Uso de ferramentas de ciência de implementação para avaliar a ampliação da oferta de Profilaxia Pré-exposição (PrEP) ao HIV no estado do Rio de Janeiro

Abstract

Pre-exposure Prophylaxis for HIV (PrEP) was introduced in the Brazilian health system in 2017, and its implementation in the state of Rio de Janeiro began in 2018. In this context, investments in implementation science have been considered essential to monitor the progress of prophylaxis deployment and optimize its effectiveness. During the execution of a program, it is crucial to evaluate this implementation, to verify how the program activities are being carried out in accordance with the proposed requirements. The tools of Implementation Science have the potential to maximize PrEP's effectiveness in reducing the incidence of HIV among populations most vulnerable to the virus. The objective of the study is to develop a methodology for evaluating the implementation of PrEP in the state of Rio de Janeiro based on the theoretical and methodological framework of Implementation Science. This is a theoretical-methodological proposal for evaluating the implementation of PrEP in the state of Rio de Janeiro, comprising three stages: a literature search of PrEP Implementation Science articles and official guidelines for PrEP implementation in Brazil; the construction of a logic model with the main determinants and strategies for PrEP expansion and maintenance, based on the CFIR and RE-AIM frameworks; and the development of an evaluation matrix as a proposed application within a monitoring and evaluation plan. A logic model was constructed that presents the shared relationships among the elements of a program. It incorporates the determinants, implementation strategies, mechanisms, and outcome indicators of the intervention. The evaluation matrix, based on the indicators of the RE-AIM framework, details the key questions, the indicators, and the data collection methods, which aim to measure each key question. The use of Implementation Science tools for evaluating the implementation of PrEP allows this intervention to expand according to the previously established protocols, ensuring an evidence-based approach and enabling the optimization of resources and maximization of PrEP's impact in reducing the incidence of HIV.