Applying FRAME-IS to Characterize Provider-led Adaptations to a Cervical Cancer Prevention Intervention in Kenya

Area of Science:

• Public Health
• Implementation Science
• Global Health

Background:

• Optimizing evidence-based interventions (EBIs) in low-resource settings requires contextually refined implementation strategies.
• Cervical cancer prevention is a critical global health challenge, particularly in resource-limited areas.
• Sustainable service delivery necessitates adaptable strategies for interventions like the single-visit, screen-and-treat approach with thermal ablation (SV-SAT+TA).

Purpose of the Study:

• To apply the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to capture and disseminate strategy adaptations.
• To document adaptations made to a SV-SAT+TA strategy for establishing sustainable cervical cancer prevention services in Kenya.
• To analyze adaptation trends and their characteristics during the implementation phase.

Main Methods:

• Utilized a FRAME-IS-based tracking spreadsheet for data collection across 10 facilities.
• Collected data through technical assistant site visits, phone calls, and monthly meetings with health providers.
• Employed descriptive statistics and the exact Poisson test to analyze adaptation trends and compare rates by facility level and implementation phase.

Main Results:

• Identified 28 adaptations, with 70% occurring in the early implementation phase.
• Educational (57%) and resources-related (21%) adaptations were most common, often targeting providers and aiming to increase adoption.
• Adaptation rates significantly declined over time, from 2.0 per facility in the early phase to 0.80 in the late phase (p=0.02).

Conclusions:

• Educational and resource-related adaptations are critical for successful SV-SAT+TA implementation.
• Further research should evaluate the impact of adaptations on outcomes and refine the FRAME-IS framework.
• Developing an 'adaptome' can guide scalable strategies for cervical cancer prevention in similar settings.