ASSESSING THE IMPLEMENTATION FIDELITY OF HPV SELF‑COLLECTION (THE EMA STRATEGY): A CASE STUDY IN LA MATANZA
Keywords:
Implementation Science, Uterine Cervical Neoplasms, Human Papillomavirus DNA Tests, ArgentinaAbstract
Background
In Argentina, HPV self-collection offered by Community Health Workers was demonstrated to be effective to improve cervical cancer screening uptake. However, there is no evidence about the degree of fidelity -in relation to the core components proposed with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity.
Methods
This descriptive study involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation was carried out through the analysis of a self-administered survey of health promoters, observations, and secondary data. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders.
Results
Our results showed that the core components with highest fidelity were Training, Sample handling, and transportation. Regarding the Offer of HPV self-collection, we found some adaptations such as locations in which health promoters offered HPV self-collection, and fewer pieces of information provided during the offer. In the Follow-up and Treatment core component we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of health promoters that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers.
Conclusions
Out study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in low-middle income settings.
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Copyright (c) 2024 Melisa Paolino, Victoria Sánchez Antelo, Milca Cuberli, Mariana Curotto, Anabella Le Pera, Fernando Binder, Juan David Mazzadi, Beatriz Firmenich, Silvina Arrossi
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