Implementation opportunities and challenges identified by key stakeholders in scaling up HIV Treatment as Prevention in British Columbia, Canada: a qualitative study

Abstract

Background: The province of British Columbia (BC), Canada, was among the first jurisdictions to scale up HIV Treatment as Prevention (TasP) to the population level, including funding and policy commitments that enhanced HIV testing efforts (e.g., expansion of routine, opt-out testing), while also making antiretroviral therapy universally available to all people living with HIV. As such, BC represents a critical context within which to identify factors that influenced the scalability of TasP (e.g., acceptability, adoption, fidelity, equitable reach, sustainability), including key opportunities and challenges. Methods: We draw on in-depth, semi-structured interviews with 10 key stakeholders, comprised policymakers at the local and provincial levels and representatives from community-based organizations. Using the Consolidated Framework for Implementation Research (CFIR) to guide data collection, coding, and analysis, we identified key factors that influenced practice transformation and scale up.

Assessing drivers of implementing ‘Scaling-up the Systems Analysis and Improvement Approach’ for Prevention of Mother to Child HIV Transmission in Mozambique (SAIA-SCALE) over implementation waves

“…It is also consistent with the original SAIA trial which found that "investments in infrastructure and human resources [could] be critical to improve prevention of mother-to-child HIV transmission service delivery and protect infants from HIV" (34), particularly in low performing health facilities in other African countries, including where SAIA-SCALE was implemented in Mozambique (8). These ndings are also consistent with those documented in other studies on the scale-up of pediatric and adult HIV interventions across the world, that highlight the shortcomings of believing in the technological x and call for the need to attend to the importance of contextual factors that mediate intervention uptake and scale-up (11)(12)(13).…”

“…Like for intervention implementation, the scale-up of HIV-related interventions across high income and low-and middle-income countries calls for the need to attend to the importance of contextual factors that mediate intervention uptake and scale-up (11)(12)(13). A comparative analysis of the scale-up on an mHealth intervention that uses SMS communication to improve patient adherence to medication and engagement in care in Canada and Kenya, showed, even with robust research evidence, scale-up was a precarious and uncertain process, embedded within the wider politics and nancing of Canadian and Kenyan health systems (11).…”

“…A comparative analysis of the scale-up on an mHealth intervention that uses SMS communication to improve patient adherence to medication and engagement in care in Canada and Kenya, showed, even with robust research evidence, scale-up was a precarious and uncertain process, embedded within the wider politics and nancing of Canadian and Kenyan health systems (11). Key factors that contributed to the successful scale-up of a treatment as prevention intervention include stakeholder buy-in, including government symbolic investments on the intervention were grounded on perceptions about quality and strength of evidence supporting the intervention (12), which highlights the importance of packaging interventions for greater impact and relevance (11). Additional determinants, identi ed through differentiated service delivery models across the HIV continuum of care and treatment, include focusing on investing resources that can address patient differentiated needs, ensure sustainable inclusion of more health worker categories (especially community health workers), and strengthen supply chains (13).…”

“…Personal attributes of intervention leaders and implementers are important determinants. This includes highly motivated and social justiceoriented individuals facilitate implementation of evidence-informed adaptations across a highly decentralized service delivery system using program data (12).…”

Implementation of mandatory opioid prescribing limits in North Carolina: healthcare administrator and prescriber perspectives

“…Participants were employed at community hospitals (major teaching, minor teaching, and nonteaching) [ 16 ], federal government hospitals, private practices, and regional medical centers located across NC. We used a stratified purposeful sample to recruit prescribers in order to explore variations on experiences from those with different training and patient populations [ 17 , 18 ]. We employed multiple strategies for sampling prescribers; this included sampling the four most common subspecialties providing outpatient opioid prescriptions for acute and post-surgical pain in NC (i.e.…”