While the I’m Ready Jamaica intervention is a valuable service for people who want to take steps to know their status through HIV self-testing, it’s supported by implementation science.
“Implementation science” can be defined as “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and hence, to improve the quality and effectiveness of health services.” The main objective of implementation science is to identify barriers and facilitators that affect program uptake and to be responsive to the health access and service needs of key populations in a variety of contexts.
Why we used an implementation science approach for the I’m Ready program
At Health Connect Jamaica, we are committed to ensuring we implement HIV self-testing in a way that will have the biggest impact and the most benefits for people living in Jamaica. Implementation science helps us to move what we know—through past research, investigations or policies—into what we do and how we do it.
In this case, we know that HIV self-testing has been shown to be effective for individual use, and has now been approved for use in Jamaica. What we’re doing is making sure HIV self-testing is thoughtfully implemented through the I’m Ready Jamaica intervention , all while we’re collecting data about participants and program use to increase what we know about HIV self-testing and connecting to care.
Learning how to implement and evaluate is also important so we can make sure everyone has equal access to the testing and services they need for their health and well-being. We know that one size doesn’t fit all.
I’m Ready’s intended outcomes
The main goal of the I’m Ready Jamaica intervention is to implement and evaluate how well we are able to reach and support people who are undiagnosed with HIV across Jamaica to get access to testing, care and treatment. We are also aiming to significantly improve health equity for key populations, specifically youth, regarding testing, care, and for access to appropriate services.
Additionally, we are exploring the scalability and sustainability of the program, including evaluating whether the program is cost-effective and if it provides “value for money.” This information will be valuable for program managers and government decision-makers.
We anticipate that what we learn through this process will be used to create sustainable HIV self-testing programs and better connections to care and prevention across the country.
How we used implementation science to develop the I’m Ready program
The main goal of the I’m Ready Jamaica intervention is to implement and evaluate how well we are able to reach and support people who are undiagnosed with HIV across Jamaica to get access to testing, care and treatment. We are also aiming to significantly improve health equity for key populations, specifically youth, regarding testing, care, and for access to appropriate services.
Additionally, we are exploring the scalability and sustainability of the program, including evaluating whether the program is cost-effective and if it provides “value for money.” This information will be valuable for program managers and government decision-makers.
We anticipate that what we learn through this process will be used to create sustainable HIV self-testing programs and better connections to care and prevention across the country.
Our implementation science framework: RE-AIM
In order to provide a framework to examine these programming questions, we chose the RE-AIM implementation science framework as a guidepost for the research and evaluation activities of the I’m Ready program.
These are the five domains of RE-AIM, as we defined them for this intervention:
- Reach: The absolute number, proportion, and representativeness of individuals who participate in the intervention who are undiagnosed.
- Effectiveness: The impact of the intervention on important outcomes. This includes how many people learn about their diagnosis.
- Adoption: Absolute number, proportion, and representativeness of settings and intervention agents who are utilizing the I’m Ready Jamaica intervention.
- Implementation: Fidelity to the various elements of the program. This includes consistency of delivery as intended as well as the program costs.
- Maintenance: The extent to which the I’m Ready Jamaica intervention becomes a part of routine organizational practice and policies, and how can we make this type of intervention work in other settings.
We are also collecting information on:
We are collecting data to understand how low-barrier access to free HIV self-testing kits through the I’m Ready Jamaica app, combined with the peer navigator support through the secure telehealth service within the app, may together help reach those who are undiagnosed with HIV.
We’re especially interested in understanding if this makes a difference for people who may not be coming forward for testing in the healthcare system because of structural barriers like , homophobia and stigma.
We know that some people may need peer support for their testing or to navigate connections to care, while others may be more comfortable with a “do-it-yourself” approach. This is why we allow both approaches in our I’m Ready Jamaica mobile app.
We know from our work so far that 98% of people who use an HIV self-test for the 1st time would use it again, and over 93% would recommend it to a sexual partner or friend. In the I’m Ready Jamaica intervention, we are offering participants up to 3 free HIV self-test kits per year to use themselves or to share with a partner or friend.
We will be evaluating how well this works to reach others who are undiagnosed and need access to testing to confirm their status and get supported with care.
Looking ahead
After months of planning and preparation, we’re ecstatic to have the I’m Ready Jamaica intervention ready for roll out. We are eager to sharing our findings with community members, our peers in science , policymakers, and anyone who’s interested in improving HIV testing and care in Jamaica.
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