From Policy to Practice: A Process Evaluation of Implementing Opt-Out HIV Testing in Antenatal Clinics Across Ghana
Bibliographic record
Abstract
Abstract In 2008, Ghana adopted the WHO/UNAIDS guideline for 'opt-out' HIV testing in antenatal clinics (ANCs). Although initial concerns were expressed about healthcare providers’ (HCPs’) ability to adhere to the intervention’s delivery, mainstream research has predominantly emphasised effectiveness questions to report variable testing uptake. This process evaluation aims to uncover the contextual factors that moderate adherence to the intervention in 12 of Ghana’s antenatal clinics (ANCs). We employed Carroll's (2007) modified framework of implementation fidelity to investigate factors that moderated the implementation of the provider-initiated opt-out HIV testing policy. Moderating factors explored were complexity, context, facilitating strategies, and participant responsiveness. We conducted 28 individual interviews and 11 focus group discussions, together with unstructured non-participant observations of the ANC environment and HIV testing activities. Key informants included 4 national-level officers, 4 regional-level officers, and 12 ANC managers. HCP interviews explored the complexity and facilitation of the HIV testing process and experiences with the opt-out intervention. Pregnant women's interviews explored their experiences with the opt-out intervention. The data was analysed using the constructs of Carroll’s implementation framework. We found weak antenatal clinic infrastructure, the complex nature of the opt-out intervention, a lack of facilitation, varied participant responses and power imbalance as moderators of the opt-out intervention implementation. These moderating factors collectively hinder the adoption of a right-based approach to HIV testing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.115 | 0.122 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.005 |
| Scholarly communication | 0.006 | 0.006 |
| Open science | 0.003 | 0.007 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".