Service Penetration, Acceptability, Appropriateness, and Fidelity of a Multicomponent navigation strategy for HIV-associated Kaposi’s Sarcoma: mixed methods evalution

Abstract

Kaposi’s sarcoma (KS) remains common in sub-Saharan Africa and despite persistently high mortality less than 50% of people with advanced-stage KS with an indica>on for chemotherapy currently receive it in western Kenya. To address this, a tailored mul>-component naviga>on strategy including physical naviga>on and care coordina>on, peer mentorship, educa>on, assistance with health insurance, a health insurance s>pend, and transporta>on s>pends was implemented within AMPATH healthcare network in western Kenya in 2021. This study evaluates service penetra>on (engagement), acceptability, appropriateness, and fidelity to the mul>-component naviga>on strategy. We used a convergent mixed methods approach using Proctor et al.’s framework for implementa>on outcomes. We enrolled all adults with newly diagnosed HIV-associated KS from 2021 to 2024. Quan>ta>ve data included structured ques>onnaires, CD4+ T cell count, and naviga>on ac>vity logs. Scores for acceptability and appropriateness ques>onnaires ranged from 4 to 20, with 20 represen>ng high levels. In-depth interviews were also conducted among people with HIV-associated KS, healthcare workers, and naviga>on team members. Descrip>ve sta>s>cs were used for measures of service penetra>on (engagement), acceptability, appropriateness, and fidelity. Framework analysis was used for in-depth interviews. Among the 124 Adults with HIV associated KS eligible to par>cipate, service penetra>on was 74% within 90 days aher KS diagnosis. The median acceptability score among people with HIV- associated KS was 20 (Range: 19, 20) and appropriateness was 20 (Range 20, 20). Fidelity to at least one component was 87% (N=80), and no par>cipant experienced all 6 components.Fidelity was 2.2% (N=2) for the transporta>on s>pends (7 total) and 28% (N=26) for the health insurance enrollment s>pend. During in-depth interviews, pa>ents and healthcare workers described high levels of acceptability and appropriateness of the naviga>on strategy. Pa>ents described experiences of variability in naviga>on strategy components, and healthcare worker and naviga>on team members described how financial constraints and >me constraints contributed to variability in fidelity. A mul>-component naviga>on strategy designed to improve chemotherapy engagement for HIV-associated KS was both acceptable and appropriate. Fidelity was variable with low fidelity to financial components, sugges>ng areas for future adapta>on to ensure sustainability and context appropriateness during integra>on into the health system and future scale-up.