ArticleImplementation science communications2026
De-implementation of unnecessary antibiotic use for upper respiratory tract infections in ambulatory HIV care in Mozambique: a two-arm parallel cluster-randomized controlled hybrid type II trial.
Article in Implementation science communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAntibiotics are commonly overused to treat upper respiratory tract infections (URTIs) in HIV-infected adults in primary healthcare settings, even though viruses cause most URTIs. Therefore, a de-implementation of unnecessary antibiotic prescribing for URTIs was implemented in these settings. Thus, this study aimed to evaluate a strategy to de-implement unnecessary antibiotic prescriptions among ambulatory HIV-infected adults with acute URTI symptoms using the reach-effectiveness-adoption-implementation-maintenance (RE-AIM) framework.
methodsWe conducted a three-phase (pre-implementation, adaptation-implementation, and post-implementation), hybrid type II effectiveness-implementation study utilizing a two-arm, parallel cluster-randomized controlled trial design involving HIV-infected adults recruited from six primary healthcare facilities (intervention 1
resultsAmong 387 HIV-infected adults approached, 379 (97.9%) were successfully recruited, with 182 (48%) in the intervention and 197 (52%) in the control group. Among the recruited patients, the mean age was 44 ± 12.3 years, and 286 (75.5%) were female. The intervention resulted in 33.2% fewer antibiotics prescribed compared to controls (RR = 0.41; 95% CI: 0.31-0.55). The antibiotic prescribing rate was 23.1% in the intervention and 56.3% in the control group. All three intervention sites (100%) and all clinicians (100%) demonstrated a commitment to de-implementing antibiotics. The implementation protocol was delivered as planned. Almost all participants (n = 21) in focus group discussions (FGD) were either satisfied or very satisfied with the intervention. They reported the effectiveness of the CDSA and the change in attitudes and antibiotic prescribing practices.
conclusionsBased on the RE-AIM evaluation, the implementation of the planned intervention was successful as it effectively promoted de-implementation and reduced unnecessary antibiotics for URTIs. The strategy employed in this study should be evaluated in other areas to determine if the same findings are observed elsewhere.
trial registrationISRCTN, ISRCTN88272350. Registered 16 May 2024, https://www.isrctn.com/ISRCTN88272350 .
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