Contextualising and tailoring standards-based audit (SBA) processes for sickle cell disease (SCD) care in Zambia: A pilot Study

Abstract Background Sickle Cell Disease (SCD) is the most common inherited haemoglobinopathy in the world, affecting mostly Sub-Saharan Africa (SSA) accounting for approximately 75% of the burden. Morbidity and mortality remain high in SSA due to limited resources and lack of effective implementation of evidence-based clinical interventions: Newborn screening for early detection, hydroxyurea use, penicillin prophylaxis, malaria prophylaxis; and appropriate blood transfusion therapy, to name a few. Implementation of these evidence-based interventions has improved outcomes in high income countries, through translation into and implementation of guidelines for use by clinicians. However, there are gaps in the implementation of these evidence-based practices and standards of care in SSA and LMIC. To address these gaps, Standards based audit (SBA) is an implementation strategy that is being used as part of the Patient-centered Sickle Cell Disease Management in Sub-Saharan Africa (PACTS) study to improve implementation of evidence-based practice. However, the implementation of this process in SCD care and LMIC context has not been studied at length. My study therefore aims to understand how standards-based audits can be optimised by contextualising and tailoring its approach and application in SCD practice in Zambia. Methods To achieve I will evaluate readiness for SBA implementation by conducting a scoping review and a mixed methods approach to identify meso- and micro-level factors that influence the process and approach of SBA within the four PACTS sites in Zambia. To explore and understand the processes of SBA implementation and its optimization by contextualization, this study proposes the use of three frameworks, namely the Consolidated Framework for Implementation Research (CFIR with embedded COM-B), Normalisation Process Theory (NPT) and RE-AIM. These theories will provide a way to predict the likelihood of implementation success and develop better strategies to achieve more successful implementation, and assess implementaion. I will then use participatory approaches through the modified Delphi method to generate standards of care and experience-based co-design with facility health care professionals to design contextualised and tailored SBA approaches. The co-designed contextualised and tailored SBA approach for improved SCD care will be implemented and evaluated for its feasibility, acceptability and effectiveness. I will then develop an SBA SCD care toolkit that can be scaled up for SCD care in Zambia and extended toother Sub-Saharan African contexts to ultimately improve the quality of care for people living with SCD. Expected Results I expect to understand process of tailoring and contextualising an implementation strategy, SBA and to evaluate the degree of normalisation of this tailored SBA as part of the healthcare professional's practice and sustainability. Additionally, this will be developed into an SBA SCD toolkit that can be scaled up for SCD care in Zambia and extended to other Sub-Saharan African contexts to ultimately improve the quality of care for people living with SCD.