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Table 1 Characteristics of standard implementation strategies (applied to all sites)

From: Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial

No

Strategy

Actor(s)

ActionË 

Action target

Dose

Timing

01

Organize a meeting with leaders of the Vietnam Authority of HIV/AIDS Control (VAAC) to introduce SNaP

• The central research team*

• Prepare resources and organize a meeting with VAAC to introduce SNaP and discuss collaboration

• VAAC is the governmental organization in charge of HIV/AIDS care in Vietnam and also one of the main collaborators of the study. It is critical that VAAC understands the SNaP intervention and the resources needed for the study at different levels so that they can provide support for the study at the national level

Once

Before SNaP implementation

02

Develop and share a timeline and plan for field activities annually with VAAC and Hanoi Medical University (HMU)—two local collaborators in Vietnam

• The central research team

• Develop and share annual implementation plan with central collaborators and stakeholders at VAAC and HMU

• Stakeholders at VAAC and HMU need to know the timeline and implementation activities of each year as well as their responsibilities, so that they can collaborate well with the central research team to implement SNaP

Annually

Beginning of each year of the study

03

Collect data on site infrastructures and personnel through site initial assessments

• The central research team

• Site leaders and staff

• Design a site assessment tool and send them to sites to be completed.

• Complete the assessment and return to central team for analysis (done by site staff)

• Data on site infrastructures and personnel is collected from sites to inform the feasibility of implementation strategies

Once

Before SNaP implementation

04

Perform initial site visits to introduce SNaP, discuss cooperation mechanism with leaders and staff at provincial and site levels, and identify appropriate personnel for SNaP implementation

• The central research team

• Site leaders and staff

• Visit provincial Centers for Disease Control (CDCs) and sites participating in the study to build the initial rapport with members of the board of directors and site staff

• Introduce SNaP and receive comments of sites on the implementation of the SNaP

• Discuss the plan for collaboration with the sites to implement SNaP (done by all actors)

• Identify the list of potential staff to participate in launching events, trainings, and SNaP activities

• Explore current routines for antiretroviral therapy (ART) and methadone referral at sites, evaluate sites’ resources and willingness to implement SNaP

• Identify appropriate staff of sites to participate in SNaP and seek approval from site leaders (done by all actors)

• In order to implement SNaP well, site leaders and staff need to understand the nature of the SNaP intervention, design of an implementation study, timeline, budget, human resources needed, and their roles and responsibilities

• Since leadership support is critical to successful implementation of SNaP, provincial and site leaders should be involved in the planning of SNaP and feel empowered

• Appropriate staff of sites is identified to participate in launching events, training events and to implement SNaP

• The central team understands site characteristics needed to implement SNaP in order to design feasible and acceptable implementation strategies

Once during site visits

Before SNaP implementation

05

Identify a focal point person for each province

• The central research team

• Provincial CDC leaders, site leaders, and staff

• Visit provincial CDCs and work with them to identify the focal points of contact for SNaP implementation

• In order to ensure effective implementation of SNaP at the sites, it is important to identify focal points of contact at each provincial CDCs. They will help with coordinating the intervention at the provincial level.

Once

Before SNaP implementation

06

Establish a community advisory board consisting of local stakeholders and people who infect drugs (PWID)

• The central research team

• Members of the community advisory board

• Invite the focal points of contact at provincial CDCs and representatives of site staff and PWID in the community to join the community advisory board.

• Organize semi-annual meetings with the community advisory board

• Provincial leaders and site staff joining the community advisory board are motivated to help coordinate and provide feedback for SNaP implementation

• Local stakeholders and the community of PWID have the opportunity to voice their needs and concerns.

Once before enrollment and every 6 after

Before SNaP implementation and every 6 months after implementation

07

Simplify SNaP procedures to prevent duplicate tasks for site staff

• The central research team

• Explore current routines for ART and methadone referral at sites

• Simplify SNaP procedures to ensure the procedures are simple to implement and do not repeat existing procedures at sites

• Workload burden related to SNaP is reduced, so that site staff are more motivated to implement SNaP

Once

Before SNaP implementation

08

Revise the SNaP intervention manual, taking into account changes in the local healthcare systems, HIV care policies, and feasibility of scale-up

• The central research team

• Collect information on the structure of the local health systems and the most current policies related to HIV care in Vietnam

• Revise the intervention manual accordingly and add new HIV care policies

• The processes of referral and linking to care are consistent with the most current HIV policies and laws in Vietnam

• The implementation of SNaP on a large scale is feasible and acceptable given the structure and operation of healthcare systems at the provincial and district levels

• Psychosocial counselors and system navigators are prepared to help clients overcome systematic barriers to accessing HIV care

Once

Before SNaP implementation

09

Conduct regional-level launching events (with VAAC, departments of health, provincial CDC leaders, directors of district health centers)

• The central research team

• VAAC leaders, provincial CDC leaders, and site leaders

• Provide an overview of SNaP intervention for local leaders

• Give speeches to show local leadership support and willingness to implement SNaP (done by VAAC and local leaders)

• All stakeholders understand the nature of SNaP intervention, design of an implementation study, timeline, budget, and human resources needed for the study at sites, so that they motivated to collaborate and implement SNaP.

• Leadership support and political will also motivate site staff to participate in SNaP and implement SNaP well

Once for each of the four regions

At the beginning of SNaP implementation

10

Conduct regional trainings

• The central research team

• System navigators and psychosocial counselors at sites

• Conduct a 4-day training on the SNaP intervention, knowledge and skills for SNaP delivery, the data collection system and other research procedures

• Site staff understands SNaP intervention and their responsibilities. They are also trained to have the necessary skills and knowledge to implement SNaP well at their sites

Once for each of the four regions

At the beginning of SNaP implementation

11

Monthly payment to provincial CDC staff and site staff

• The central research team

• Focal points of provincial CDC

• System navigators and psychosocial counselors at sites

• Provide monthly payment to provincial CDC for their coordination of SNaP activities

• Provide payment for site staff for administrative costs and successful referral of participants to ART treatment

• The study team provides incentives for provincial CDCs to coordinate SNaP activities at the site level.

• Payment for administrative costs and successful referral to ART initiation for participants are also provided so that site staff are motivated to implement SNaP as intended.

Monthly

After enrollment begins

12

Send semi-annual progress reports of SNaP implementation to provincial CDCs

• The central research team

• Provincial CDC leaders

• Analyze SNaP progress data and write up reports

• Share the progress reports of sites with corresponding provincial CDCs

• Provincial leaders are regularly updated on the progress and results of SNaP. They can take charge of coordinating SNaP activities and providing continuous leadership support.

Semi-annually

Every 6 months after enrollment

13

Integrate plans to address turnover, such as replacing and re-training for new staff

• The central research team

• Site leaders and staff

• Inform the central research team of staff turnover and replacement (done by site leaders and staff)

• Conduct training for new staff

• The central research team needs to be properly informed of turnover events, so that they can provide training for new staff.

• It is important that new staff understands their responsibilities and has the knowledge and skills to deliver SNaP as intended.

On-going

After turnover events

14

Organize online booster training session

• The central research team

• Site leaders and staff

• Create booster training content based on process evaluation of sites’ implementation of SNaP

• Create an online platform and upload training materials

• Provide access and guidance to site staff to learn through the online training platform

• Participate in online booster training (done by site staff)

• The skills of system navigators and counselors are improved and their weaknesses in implementing SNaP are addressed

Two times throughout the study

6 and 14 months after implementation of the first regional training

15

Conduct group calls every 6 months by region or province to share experience and feedback

• The central research team

• Site leaders and staff

• Facilitate group calls every 6 months for sites in the same arm

• Site staff knows how SNaP is implemented at other sites and have the platform to share their knowledge and experience

Semi-annually

Every 6 months after enrollment

  1. *The central research team refers to the research team from the UNC Vietnam project in Hanoi, including the project management, leads of tailored approach and standard approach arm, project assistant, data assistant, and evaluation and management officer
  2. Ë Actions are implemented by the central research team, unless otherwise specified
  3. Abbreviations: ART antiretroviral therapy, CDC Center for Disease Control, HMU Hanoi Medical University, PWID people who inject drugs, SNaP system navigation and psychosocial counseling intervention, VAAC Vietnam Authority of HIV/AIDS Control