with more than 1000 incident acquisitions in 2021 accounted for 57% of new acquisitions. Twenty-four counties were grouped into the concentrated epidemic type—due to their low prevalence in the general population, high prevalence in KPs and relatively higher density of female sex workers and men who have sex with men populations. Four counties reflected a generalized epidemic, where HIV prevalence was more than 10% and 30%, respectively, among the general and key populations. The remaining 19 counties were classified as having mixed epidemics. Gaps in programmes were identified and counties where these gaps need to be addressed were also prioritized.

Conclusions

The HIV burden in Kenya is unevenly distributed and hence the mix of prevention strategies may vary according to the epidemic typology of the county. Prioritization of programmes based not only on disease burden and epidemic typology, but also on the prevailing gaps in coverage for reducing inequities is a key aspect of this appraisal.

导言：联合国艾滋病规划署（UNAIDS）制定的《2025 年艾滋病预防路线图》建议采取以优先人群和地区为重点的精准预防方法。随着许多国家新感染艾滋病毒的人数减少，在了解国家以下一级的疫情和传播动态的基础上，采用 "计划科学 "方法设计有区别的艾滋病毒预防对策至关重要：为了支持战略规划，肯尼亚利用现有的几个数据源，在国家以下层面对 47 个县进行了流行病评估，这些县的 2019 年人口从拉穆的 14 万到内罗毕市的 440 万不等。利用 2021 年 Spectrum/EPP/Naomi 模型对国家和国家以下各级艾滋病毒发病率和流行率的估计，确定了艾滋病毒发病率和流行率较高的县，以确定地域优先次序。当地重点人群（KP）网络的规模以及重点人群和普通人群中的艾滋病毒感染率被用来确定流行病类型，并为艾滋病毒预防计划确定优先人群。通过分析 2021 年的常规计划监测数据，评估了艾滋病毒预防计划的覆盖差距，包括预防垂直传播、抗逆转录病毒疗法、重点人群计划、少女和年轻妇女计划以及自愿男性包皮环切术计划：2021 年感染人数超过 1000 人的 10 个县占新感染人数的 57%。24 个县被归类为集中流行型--因为它们在普通人群中的流行率低，在科索沃人中的流行率高，女性性工作者和男性同性性行为者的密度相对较高。有 4 个县属于普遍流行型，普通人群和重点人群的艾滋病毒感染率分别超过 10%和 30%。其余 19 个县被归类为混合流行。确定了方案中的差距，并将需要弥补这些差距的县列为优先事项：肯尼亚的艾滋病毒负担分布不均，因此预防战略的组合可能因各县的流行病类型而异。不仅要根据疾病负担和流行病类型，还要根据覆盖范围的普遍差距来确定方案的优先次序，以减少不公平现象，这是本次评估的一个关键方面。
{"title":"A sub-national HIV epidemic appraisal in Kenya: a new approach for identifying priority geographies, populations and programmes for optimizing coverage for HIV prevention","authors":"Ramesh Banadakoppa Manjappa,&nbsp;Parinita Bhattacharjee,&nbsp;Souradet Yuh-Nan Shaw,&nbsp;Joshua Gitonga,&nbsp;Japheth Kioko,&nbsp;Franklin Songok,&nbsp;Faran Emmanuel,&nbsp;Peter Arimi,&nbsp;Helgar Musyoki,&nbsp;Ruth Laibon Masha,&nbsp;James Blanchard","doi":"10.1002/jia2.26245","DOIUrl":"10.1002/jia2.26245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The HIV Prevention 2025 Roadmap, developed by UNAIDS, recommends the adoption of a precision prevention approach focused on priority populations and geographies. With reduction in new HIV acquisitions in many countries, designing a differentiated HIV prevention response, using a Programme Science approach, based on the understanding of the epidemic and transmission dynamics at a sub-national level, is critical.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To support strategic planning, an epidemic appraisal at the sub-national level across 47 counties, with the 2019 population ranging from 0.14 million in Lamu to 4.40 million in Nairobi City, was conducted in Kenya using several existing data sources. Using 2021 Spectrum/EPP/Naomi model estimates of national and sub-national HIV incidence and prevalence, counties with high HIV incidence and prevalence were identified for geographic prioritization. The size of local key population (KP) networks and HIV prevalence in key and general populations were used to define epidemic typology and prioritize populations for HIV prevention programmes. Analysis of routine programme monitoring data for 2021 was used to assess coverage gaps in HIV prevention programmes, including prevention of vertical transmission, anti-retroviral therapy, KP programmes, adolescent girls and young women programme, and voluntary male medical circumcision programme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten counties with more than 1000 incident acquisitions in 2021 accounted for 57% of new acquisitions. Twenty-four counties were grouped into the concentrated epidemic type—due to their low prevalence in the general population, high prevalence in KPs and relatively higher density of female sex workers and men who have sex with men populations. Four counties reflected a generalized epidemic, where HIV prevalence was more than 10% and 30%, respectively, among the general and key populations. The remaining 19 counties were classified as having mixed epidemics. Gaps in programmes were identified and counties where these gaps need to be addressed were also prioritized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HIV burden in Kenya is unevenly distributed and hence the mix of prevention strategies may vary according to the epidemic typology of the county. Prioritization of programmes based not only on disease burden and epidemic typology, but also on the prevailing gaps in coverage for reducing inequities is a key aspect of this appraisal.</p>\u0000 </section>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Programme Science in PEPFAR: a pathway to a sustainable HIV response PEPFAR 中的计划科学：实现可持续艾滋病毒防治的途径。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26244
Michael J. A. Reid, Rebecca Bunnell, Emily Kainne Dokubo, John Nkengasong

Since its inception, the President's Emergency Plan For AIDS Relief (PEPFAR) has had an unprecedented impact on the global HIV epidemic. In the past 20 years, PEPFAR has saved more than 25 million lives, supporting over 20 million people with life-saving treatment across 55 countries [1]. From the beginning, its programmes have relied on the best scientific insights and biomedical discoveries to advance the strategic HIV agenda. Moving forward, PEPFAR faces numerous important challenges in supporting partner countries to achieve the UNAIDS targets of ensuring that 95% of people with HIV know their status, 95% of those are on treatment and 95% of those are virologically suppressed [2], and achieving its goal of ending the HIV pandemic as a public health threat by 2030. As such, it is important to consider how Programme Science—an approach that emphasizes the need for context-specific evidence and knowledge generated on an ongoing basis, to inform the timely and strategic programmatic decisions [3, 4]—can help ensure that PEPFAR programmes implement the right set of context-specific interventions to achieve and sustain the changes essential for HIV prevention and treatment outcomes. In this paper, we detail (1) the evolving challenges and opportunities PEPFAR faces in achieving 95-95-95, (2) how Programme Science can be strategically applied to overcome these challenges, and (3) the necessary adaptations needed to sustain HIV programmes, informed by the best, contextually relevant science.

As PEPFAR and its partners intensify efforts to achieve the UNAIDS targets and sustain the progress achieved, they face a range of complex and urgent health challenges. Addressing these challenges requires a Programme Science approach that is responsive to diverse real-world contexts—be they geographical, organizational or sociological [5].

One of the most urgent challenges PEPFAR programmes face is reaching those populations that are not effectively covered by existing services. This is especially true in many countries with high HIV burden, where there is a pressing and urgent need to devise innovative approaches to engage adolescents and young women who are at inordinate risk of HIV acquisition. Equally important is the provision of targeted interventions for specific key and priority groups like men who have sex with men and female sex workers, who often face significant barriers in accessing health services due to stigma, discrimination, and legal and human rights issues.

Another critical area of focus is supporting continuity of care for people living with HIV who have been linked to HIV services. Across PEPFAR programmes, over 450,000 persons experienced interruptions in treatment at some point in the third quarter of 2023 [6]. As such, supporting clients to stay engaged in lifelong care necessitates the identification and implementation of a tailored mix of

要实现 PEPFAR 战略计划中概述的目标，需要改变计划为科学提供信息的方式，以及如何和何时利用科学来制定计划。这就要求艾滋病毒防治计划在确定如何利用科学来弥补艾滋病毒防治服务提供方面的差距，以及确定如何最好地推广新的综合服务提供模式或潜在的变革性生物医学工具方面发挥主要作用。今后，PEPFAR 将在受支持的国家和地区规划未来的计划，为计划科学做出贡献，同时也鼓励其他从事艾滋病防治工作的人员扩大对计划科学的贡献。PEPFAR 即将发布的《国家业务规划指南》将强调 "计划科学 "对于 PEPFAR 支持的国家和地区计划在其业务规划过程中优先考虑的重要性，旨在解决每个国家或地区特有的战略优先事项和计划差距。将计划科学纳入业务规划，PEPFAR 可以更好地弥补已确定的知识和实践差距，确保干预措施既有科学依据，在全球不同背景下切实可行，又能响应当地的战略优先事项。下一步的关键工作是，与各国卫生部、国家公共卫生机构、当地学术合作伙伴和社区领导层合作，增强各国艾滋病计划的能力，以确定计划科学在哪些方面可以帮助弥补差距，确保在必要的时间和规模上为计划提供证据信息，从而产生影响。建立利用计划科学为战略规划和资源分配提供信息的能力，可确保各项计划不断应对艾滋病毒流行病的演变，并确保提供所需的生物医学和临床工具以及基本资源。赞比亚提供了一个有用的范例，说明了这一方法如何发挥作用；卫生部在总统艾滋病紧急救援计划的技术和有限资金支持下管理的一个数据中心，正在使用严格的分析方法对计划数据进行分析，以了解如何以及在哪些方面改进计划最有可能产生影响。赞比亚的例子还说明，将 "计划科学 "纳入 PEPFAR 国家计划的运作方式，也有助于推动 PEPFAR 对可持续发展、加强公共卫生系统和变革性伙伴关系的承诺[16]。随着 PEPFAR 进入应对艾滋病毒大流行的新阶段，必须确保政策和战略既以证据为基础，又适合不同社区和地区的独特挑战。因此，"总统艾滋病紧急救援计划 "致力于采取必要步骤，确保艾滋病毒防治计划获得授权，并有能力开展计划科学所需的各类分析，从而改进计划。我们正在明确地在我们的供资和政策指导中设计新的流程和机制，为加快进展所需的科学和创新营造有利环境。这些变化可以确保每个国家都能实现 95-95-95 的目标，确保 PEPFAR 计划能够继续适应不断变化的流行病，同时赋予当地相关利益方权力，使其在利用科学改进计划方面发挥主导作用。第一稿由马约尔撰写，所有其他作者对随后的草稿进行了修改和编辑。所有作者都审阅了提交的最终草案。
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引用次数: 0
Advancing Programme Science approaches to understand gaps in HIV prevention programme coverage for key populations in 12 Nigerian states: findings from the 2020 Integrated Biological and Behavioural Surveillance Survey 推进方案科学方法，了解尼日利亚 12 个州重点人群艾滋病毒预防方案覆盖面的差距：2020 年生物和行为综合监测调查的结果。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26269
Leigh M. McClarty, Kalada Green, Stella Leung, Chukwuebuka Ejeckam, Adediran Adesina, Souradet Y. Shaw, Bronwyn Neufeld, Shajy Isac, Faran Emmanuel, James F. Blanchard, Gambo Aliyu

Introduction

Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions—condoms, HIV testing, and needle and syringe programmes (NSP)—among four key population groups—female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people.

Methods

Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps.

Results

Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets.

Conclusions

Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to

导言：要实现尼日利亚到 2030 年根除这一流行病的目标，就必须实现艾滋病毒预防计划的有效覆盖。最近的证据突显了全国在服务覆盖面和利用率方面存在的差距。有效计划覆盖范围框架是一项计划科学工具，通过使用计划嵌入式研究和学习所产生的数据来检查计划覆盖范围的差距，从而优化计划对人群的影响。我们利用尼日利亚的综合生物和行为监测调查（IBBSS）数据应用了该框架，研究了四种预防干预措施--避孕套、HIV 检测、针头和注射器计划（NSP）--在四个关键人群--女性性工作者（FSW）、男男性行为者（MSM）、注射吸毒者（PWID）和变性人--中的覆盖情况：对尼日利亚 2020 年在 12 个州实施的 IBBSS 数据进行了分析，以研究艾滋病毒预防计划在重点人群中的覆盖情况。针对每个重点人群和相关预防干预措施，利用加权的 IBBSS 数据回顾性地生成覆盖范围级联，以确定和量化覆盖范围的差距。所需的覆盖目标参考了尼日利亚国家艾滋病毒/艾滋病战略框架中阐明的目标，如果没有，则参考政策规范机构的指导方针。可用性、外联和利用率等覆盖替代指标是利用国际基础科学统计系统数据收集工具中的变量定义的。Sankey 图表直观地显示了参与者在覆盖率级联步骤之间的路径：结果：在所有主要人群中，HIV 检测和 NSP 的覆盖率均未达到要求。安全套的使用覆盖率在女性外阴残割者和男男性行为者中超过了规定的覆盖目标，而只有女性外阴残割者的使用覆盖率超过了 90% 的规定覆盖目标。所有关键人群的外展覆盖率都很低，低于所有要求的覆盖目标：我们的研究结果表明，尼日利亚重点人群的艾滋病预防计划覆盖率存在重大差距，并显示出覆盖率级联的非线性变化，这表明需要创新的解决方案来优化预防服务的覆盖率。需要开展方案嵌入式研究，以更好地了解尼日利亚的重点人群如何获取和使用不同的艾滋病预防服务，从而优化方案、政策和资源分配决策，以实现有效的方案覆盖和人群影响。
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引用次数: 0
Programme science methodologies and practices that address “FURRIE” challenges: examples from the field 应对 "FURRIE "挑战的计划科学方法和实践：来自实地的实例。
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2024-07-10 DOI: 10.1002/jia2.26283
James R Hargreaves, Solange Baptiste, Parinita Bhattacharjee, Frances M Cowan, Michael E Herce, Krista Lauer, Izukanji Sikazwe, Elvin Geng

Introduction

“Programme science” deploys scientific methods to address questions that are a priority to support the impact of public health programmes. As such, programme science responds to the challenges of making such studies: (1) feasible to undertake, (2) useful, (3) rigorous, (4) real-world-relevant, (5) informative, and undertaken by (6) equitable partnerships. The acronym “FURRIE” is proposed to describe this set of six challenges. This paper discusses selected HIV/STI (sexually transmitted infection) programme science case studies to illustrate how programme science rises to the FURRIE challenges.

Discussion

One way in which programme science is made more feasible is through the analysis and interpretation of data collected through service delivery. For some questions, these data can be augmented through methods that reach potential clients of services who have not accessed services or been lost to follow-up. Process evaluation can enhance the usefulness of programme science by studying implementation processes, programme−client interactions and contextual factors. Ensuring rigour by limiting bias and confounding in the real-world context of programme science studies requires methodological innovation. Striving for scientific rigour can also have the unintended consequence of creating a gap between what happens in a study, and what happens in the “real-world.” Community-led monitoring is one approach to grounding data collection in the real-world experience of clients. Evaluating complex, context-specific strategies to strengthen health outcomes in a way that is informative for other settings requires clear specification of the intervention packages that are planned and delivered in practice. Programme science provides a model for equitable partnership through co-leadership between programmes, researchers and the communities they serve.

Conclusions

Programme science addresses the FURRIE challenges, thereby improving programme impact and ultimately health outcomes and health equity. The adoption and adaptation of the types of novel programme science approaches showcased here should be promoted within and beyond the HIV/STI field.

导言："计划科学 "运用科学方法来解决优先支持公共卫生计划影响的问题。因此，"计划科学 "要应对以下挑战：(1) 开展此类研究的可行性；(2) 实用性；(3) 严谨性；(4) 与现实世界相关性；(5) 信息性；(6) 公平的伙伴关系。本文提出了首字母缩写词 "FURRIE "来描述这六大挑战。本文讨论了部分 HIV/STI（性传播感染）计划科学案例研究，以说明计划科学如何应对 FURRIE 挑战：使计划科学更加可行的方法之一是分析和解释通过提供服务收集到的数据。对于某些问题，可以通过接触尚未获得服务或失去后续服务的潜在服务对象的方法来扩充这些数据。过程评估可以通过研究实施过程、计划与客户之间的互动以及背景因素来提高计划 科学的实用性。在计划科学研究的真实世界背景下，要通过限制偏差和混杂因素来确保严谨性，就需要在方法上进行创新。力求科学严谨也可能产生意想不到的后果，即在研究中发生的事情与 "现实世界 "中发生的事情之间产生差距。以社区为主导的监测是将数据收集工作建立在客户实际经验基础上的一种方法。要评估复杂的、针对具体情况的战略，以加强健康成果，并为其他环境提供信息，就需要明确说明在实践中计划和实施的一揽子干预措施。计划科学通过计划、研究人员和他们所服务的社区之间的共同领导，为公平的伙伴关系提供了一种模式：结论：计划科学解决了 FURRIE 面临的挑战，从而提高了计划的影响力，并最终改善了卫生成果和卫生公平性。应在艾滋病毒/性传播感染领域内外推广采用和调整此处展示的新型计划科学方法。
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