Bridging the science-to-service gap: Implementation of a supervised HIV self-testing intervention among young adults at a tertiary education institution in Zimbabwe

Abstract

Background The evidence-based practices of implementation science constitute the integration of study findings into routine practice of public health interventions such as HIV testing services (HTS). While young people are at high risk of HIV infection, a national survey showed that adolescents and youths were less likely to go for an HIV test. This study aimed to develop and implement a systematic and multifaceted HIV self-testing (HIVST) intervention to promote the uptake of HTS among young people.Methods The study was conducted at Africa University, Mutare where desk and literature review was conducted to gather evidence on HIVST. Multiple stakeholder consultation was carried out to understand contextual enablers and barriers that either promote or undermine adoption of the intervention. Strategies for situation analysis and evidence gathering included community engagement meetings, training of implementers and conducting a baseline survey. A consensus group adapted the Consolidated Framework for Implementation Research (CFIR) to understand the realities of context and intervention while the Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) guide was used to analyze the intervention implementation and evaluation survey.Results The baseline enquiry indicated that the CFIR dimensions which positively influences intervention implementation were: network, network and communications, preparation of implementation, availability of resources, planification, implication and formally appointed internal leadership while origin of intervention and self-efficacy had negatively influenced implementation. Evaluating the intervention fidelity using the RE-AIM framework revealed that high performance with regard to reach, effectiveness, adoption and implementation but low maintenance. This study also applied the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects, and equity) for selecting the final components used in implementation.Conclusion Combining literature search, documents review, stakeholder consultation, together with provider and end-user engagement can potentially improve intervention delivery for closed populations such as Universities. Blending program agents with systematic process of activities correspondingly enhance HTS uptake among young people. The utilization of the CFIR and RE-AIM analytical frameworks in this study, offered flexible and simplified implementation and analysis of the intervention.