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. 2023 Aug 17:11:1228434.
doi: 10.3389/fpubh.2023.1228434. eCollection 2023.

Rapid implementation mapping to identify implementation determinants and strategies for cervical cancer control in Nigeria

Ijeoma Uchenna Itanyi  1   2 , Clare Viglione  3 , Anne F Rositch  4 , John Olajide Olawepo  2   5 , Babayemi Oluwaseun Olakunde  2   6 , Akudo Ikpeazu  7 , Uche Nwokwu  8 , Nwamaka Lasebikan  2   9 , Echezona Edozie Ezeanolue  2   10 , Gregory A Aarons  3   11
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Rapid implementation mapping to identify implementation determinants and strategies for cervical cancer control in Nigeria

Ijeoma Uchenna Itanyi et al. Front Public Health. .

Abstract

Background: Cervical cancer constitutes a huge burden among women in Nigeria, particularly HIV-infected women. However, the provision and uptake of cervical cancer screening and treatment is limited in Nigeria. Understanding implementation determinants is essential for the effective translation of such evidence-based interventions into practice, particularly in low-resource settings. COVID-19 pandemic necessitated online collaboration making implementation mapping challenging in some ways, while providing streamlining opportunities. In this study, we describe the use of a virtual online approach for implementation mapping (steps 1-3) to identify implementation determinants, mechanisms, and strategies to implement evidence-based cervical cancer screening and treatment in existing HIV infrastructure in Nigeria.

Methods: This study used a mixed methods study design with a virtual modified nominal group technique (NGT) process aligning with Implementation Mapping steps 1-3. Eleven stakeholders (six program staff and five healthcare providers and administrators) participated in a virtual NGT process which occurred in two phases. The first phase utilized online surveys, and the second phase utilized an NGT and implementation mapping process. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to elicit discussion around determinants and strategies from the outer context (i.e., country and regions), inner organizational context of existing HIV infrastructure, bridging factors that relate to bi-directional influences, and the health innovation to be implemented (in this case cervical cancer screening and treatment). During the NGT, the group ranked implementation barriers and voted on implementation strategies using Mentimeter.

Results: Eighteen determinants to integrating cervical cancer screening and treatment into existing comprehensive HIV programs were related to human resources capacity, access to cervical cancer services, logistics management, clinic, and client-related factors. The top 3 determinants included gaps in human resources capacity, poor access to cervical cancer services, and lack of demand for services resulting from lack of awareness about the disease and servicesA set of six core implementation strategies and two enhanced implementation strategies were identified.

Conclusions: Rapid Implementation Mapping is a feasible and acceptable approach for identifying and articulating implementation determinants, mechanisms, and strategies for complex healthcare interventions in LMICs.

Keywords: EPIS framework; Nigeria; cervical cancer; determinants; implementation mapping; implementation strategies.

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Conflict of interest statement

AFR is currently employed by Hologic but this work was done while she was a faculty member at Johns Hopkins University, where she maintains an adjunct appointment, as part of her independent research program. EEE was employed by HealthySunrise Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The rapid implementation mapping protocol. *Participants in each step of the protocol.
Figure 2
Figure 2
Matching core and enhanced implementation strategies to implementation determinants. Key: determinants (red), core implementation strategies (blue), enhanced implementation strategies (green).
See this image and copyright information in PMC

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