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Implementation Science at UW

Keywords: Tessa Concepcion

✪ Acceptability and Feasibility of Remote PrEP Visits for Adolescent Girls and Young Women in South Africa

Authors:

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.

✪ Open Access

Published: May 2026

Read the full text in the open access journal AIDS and Behavior

Abstract:

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.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Integrating a mental health intervention into PrEP services for South African young women: a human-centered implementation research approach to intervention development

Authors:

Jennifer Velloza, Nomhle Ndimande-Khoza, Lisa Mills, Tessa Concepcion, Sanele Gumede, Hlukelo Chauke, Ruth Verhey, Dixon Chibanda, Sybil Hosek, Bryan J. Weiner, Connie Celum, Sinead Delany-Moretlwe

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: July 2024

Read the full text open access in the Journal of the International AIDS Society

Abstract:

Introduction

Adolescent girls and young women (AGYW) who may benefit from HIV pre-exposure prophylaxis (PrEP) face high levels of common mental disorders (e.g. depression, anxiety). Common mental disorders can reduce PrEP adherence and increase HIV risk, yet mental health interventions have not been well-integrated into PrEP delivery.

Methods

We conducted a four-phase human-centered design process, from December 2020 to April 2022, to understand mental health challenges among AGYW in Johannesburg, South Africa and barriers to integrated mental health and PrEP services. In the “Discover” phase, we conducted in-depth interviews with AGYW and key informants (KIs) in Johannesburg. We conducted a rapid qualitative analysis, informed by the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers of integrated mental health and PrEP services and mapped barriers to potential implementation strategies. In the “Design” and “Build” phases, we conducted stakeholder workshops to iteratively adapt an evidence-based mental health intervention, the Friendship Bench, and refine implementation strategies for South African PrEP delivery settings. In the “Test” phase, we piloted our adapted Friendship Bench package.

Results

Interviews with 70 Discover phase participants (48 AGYW, 22 KIs) revealed the importance of integrated mental health and PrEP services for South African AGYW. Interviewees described barriers and implementation strategies for mental health and PrEP services around the CFIR domains: intervention characteristics (e.g. challenges with AGYW “opening up”); outer Johannesburg setting (e.g. community stigma); inner clinic setting (e.g. judgmental healthcare providers); characteristics of counsellors (e.g. training gaps); and the implementation process (e.g. need for demand creation). The Design and Build workshops included 13 AGYW and 15 KIs. Implementation barriers related to the quality and accessibility of public-sector clinic services, lay counsellor training, and community education and demand creation activities were prioritized. This led to 12 key Friendship Bench adaptations and the specification of 10 implementation strategies that were acceptable and feasible in initial pilot testing with three AGYW.

Conclusions

Using a human-centered approach, we identified determinants and potential solutions for integrating mental health interventions within PrEP services for South African AGYW. This design process centered stakeholders’ perspectives, enabling rapid development of an adapted Friendship Bench intervention implementation package.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study

Authors:

Tessa Concepcion, Peter Mogere, Kenneth Ngure, Njoroge Mwathi, Roy Njiru, Boaz Kipkorir, Catherine Kiptinness, Gakuo Maina, Emmah Owidi, Tamara Owens, Pamela Kohler, Bradley H. Wagenaar, Shannon Dorsey, Pamela Y. Collins, and Jennifer Velloza

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: September 2023

Read the full text in the open access journal Frontiers in Public Health

Abstract:

Background

Kenyan adolescent girls and young women (AGYW) experience a dual burden of HIV and common mental disorders (CMD). HIV clinics are a key entry point for AGYW in need of integrated CMD and HIV care; however, rates of screening and referral for CMDs are low. Our objective was to test an evidence-based provider training strategy, simulated patient encounters (SPEs), on CMD service delivery for AGYW in a Kenyan HIV clinic.

Methods

This pilot study was conducted in a public HIV clinic in Thika, Kenya from January to November 2021. The simulated patient encounter (SPE) implementation strategy included case script development from prior qualitative work, patient actor training, and a three-day SPE training including four standardized mock clinical encounters followed by quantitative surveys assessing provider competencies for each encounter. We abstracted medical record data related to HIV and CMDs such as HIV status, reason for visit, CMD screening test performed, and counselling or referral information. We conducted an interrupted time series analysis using abstracted HIV and CMD screening rates from AGYW ages 16–25 years visiting the clinic 7 months before and 3 months after SPE training. We used generalized linear models to assess changes in CMD screening rates after training.

Results

A total of 10 providers participated in the training. Competency ratings improved across four mock encounters (mean score from 8.1 to 13.7) between first and fourth encounters. We abstracted all medical records (n = 1,154) including from 888 (76%) AGYW seeking HIV treatment, 243 (21%) seeking prevention services, and 34 (3%) seeking other services. CMD screening rates increased immediately following training from 8 to 21% [relative risk (RR) = 2.57, 95% confidence interval (CI) = 1.34–4.90, p < 0.01]. The 3 months following the SPE training resulted in an 11% relative increase in CMD screening proportion compared to the 7 months pre-SPE (RR: 1.11, 95% CI: 1.04–1.17, p < 0.01). Finally, 1% of all pre-SPE screens resulted in referral versus 5% of post-SPE screens (p = 0.07).

Conclusions

The SPE model is a promising implementation strategy for improving HIV provider competencies and CMD service delivery for adolescents in HIV clinics. Future research is needed to explore effects on adolescent clinical outcomes in larger trials.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Addressing the Know-Do Gap in Adolescent HIV: Framing and Measuring Implementation Determinants, Outcomes, and Strategies in the AHISA Network

Authors:

Krsitin Beima-Sofie, Irene Njuguna, Tessa Concepcion, Stephanie M. DeLong, Geri Donenberg, Brian C. Zanoni, Dorothy Dow, Paula Braistein & Anjuli Wagner

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: March 2023

Read the full text in the open access journal Prevention Science

Abstract:

Implementation science (IS) uses systematic methods to close gaps between research and practice by identifying and addressing barriers to implementation of evidence-based interventions (EBIs). To reach UNAIDS HIV targets, IS can support programs to reach vulnerable populations and achieve sustainability. We studied the application of IS methods in 36 study protocols that were part of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA). Protocols focused on youth, caregivers, or healthcare workers in high HIV-burden African countries and evaluated medication, clinical and behavioral/social EBIs. All studies measured clinical outcomes and implementation science outcomes; most focused on early implementation outcomes of acceptability (81%), reach (47%), and feasibility (44%). Only 53% used an implementation science framework/theory. Most studies (72%) evaluated implementation strategies. Some developed and tested strategies, while others adapted an EBI/strategy. Harmonizing IS approaches allows cross study learning and optimization of delivery of EBIs and could support attainment of HIV goals.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**