Emily C. Williams, Madeline C. Frost, Olivia V. Fletcher, Carol E. Achtmeyer, Jessica A. Chen, Rachel L. Bachrach, E. Jennifer Edelman, Bryan J. Weiner, George N. Ioannou, and Judith I. Tsui
University of Washington affiliated authors are displayed in bold.
Published: August 2026
Grace Umutesi, Bryan J. Weiner, Teresa Jewell, Saidi Kapiga, Jeff Lane, Nelly R. Mugo & Ruanne V. Barnabas
University of Washington affiliated authors are displayed in bold.
Published: March 2026
Cervical cancer is a global public health problem. While HPV vaccination effectively prevents cervical cancer, vaccination coverage remains low in low -and middle-income countries (LMICs) where around 94% of cervical cancer-related deaths occur. To improve coverage and accelerate progress toward achieving cervical cancer elimination, the World Health Organization (WHO) recommended that countries switch to a single-dose HPV vaccination schedule in 2022. Despite strong evidence of the health and economic benefits of a single-dose HPV vaccination schedule, its adoption has varied across countries.
We sought to rapidly review existing evidence to assess the “how” of policy reform on HPV vaccination, leveraging a policy analysis of single-dose HPV vaccination adoption in three East African countries. We used the Health Policy Triangle Framework (HPF) to compile key considerations that led to the adoption of single-dose HPV vaccination in Ethiopia, Uganda, and Tanzania. Relevant articles from peer-reviewed journals and grey literature published up to December 2024 were selected using pre-set inclusion and exclusion criteria. Data were extracted and summarized using a rapid qualitative analysis approach guided by the HPF. Twenty-four articles from academic and grey literature were examined.
Beyond context-specific aspects, a few common themes emerged across the three countries. Political will focused on addressing cervical cancer as a public health problem, and it was crucial to prioritize the revision of the HPV vaccination policy. The policy revision on the HPV vaccination schedule was undertaken, building on existing evidence and the WHO endorsement. Additionally, the availability of key evidence on the magnitude of this public health problem (eg: burden of the disease), the potential benefit of a single-dose schedule (efficacy, and the economic impact) played an important role in the policy revision process. At the national level, National Immunization Technical Advisory Groups (NITAGs) that provided evidence-based guidance to policy-makers were central to the single-dose decision-making process. Our findings highlighted key considerations for the policy revision process in three East African countries, which could inform strategic policy decisions in these countries and comparable settings.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Aneth Dinis, Quinhas Fernandes, Orvalho Augusto, Bryan J. Weiner, Sarah Gimbel, Ermyas Birru, Dorlim Uetela, Grace John-Stewart, Stephen Gloyd, Isaias Ramiro & Kenneth Sherr
University of Washington affiliated authors are displayed in bold.
Published: December 2025
Assessing implementation fidelity—the degree to which a program is implemented as intended—is essential to understand whether poor outcomes are due to implementation problems or the design of an intervention. Few studies in health research have documented the association between implementation fidelity and effectiveness. The Integrated District Evidence-to-Action (IDEAs) is a multicomponent audit and feedback strategy designed to improve the implementation of maternal and child clinical guidelines in Mozambique. In a previous study, we found mixed results of IDEAs effectiveness. The objective of the present study is to understand how implementation fidelity may have influenced the effectiveness of the strategy.
IDEAs was implemented in 154 health facilities across 12 districts in Manica and Sofala provinces in Mozambique between 2016 and 2020. We used the conceptual framework for implementation fidelity to guide descriptive analysis of IDEAs adherence. Regression modeling was used to study patterns of the direction of association between measures of fidelity and effectiveness for ten service delivery outcomes and five service readiness outcomes.
We describe adherence on 15 measures of fidelity, of which 12 had high fidelity. Poor fidelity was found in conducting facility service readiness assessments and completing micro-interventions from action plans. Service delivery measures tended to be positively associated with participation and degree of micro-intervention completion and negatively associated with a higher number of action plans elaborated by participating teams. For the service readiness outcomes, delivery of essential care was positively associated with participation and micro-intervention completion, and staff availability was negatively associated with supervision.
Participation in audit and feedback meetings, the number of action plans elaborated, and the degree of completion of micro-interventions seem to be related to the effectiveness results. IDEAs should be adapted to reduce the number of action plans elaborated and promote better micro-intervention completion. Additionally, combining audit and feedback strategies with other strategies might enhance effectiveness in service outcomes. This study examines how to analyze the link between fidelity and effectiveness of a strategy to inform better design and recommend context-specific improvements.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Emily Callen, Susan M. Graham, Winter Forsyth, Nicola R. Gerbino, Zoë Senter, Brett Hauber, Bryan J. Weiner, Courtney Bagdon-Cox & Helen E. Jack
University of Washington affiliated authors are displayed in bold.
Published: December 2025
Release from prison or jail is a high-risk time for HIV acquisition, yet prior efforts to expand access to pre-exposure prophylaxis (PrEP) and other HIV prevention services for people releasing from jail or prison have faced substantial implementation barriers.
Characterize the implementation landscape for HIV prevention for people releasing from prison or jail in Washington State, gathering input from staff at carceral institutions and community-based organizations to inform implementation of evidence-based HIV prevention strategies.
Qualitative study.
Healthcare and reentry staff in prisons and jails (n = 15) and staff at community-based organizations that may serve people releasing from jail or prison (n = 20), selected through chain referral sampling.
Semi-structured qualitative interviews were conducted to theoretical saturation, then coded using a mixed inductive-deductive approach, based on the Consolidated Framework for Implementation Research.
Carceral institutions had few programs aimed specifically at HIV prevention. Carceral institutions had PrEP available but did not offer it widely, focusing on behavioral health or acute medical needs. Some community-based organizations offered PrEP or other forms of HIV prevention, but many focused on meeting basic needs or building community. Five themes characterized the implementation landscape for HIV prevention: 1) primacy of basic needs means HIV prevention is lower priority, 2) adding HIV prevention programming would require new funding, 3) differences in culture and philosophy influence interest in providing PrEP, 4) disconnection between carceral institutions and providers in the community limits linkage to care, 5) organizations balance protecting confidentiality while coordinating care.
Rather than directly focusing on HIV prevention, carceral institutions and community-based organizations often focused on substance use disorder treatment, and there are opportunities to integrate additional HIV prevention education and interventions into substance use care. Closer relationships between carceral institutions and community organizations may improve care coordination but would require staff capacity.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Raúl D. Gierbolini-Rivera, Milena Franco Silva, Milena Franco Silva, Lorna Fabiola Pineda, Bryan J. Weiner, Byron J. Powell, Ross C. Brownson & Diana C. Parra
University of Washington affiliated authors are displayed in bold.
Published: November 2025
Chronic diseases are a leading public health concern in the Americas, and physical inactivity contributes significantly to their burden. Open streets program—community initiatives that temporarily close urban streets to vehicles—promote physical activity and community engagement, demonstrating positive health and social impacts. Effective implementation depends on identifying suitable strategies and frameworks. The Expert Recommendations for Implementing Change (ERIC) taxonomy, developed for clinical/healthcare contexts, has not been widely assessed for community-based interventions such as Open Streets. Implementation strategies could lead to specific outcomes (e.g., adoption, sustainability) that differ from program outcomes (e.g., PA levels, chronic disease prevalence). This scoping review focuses on the strategies that influence implementation outcomes. The primary aims of this review were to (1) identify implementation strategies for Open Streets programs and (2) identify opportunities for Open Streets programs to promote chronic disease prevention and physical activity, specifically in the Americas.
A scoping review was conducted using Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Six databases (PubMed, Scopus, Scielo, Web of Science, TRIS, and LILACS) were searched for studies on Open Streets programs in the Americas (January 2004–April 2024). Three reviewers independently screened studies in Rayyan. Strategies were extracted and coded according to the 73 ERIC taxonomy strategies. Quality appraisal used MMAT for empirical studies, AMSTAR-2 for reviews, and AACODS for gray literature.
Fifty-nine studies met the inclusion criteria, yielding 63 distinct implementation strategies for Open Streets programs. All 63 strategies were classified within the ERIC taxonomy. Frequently aligned ERIC strategies included building coalitions, capturing local knowledge, conducting needs assessments, and fostering stakeholder engagement. Open Streets strategies emphasized multisectoral collaboration, cultural adaptation, equity, and sustainability.
Among the 63 identified Open Streets strategies, many aligned with ERIC, providing a foundation in stakeholder engagement, coalition building, and flexible, context-sensitive implementation. However, several ERIC strategies were not relevant to Open Streets, underscoring that while many ERIC strategies were applicable, not all suited this setting. Open Streets programs may require supplemental approaches to address equity, cultural competence, and multisectoral collaboration. Findings present opportunities to tailor, test, and scale strategies that maximize the population health impact of Open Streets and similar community-based programs.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Melissa Latigo Mugambi, Annabell Dollah, Rosebel Ouda, Nancy Oyugi, Ben O. Odhiambo, Mary M. Marwa, Judith Nyakina, John Kinuthia, Bryan J. Weiner, Grace John-Stewart, Ruanne Vanessa Barnabas, & Brett Hauber
University of Washington affiliated authors are displayed in bold.
Published: June 2025
The delivery of HIV prevention services (e.g., HIV testing, pre-exposure prophylaxis (PrEP) initiation and refills, and STI testing) in community pharmacies could address clinic barriers faced by pregnant women such as extended travel and wait times. We conducted a qualitative study in Western Kenya to select and prioritize attributes and levels for a discrete choice experiment (DCE) to design pharmacy-based HIV prevention services for pregnant women.
We began by identifying a comprehensive list of attributes and levels relevant to women considering HIV prevention during pregnancy. This list was informed by recommended HIV prevention interventions for pregnant women, our objective to design services for pharmacy settings, and attributes identified in the literature as important for other populations when choosing HIV and pharmacy-based services. From March to November 2022, we recruited participants using stratified purposeful sampling and collected qualitative data through seven focus group discussions with women, four with health providers, and eight individual interviews with technical experts. Interviews were audio-recorded, translated, transcribed, and summarized in debrief reports. We conducted debriefing meetings and analyzed these reports to identify and refine the essential attributes that would influence decisions to access HIV prevention services from a pharmacy during pregnancy.
We initially identified twelve potential attributes that were evaluated during the focus groups. Five attributes were eliminated based on ranking exercises with women and health providers. Additional attributes suggested during the focus groups were ranked low by participants or not mentioned frequently enough and, therefore, not included. We finalized and refined levels for each attribute using insights from the literature, participant feedback, and design considerations. The study identified seven attributes: service location, type of HIV test, STI testing availability, partner HIV testing availability, PrEP availability, service access methods (e.g., appointment versus walk-ins), and service fee.
This study was the first step in data collection toward defining attributes and levels for a DCE survey and successfully identified seven preliminary attributes and levels. Pre-testing and pilot testing activities further explored the feasibility and understanding of the attributes and levels.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Joseph Sila, Anjuli Dawn Wagner, Felix Abuna, Julia C Dettinger, Ben Odhiambo, Nancy Ngumbau, George Oketch, Enock Sifuna, Laurén Gómez, Sarah Hicks, Bryan J. Weiner, Grace John-Stewart & John Kinuthia
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Pre-exposure prophylaxis (PrEP) is recommended for HIV prevention in pregnant and postpartum women at substantial ongoing risk for HIV. In resource-limited settings, there exist gaps in the integration of PrEP into antenatal care.
We conducted a difference-in-differences analytic approach (3 months pre- and 3 months post) between January 2022 and July 2022 in 8 facilities (4 intervention and 4 comparison) in western Kenya. During the 6-month period, we tested a combination of 2 stakeholder selected implementation strategies – retraining health providers and fast tracking PrEP clients– to improve PrEP delivery. All study facilities dispensed PrEP in the Maternal and Child health clinics (MCH). We evaluated absolute changes in: PrEP penetration, PrEP fidelity, client PrEP knowledge, client satisfaction, and client waiting and service times as outcomes specified a priori while PrEP offer and HIV testing were outcomes specified post hoc. We measured acceptability and appropriateness by providers of the implementation strategies using AIM and IAM respectively.
We observed statistically significant improvements in PrEP penetration and PrEP offer (p < 0.05) and non-significant improvements in fidelity. PrEP penetration increased 6 percent points (p = 0.002), PrEP offer increased nearly 6 percentage points (p = 0.002), and PrEP fidelity increased 4 percentage points (p = 0.202) in intervention vs comparison facilities. Client PrEP knowledge increased 0.45 out of 7 total points (p < 0.001) and PrEP screening increased 13 percentage points (p = 0.001). We observed no significant changes in service time (0.13-min increase; p = 0.249), waiting time (0.03-min decrease; p = 0.796), or client satisfaction (0.04/24 total point decrease; p = 0.849) in intervention vs comparison facilities. HIV testing did not significantly change (7 percentage point decrease, p = 0.305). The implementation strategy bundle was deemed appropriate and acceptable by the providers (appropriateness: 18.5/20; acceptability: 18.5/20). Overall, the implementation strategy bundle was associated with larger increases in implementation outcomes among women receiving a visit other than their first ANC visit, as well as among sites without stockouts of HIV test kits.
A stakeholder-selected implementation strategy bundle that included retraining healthcare workers, fast tracking PrEP clients to reduce waiting time, and PrEP dispensing in MCH improved several implementation outcomes without significantly affecting waiting time or reducing service time.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Aneth Dinis, Orvalho Augusto, Quinhas Fernandes, Ermyas Birru, Ruth Etzioni, Sarah Gimbel, Stephen Gloyd, Isaías Ramiro, Artur Gremu, Grace John-Stewart, Bradley H. Wagenaar, Bryan J. Weiner, Sérgio Chicumbe, & Kenneth Sherr
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Limited evidence exists on audit and feedback (A&F) in low-resource contexts. We tested the Integrated District Evidence-to-Action (IDEAs), a multicomponent A&F strategy in Mozambique’s maternal and child health (MCH) services. IDEAs include A&F meetings, readiness assessments, and facility support. We report the effectiveness results. IDEAs were implemented in 2016–2020 across two provinces, 12 districts, and 154 primary health facilities in Mozambique. We assessed 1) ten service delivery outcomes across antenatal, maternity, postpartum, childcare, and reproductive health services and 2) five service readiness outcomes (medicines, infrastructure, equipment, care, and staffing availability). We used propensity score matching to minimize bias and a controlled interrupted time series with a negative binomial mixed effects model for service delivery analysis, presenting incidence rate ratios (IRR) with 95% confidence intervals (95% CI). For service readiness outcomes, we created composite scores for each domain and a difference-in-difference analysis using an ordinal mixed effects model, reporting odds ratios (OR) and 95% CI. Significant associations were found with first at-risk child appointments (IRR = 1.06 [1.04, 1.07]), first polymerase chain reaction tests for HIV-exposed children (IRR = 1.02 [1.01, 1.03]), new contraceptive users (IRR = 0.95 [0.94, 0.96]), women starting long-lasting contraceptives (IRR = 0.94 [0.93, 0.95]), availability of infrastructure (OR = 5.84 [1.32, 25.88]) and essential care (OR = 0.13 [0.03, 0.54]). No significant associations were found between IDEAs and six of 10 service delivery outcomes (women with a fourth dose of preventive malaria treatment; women protected with tetanus vaccine; women with four+ antenatal visits; deliveries with active management of the third stage of labor; first postpartum consultations and fully vaccinated children) and on medicine, equipment, and staffing availability. We observed mixed effectiveness in implementing IDEAs, with null and sub-optimal effects suggesting the need to refine and adapt strategy components to more effectively address clinical and readiness outcomes.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Mercy Owuor, Beatrice Wamuti, David A Katz, Wenjia Liu, Harison Lagat, Edward Kariithi, Brienna Naughton, Hanley Kingston, Mary Mugambi, Rose Bosire, Sarah Masyuko, Carey Farquhar, and Bryan J Weiner
University of Washington affiliated authors are displayed in bold.
Published: March 2025
This study explores factors affecting community-level demand for assisted partner services (APS) and HIV testing services (HTS) in western Kenya.
This is a multilevel qualitative analysis conducted as part of the APS Scale-up Study, a hybrid type 2 implementation-effectiveness study of APS integrated within routine HTS. For this analysis, in-depth phone interviews assessed demand for APS and factors influencing decisions to participate in APS.
Participants were recruited from eight healthcare facilities and (for APS stakeholders) from affiliated healthcare institutions in western Kenya (Kisumu and Homabay). Interviews were conducted by phone in 2019 and 2020.
67 participants were interviewed: 14 APS providers, 16 female index clients, 17 male sexual partners and 20 community members. Participants were recruited using criteria-based purposive sampling to represent different types of facilities and to include indexes who named different numbers of partners and stakeholders representing all Kenyan healthcare system levels.
Collectively, participants perceived that demand and uptake of APS could be impacted by multiple stigmas related to HIV, sexual behaviours and identities; long clinical wait times; certain gender norms and expectations; and fear of relationship dissolution, loss of financial support and intimate partner violence. However, different stakeholder groups generally focused on different factors; women focused more on gender dynamics and family roles; male sexual partners on stigma and structural barriers; HTS providers focused on HIV testing accessibility; and community-level stakeholders focused on low community awareness of APS.
Stigma reduction, awareness about APS, creation of male entry points at the facility level and provision of social support mechanisms have the potential to increase demand for APS.
Data are available upon reasonable request. The datasets generated and/or analysed during the current study are not publicly available because some interview transcripts may contain sensitive individual information; however, they can be made available from the corresponding author on reasonable request.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Lisa DiMartino, Allison J. Carroll, Jennifer L. Ridgeway, Anna Revette, Joan M. Griffin, Bryan J. Weiner, Sandra A. Mitchell, Wynne E. Norton, Christine Cronin, Andrea L. Cheville, Ann Marie Flores, Justin D. Smith on behalf of the IMPACT Consortium
University of Washington affiliated authors are displayed in bold.
Published: February 2025
Methods of integrating qualitative data across diverse studies and within multi-site research consortia are less developed than those for integrating quantitative data. The development ofsuchmethods is essential to support the data exchange needed for cross-study qualitative inquiry and given the increasing emphasis on data sharing and open science. We describe methods for qualitative data integration within the National Cancer Institute’s Improving the Management of symPtoms During And following Cancer Treatment (IMPACT) Consortium funded by the Cancer MoonshotSM. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Our case study highlights potential solutions for unique challenges faced when integrating qualitative data across multiple settings in a research consortium.
The IMPACT consortium is comprised of three research centers (RCs) each conducting pragmatic trials examining the effectiveness of routine symptom management on patient-centered outcomes. After reaching consensus on use of CFIR as the common implementation determinant framework, RCs developed a semi-structured interview guide and tailored it to features of their healthcare setting and symptom management interventions. RCs conducted interviews/focus groups with healthcare system partners to examine contextual factors impacting implementation. RCs exchanged 1–2 transcripts (n = 5 total) for purposes of pilot testing the methodology.
Given the heterogeneity of study settings and contexts, it was challenging to simultaneously assign codes at both domain and construct levels and the process was resource intensive. Recommendations include employing a common framework for data collection and analyses from the outset, coding at domain level first and then incorporating construct codes, and centralizing processes via a coordinating center (or similar entity) and combining coded transcripts using qualitative software. We also generated an iteratively refined codebook that employed the CFIR schema and incorporated CFIR 2.0 to provide detailed guidance for coders conducting cross-study qualitative inquiry.
Limited guidance exists on how to support qualitative data integration, data exchange, and sharing across multiple studies. This paper describes a systematic method for employing an implementation determinant framework-guided approach to foster data integration. This methodology can be adopted by other research consortia to support qualitative data integration, cross-site qualitative inquiry, and generate improved understanding of evidence-based intervention implementation.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**