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
Ermyas Birru, Sandra Urusaro, Aneth Dinis, Stélio Tembe, Teresa Jewell, Steve Gloyd, Kenneth Sherr, & Lisa R. Hirschhorn
University of Washington affiliated authors are displayed in bold.
Published: July 2026
Although primary health care (PHC) is central to health system performance, effective facility-level management is a critical determinant of service quality, resource use, and improved health outcomes. We conducted a systematic review to synthesize evidence on interventions, implementation strategies, and outcomes aimed at strengthening PHC facility management in Sub-Saharan Africa (SSA).
We conducted a systematic review using thematic synthesis. Eight electronic databases were searched for peer-reviewed studies and grey literature published between 2012 and 2022, focusing on interventions targeting PHC facility management in SSA. Implementation strategies were mapped to the thematic cluster areas of the Expert Recommendations for Implementing Change (ERIC) framework. Implementation outcomes were classified using Proctor’s Implementation Outcome Framework, and management effectiveness domains were identified through thematic analysis.
Of 3,752 studies screened, nine met the inclusion criteria. These studies represented six SSA countries: Botswana, Ethiopia, Kenya, South Africa, Tanzania, and Zambia. Four categories of intervention were identified: (1) training and capacity building programs, (2) peer-to-peer learning, (3) audit and feedback-based quality management systems, and (4) supportive supervision. These interventions were delivered through multiple implementation strategies, including training and education, coaching and mentoring, learning collaboratives, interactive continuous learning, and routine data monitoring. Acceptability was the most consistently reported implementation outcome. Improvements in management effectiveness were identified across four domains: financial management, organizational climate and culture, resource management and utilization, and human resource management. Five studies also reported intermediate service-level outcomes including improvements in maternal and child health indicators.
Interventions aimed at strengthening PHC facility management in SSA primarily emphasize skill development, collaboration, and ongoing managerial support, typically delivered through multiple strategies. However, few studies have evaluated these interventions using rigorous experimental or pragmatic study designs. More robust implementation research is needed to identify effective strategies for strengthening PHC facility management and supporting the consistent implementation of national PHC guidelines.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Anya Romanoff, Kathleen Lynch, Lily Martin, Olayide Agodirin, Shilpa Murthy, Olalekan Olasehinde, Chukwuma Okereke, Julia M. Jackman, Betel Yibrehu, William E. Rosa, Catherine Zivanov, Erica Mann, Joy O. Ogunmuyiwa, Colleen E. Witty, Victoria L. Mango, Olusegun Isaac Alatise, T. Peter Kingham, Rachel Vreeman, Benjamin O. Anderson & Jamie S. Ostroff
University of Washington affiliated authors are displayed in bold.
Published: July 2026
Clinical practice guidelines (CPGs) were developed to standardize and optimize cancer care delivery in low- and middle-income countries (LMICs). The aim of this scoping review is to identify implementation science (IS) frameworks and strategies to promote CPG adoption and adherence in LMICs.
We identified studies that describe, develop, reference, or utilize IS frameworks or strategies to deliver or evaluate adoption of oncology CPGs in LMICs. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we searched Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), African Journals Online, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and PsycINFO on 3/21/2022, 12/20/2022, 01/26/2024, and 10/03/2025. Publications in all languages and of all study types were eligible for inclusion. Titles, abstracts, and full text were screened by two reviewers with conflicts resolved by a third reviewer. Excluded studies did not use an IS framework or strategy, did not focus on cancer care, or were conducted in a high-income country.
Searches identified 17,806 unique publications for title/abstract screening. 182 studies met criteria for full-text review; 35 were included. Twenty-four studies were country-specific, most commonly India (n = 5) and Nigeria (n = 5). The most frequent CPGs referenced were national/country-specific guidelines (n = 13) and Breast Health Global Initiative (BHGI) guidelines (n = 9). Only 16 full-text publications described original research to promote or evaluate evidence-based CPG interventions in LMICs. Established IS frameworks used in more than one study were the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (n = 2) and Consolidated Framework for Implementation Research (CFIR) (n = 2).
There is limited research utilizing IS frameworks and strategies to promote CPG adoption and adherence in LMICs and substantial heterogeneity in reporting. Greater utilization of IS frameworks, strengthening implementation capacity and improving consistency in reporting, are needed to improve CPG uptake in LMICs.
Open Science Framework (https://osf.io/nb75s).
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Makhosazane Nomhle Ndimande-Khoza, Jennifer Velloza, Hlukelo Chauke, Lisa Mills, Nicole Poovan, Nontokozo Ndlovu, Tessa Concepcion, Sybil Hosek, Connie Celum, & Sinead Delany-Moretlwe
University of Washington affiliated authors are displayed in bold.
Published: May 2026
The World Health Organization recommends differentiated service delivery (DSD) models for HIV prevention, including alternatives to clinic-based PrEP services. This study assessed the acceptability and feasibility of remote PrEP delivery—including HIV and pregnancy self-testing, and phone-based adherence counselling—among adolescent girls and young women (AGYW) in Johannesburg. The research was nested within the PrEP SMART trial (2019–2022), which evaluated scalable adherence support strategies for AGYW aged 18–25. During COVID-19 lockdowns, PrEP refills and testing kits were delivered to participants’ homes, and counselling was provided by phone. Using a phenomenological qualitative method, we conducted in-depth interviews with AGYW (n = 14) who had the option to complete remote PrEP visits (accepting or declining), study staff (n = 12), and key informants (n = 10) involved in PrEP programming. Thematic analysis explored experiences of remote delivery, focusing on acceptability and feasibility.
AGYW found remote PrEP visits convenient, empowering, and time-saving. Procedures such as self-testing and phone counselling were generally acceptable, though some expressed anxiety about performing tests incorrectly and concerns over privacy, stigma, and unintentional disclosure of PrEP use at home. About half still preferred clinic-based visits. Staff and key informants recognized benefits, but highlighted challenges related to cost, sustainability, and provider workload. Suggestions for improvement included integrating contraception and partnering with community organizations. In conclusion, remote PrEP delivery is acceptable and feasible for many AGYW but not universally suitable. These findings support the inclusion of remote PrEP options in DSD models, with attention to privacy concerns and support for self-testing in this age group.
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Wentrell Bing, Ian Rodriguez, Anne Dudley, Emily Durkin, Nicolas Fernandez, Julia Finkelstein, Gwen Grimsby, Leslie McQuiston, Hans Pohl, Puneeta Ramachandra, Erica Traxel, Carmen Tong, Briony Varda, Jill Whitehouse & Jonathan S. Ellison
University of Washington affiliated authors are displayed in bold.
Published: December 2025
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**
Craig S Rosen, Alan L Peterson, David S Riggs, Christopher K Haddock, Chunki Fong, Stacey Young-McCaughan, Jeffrey Cook, Katherine Anne Comtois, Elisa V Borah, C Adrian Davis, Katherine A Dondanville, Erin P Finley, Sara A Jahnke, Melissa Mistretta, Andrea Neitzer, Shannon Wiltsey-Stirman, Erin R Frick, Olivia Hayes, Spencer Clayton, Allison M Conforte, Araceli Flores, Jeremy Jinkerson , Zachary K Jones, Hana J Kim, Margaret Letendre, Jared S Link, Debra Nofziger, Erik N Ringdahl, John W Waggoner, Craig Woodworth, Emily Ho, Carmen P McLean & TACTICS Research Group
University of Washington affiliated authors are displayed in bold.
Published: October 2025
Clare Viglione, Amy Westermann, Job Godino, Kyung E Rhee, Blanca Melendrez, Xin M Tu, David L Boyle, Michael Hogarth, Gregory A Aarons, Noe C Crespo, Pradeep Gidwani, Margarita Holguin, Cynthia Juarez, Deysi B Merino-Gonzalez, Liliana Osorio, Herminia Ramirez, Micaela Smith, Alec Terrana, Gary S Firestein & Eric Hekler
University of Washington affiliated authors are displayed in bold.
Published: October 2025
The Healing Experiences of Adversity Among Latinos (HEALthy4You; H4Y) study was a multi-sector partnership between an academic research institution, a Federally Qualified Health Center (FQHC), and a multi-sector collective impact coalition focused on childhood obesity prevention. The goal of HEALthy4You was to develop community-centered and culturally appropriate precision interventions within FQHCs for Latino families to address predictors of adverse child experiences and treat childhood obesity. A multidisciplinary and multi-sector research, clinical, and community team (N = 29) was formed in September 2020 to co-design the study, which launched in June 2022. The team utilized a co-creation approach combined with the Exploration, Preparation, Implementation, and Sustainment framework to facilitate a collaborative design process. We conducted an internal and retrospective process evaluation in March 2023 to identify antecedents and situational factors associated with project formation, with a focus on understanding tensions and challenges with a broad partnership structure. We outline the team's co-creation process and describe internal challenges and pitfalls that emerged when developing the project. We sought to better understand the impact of differing perspectives, priorities, and goals between disciplines, sectors, and roles; differing approaches to evidence and evidence production; and team strategies to mitigate and manage competing pressures and priorities. This case report describes lessons learned, intending to share insights to support future development of best practices in project, partner, and team formation between researchers, clinicians, and community members. More specifically, these lessons could help inform community-led research endeavors between academic institutions, FQHCs, and community-based organizations (CBOs).
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Waimar Tun, Jennifer Gomez-Berrospi, Samuel Janson, Demarc Hickson, Christian Morris, Julie Pulerwitz, Mamaswatsi Kopeka, Jesse Yao, Rikiyah Mixson, Amanda McHale, Rachel Macey, Christian Buchanan, Bukola Rinola, Naana Koranteng-Yorke, Deanna Kerrigan, Oluwaseun Adebayo Bamodu, Donaldson F. Conserve & BRIDGE Research Team
University of Washington affiliated authors are displayed in bold.
Published: October 2025
Vallery Ogello, Kristin Beima-Sofie, Sandra Urusaro, Mercy Awuor, Annabell Dollah, Winnie Atieno, Cynthia Wandera, Daniel Matemo, Jennifer F Morton, Kenneth Ngure, John Kinuthia & Kenneth K Mugwanya
University of Washington affiliated authors are displayed in bold.
Published: July 2025
Women of childbearing age in sub-Saharan Africa (SSA) face a disproportionately high risk of HIV acquisition. Although oral PrEP has been universally scaled up for individuals at significant risk of HIV, its uptake and sustained use remain suboptimal. Understanding PrEP use decisions offers insights into context-specific barriers and facilitators to its utilization.
From September to November 2023, we conducted a qualitative study nested in a larger prospective, open-label clinical trial (FP-Plus). We conducted in-depth interviews (IDIs) with younger women (ages 15–24) and older women (ages ≥25) who declined, delayed, discontinued, or restarted PrEP during the study. IDIs were conducted at two FP clinics by trained Kenyan social scientists and were audio recorded, translated, and transcribed. We analyzed data using inductive and deductive thematic analysis through the lens of the theory of planned behavior (TPB) to explore experiences, beliefs, and rationale among women who made various PrEP decisions.
We interviewed 64 women, including 40 younger women and 24 older women, all of whom declined, delayed, discontinued, or restarted PrEP (n = 16 women/category). The median age of these women was 24 years (IQR, 23–30). The majority of participants (86%, 55/64) were using family planning methods, primarily injectables (42%, 23/64). PrEP discontinuation or restart was primarily influenced by changes in HIV risk dynamics. Agency and perceived HIV risk were pivotal factors in PrEP use decisions, shaping participants’ ability to practice effective prevention adherence (TPB: perceived behavioral control). Women who declined PrEP cited a lack of autonomy, partner influence, and insufficient information (TPB: social and subjective norms). Low self-efficacy influenced decisions to delay or decline PrEP (TPB: behavioral beliefs and attitudes). In addition, challenges with PrEP pill size, taste, and texture were perceived as barriers to swallowing pills among all groups of women. Participants expressed a preference for alternative PrEP formulations, such as injectable PrEP, due to perceived ease of use, privacy, and potential to support adherence.
PrEP discontinuation and restart cycles largely reflected changes in HIV risk. Women who decline or delay PrEP may benefit from personalized support to improve their autonomy, recognizing that HIV risk persists during periods of PrEP delay.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**