Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework

Abstract

Background Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention’s impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. Methods We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions. Results A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%). Conclusions Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.

A systematic review of randomized control trials of HPV self-collection studies among women in sub-Saharan Africa using the RE-AIM framework

“…We found that many HPV self-collection studies reported internal validity measures [ 45 , 47 – 50 ]. Consistent with other reviews using the RE-AIM framework [ 35 , 51 ], the majority of the studies in our review reported on the methods used to identify the target populations, sample size, and characteristics of participants. However, the participation rate and characteristics of non-participants, components that reflect external validity, were rarely reported in studies.…”

“…Additionally, limited reporting on characteristics of non-participants limits the ability to identify populations that are not engaged in or being reached by these interventions. In an effort to address broad access to interventions and include subgroups of the target population that are most in need of such interventions, researchers need to improve on the reporting of the characteristics of non-participants in an intervention study [ 35 ]. One way to do so is to utilize a participatory approach involving end-users of these interventions in designing and implementating interventions adapted to their contexts and needs [ 53 , 54 ].…”

“…Specifically, the RE-AIM framework assesses the following: (1) how an intervention reaches the target population and the extent to which the intervention participants are representative of the non-participants; (2) how an intervention achieved the projected objectives, with optimal quality of life; (3) how an intervention was broadly adopted and the extent to which delivery setting and the delivery staff were representative of non-deliverers; (4) how responsible organizations and staff implemented an intervention at a reasonable cost; and (5) an intervention’s ability to be sustained, with long-lasting individual effects [ 31 – 34 ]. RE-AIM has been used in other systematic reviews evaluating the public health impact of HIV [ 35 ] and HIV/NCD integration [ 36 ] interventions in SSA and has demonstrated utility in bridging the research to practice gap for health interventions [ 37 ].…”

Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review

“…This provides a premise for building capacity for economic evaluation in sustainable and institutionalized ways in SSA. Overall, implementation researchers should be mindful of the importance of reporting the cost of their implementing their interventions [ 147 ]. More so, they need to go beyond reporting cost-effectiveness and cost-benefit analyses to demonstrate the long-term economic effects of their interventions [ 148 ].…”

Evaluation of the Internal and External Validity of Social Media and Mobile Technology Driven HPV Vaccination Interventions: Systematic Review Using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework

“…The RE-AIM framework has been used recently in several systematic reviews to evaluate the internal and external validities of health intervention studies such as weight management intervention [18], physical activity intervention [22,23], worksite health behavior interventions [24], community settings [20], school-based health promotion [25,26], childhood obesity prevention [27][28][29], children dietary interventions with parents [30], injury prevention strategies [31], faithbased intervention [32], mobile phone-based intervention for diabetes self-management [33] and HIV prevention intervention [34]. While encouraging, there is little reporting on its potential use for translating HPV vaccination social media-driven intervention methods into regular practice settings, specifically at the population level.…”