Anais Mahone, Audra Williams, Dave Cleveland, Bernadette Johnson, Grace Watson, Mirjam-Colette Kempf, Lynn T. Matthews, Michael J. Mugavero, Latesha E. Elopre
<div> <section> <h3> Introduction</h3> <p>To address suboptimal HIV pre-exposure prophylaxis (PrEP) uptake among Black women, we designed PrEP4Her, a multi-phase, multi-component implementation strategy aimed to increase PrEP prescriptions among women receiving routine health services at a university-affiliated gynaecology (GYN) clinic located in the Southeastern United States.</p> </section> <section> <h3> Methods</h3> <p>Informed by intervention mapping, PrEP4Her, a hybrid type 3 trial, was piloted over 8 months, January 2024–August 2024, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) conceptual framework guided the evaluation of proximal implementation outcomes. In this manuscript, we present (1) <i>Reach</i> (the number of Black women prescribed PrEP and the proportion of PrEP prescribed to women with an indication, having a sexually transmitted infection (STI) within 12 months and/or reporting >1 sex partners collected from a universal health screener); (2) <i>Adoption</i> (the number of PrEP prescribers); (3) <i>Preliminary Effectiveness</i> (PrEP prescribed over time). Also, we measured the number of Black women who self-reported talking to a doctor about PrEP as a secondary outcome <i>(Fidelity)</i>. We collected evaluative data from the electronic health record (EHR), sexual health screener and self-administered post-visit survey. Descriptive statistics were utilized to describe the sample, and chi-square tests examined the relationships between patient characteristics and talking to providers about PrEP. Analyses were completed in October 2025.</p> </section> <section> <h3> Results</h3> <p>EHR data indicate there were 1274 unique first clinic visits. Most women identified as Black race (58%) and, on average, were 34 (±11.3) years old. Ten PrEP prescriptions were written by seven prescribers (i.e. adoption). Among women prescribed PrEP, nine identified as Black women and none had a recent STI (i.e. reach). PrEP was prescribed once before the pilot, eight times during the pilot and once in the month after the pilot. However, PrEP was not prescribed to women with PrEP indications (<i>N</i> = 85) (i.e. preliminary effectiveness). Nearly half (43%) of surveyed women reported talking to a provider about PrEP (i.e. fidelity); most (49%) identified as Black race. Chi-square tests show significant differences by race (<i>p</i> = 0.02).</p> </section> <section> <h3> Conclusions</h3> <p>We observed an increase in PrEP prescriptions from before to during the pilot period; however, 85 women with PrEP indications we
{"title":"PrEP4Her: Evaluating the Reach, Adoption, Preliminary Effectiveness and Fidelity of a Multi-Component Hybrid Type 3 Trial Designed to Increase PrEP Prescriptions for Black Women Receiving Gynaecologic Care in a University-Affiliated Women's Health Setting in the United States South","authors":"Anais Mahone, Audra Williams, Dave Cleveland, Bernadette Johnson, Grace Watson, Mirjam-Colette Kempf, Lynn T. Matthews, Michael J. Mugavero, Latesha E. Elopre","doi":"10.1002/jia2.70208","DOIUrl":"https://doi.org/10.1002/jia2.70208","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To address suboptimal HIV pre-exposure prophylaxis (PrEP) uptake among Black women, we designed PrEP4Her, a multi-phase, multi-component implementation strategy aimed to increase PrEP prescriptions among women receiving routine health services at a university-affiliated gynaecology (GYN) clinic located in the Southeastern United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Informed by intervention mapping, PrEP4Her, a hybrid type 3 trial, was piloted over 8 months, January 2024–August 2024, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) conceptual framework guided the evaluation of proximal implementation outcomes. In this manuscript, we present (1) <i>Reach</i> (the number of Black women prescribed PrEP and the proportion of PrEP prescribed to women with an indication, having a sexually transmitted infection (STI) within 12 months and/or reporting >1 sex partners collected from a universal health screener); (2) <i>Adoption</i> (the number of PrEP prescribers); (3) <i>Preliminary Effectiveness</i> (PrEP prescribed over time). Also, we measured the number of Black women who self-reported talking to a doctor about PrEP as a secondary outcome <i>(Fidelity)</i>. We collected evaluative data from the electronic health record (EHR), sexual health screener and self-administered post-visit survey. Descriptive statistics were utilized to describe the sample, and chi-square tests examined the relationships between patient characteristics and talking to providers about PrEP. Analyses were completed in October 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>EHR data indicate there were 1274 unique first clinic visits. Most women identified as Black race (58%) and, on average, were 34 (±11.3) years old. Ten PrEP prescriptions were written by seven prescribers (i.e. adoption). Among women prescribed PrEP, nine identified as Black women and none had a recent STI (i.e. reach). PrEP was prescribed once before the pilot, eight times during the pilot and once in the month after the pilot. However, PrEP was not prescribed to women with PrEP indications (<i>N</i> = 85) (i.e. preliminary effectiveness). Nearly half (43%) of surveyed women reported talking to a provider about PrEP (i.e. fidelity); most (49%) identified as Black race. Chi-square tests show significant differences by race (<i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We observed an increase in PrEP prescriptions from before to during the pilot period; however, 85 women with PrEP indications we","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah A. Shaw, Anjuli Wagner, Alejandra Grillo Roa, Enoch, Martha Zuniga, Steven Sawyer, Richard Williams, Taylor Brown, Francis Slaughter, Taylor Rapson, David A. Katz
<div> <section> <h3> Introduction</h3> <p>Addressing social determinants of health within HIV services is essential to achieve HIV epidemic control in the United States. Community-based organizations (CBOs) are uniquely positioned to implement integrated services, particularly for under-resourced and marginalized communities. However, effective strategies to support integrated services are needed for these settings. In a community-academic partnership, we applied implementation science tools to identify, prioritize and characterize strategies supporting three CBOs’ goals to enhance integrated services and reduce health inequities in King County, Washington, United States.</p> </section> <section> <h3> Methods</h3> <p>From November 2021 to June 2022, we facilitated nominal group technique methods with each CBO to generate strategies aligned with conditions CBOs deemed necessary for successful integration. Staff evaluated strategies’ feasibility and effectiveness using 5-point Likert scales (Feasibility: 1 = Very hard to do with current resources to 5 = Very easy; Effectiveness: 1 = Large negative to 5 = Large positive impact). Go-Zone plots comparing strategies’ feasibility and effectiveness scores were generated to inform implementation prioritization. We mapped strategies to Expert Recommendations for Implementing Change (ERIC) thematic clusters and Consolidated Framework for Implementation Research (CFIR) constructs.</p> </section> <section> <h3> Results</h3> <p>This participatory process generated 118 strategies perceived as highly impactful (mean = 4.7, range = 4.6−5.0) and with mixed feasibility (mean = 3.3, range = 3.2−4.6). Strategies most frequently aimed to improve organizational structural characteristics, staff access to knowledge/information, communications, implementer and community engagement, reflecting and evaluating, and teaming. All nine ERIC thematic clusters were represented, most commonly change infrastructure, train/educate relevant groups, develop interrelationships, use evaluative and iterative strategies, and engage consumers. Highly feasible and impactful strategies often addressed knowledge access and engagement, while fewer addressed structural characteristics and teaming. We observed patterns in barrier-strategy mapping (CFIR-ERIC) and in strategy feasibility and impact when reviewing construct combinations.</p> </section> <section> <h3> Conclusions</h3> <p>Implementing integrated services requires systems-level approaches that strengthen organizational infrastructure and respond to community priorities. Despite diverse
{"title":"Characterization of Strategies to Enhance the Provision of Holistic Services Across Three Community-Based Organizations in King County, Washington, United States","authors":"Sarah A. Shaw, Anjuli Wagner, Alejandra Grillo Roa, Enoch, Martha Zuniga, Steven Sawyer, Richard Williams, Taylor Brown, Francis Slaughter, Taylor Rapson, David A. Katz","doi":"10.1002/jia2.70147","DOIUrl":"https://doi.org/10.1002/jia2.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Addressing social determinants of health within HIV services is essential to achieve HIV epidemic control in the United States. Community-based organizations (CBOs) are uniquely positioned to implement integrated services, particularly for under-resourced and marginalized communities. However, effective strategies to support integrated services are needed for these settings. In a community-academic partnership, we applied implementation science tools to identify, prioritize and characterize strategies supporting three CBOs’ goals to enhance integrated services and reduce health inequities in King County, Washington, United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From November 2021 to June 2022, we facilitated nominal group technique methods with each CBO to generate strategies aligned with conditions CBOs deemed necessary for successful integration. Staff evaluated strategies’ feasibility and effectiveness using 5-point Likert scales (Feasibility: 1 = Very hard to do with current resources to 5 = Very easy; Effectiveness: 1 = Large negative to 5 = Large positive impact). Go-Zone plots comparing strategies’ feasibility and effectiveness scores were generated to inform implementation prioritization. We mapped strategies to Expert Recommendations for Implementing Change (ERIC) thematic clusters and Consolidated Framework for Implementation Research (CFIR) constructs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This participatory process generated 118 strategies perceived as highly impactful (mean = 4.7, range = 4.6−5.0) and with mixed feasibility (mean = 3.3, range = 3.2−4.6). Strategies most frequently aimed to improve organizational structural characteristics, staff access to knowledge/information, communications, implementer and community engagement, reflecting and evaluating, and teaming. All nine ERIC thematic clusters were represented, most commonly change infrastructure, train/educate relevant groups, develop interrelationships, use evaluative and iterative strategies, and engage consumers. Highly feasible and impactful strategies often addressed knowledge access and engagement, while fewer addressed structural characteristics and teaming. We observed patterns in barrier-strategy mapping (CFIR-ERIC) and in strategy feasibility and impact when reviewing construct combinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementing integrated services requires systems-level approaches that strengthen organizational infrastructure and respond to community priorities. Despite diverse","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarit A. Golub, Ariel M. de Roche, Lila Starbuck, Imani K. Hall, Brittany C. Wilbourn
<div> <section> <h3> Introduction</h3> <p>In 2021, the New York City Health Department (NYCHD) became one of the first jurisdictions in the United States to adopt a quality-based financing (QBF) approach to HIV prevention programming, shifting away from the traditional fee-for-service model. NYCHD used a multi-level approach that defined quality through three programme-level implementation strategies (PLS): universal screening; holistic care provision; and sex-positive, “risk-free” HIV prevention conversations. By focusing their QBF programme on implementation strategies in addition to service delivery outcomes, NYCHD held agencies accountable for both <i>what</i> was provided and <i>how</i> services were delivered.</p> </section> <section> <h3> Methods</h3> <p>Project PACE is a CDC-funded implementation science (IS) partnership between a public university and the NYCHD designed to document and evaluate their QBF approach. Data collected May 2023–September 2024 include: (1) thematic coding of qualitative interviews with agency staff (<i>n</i> = 29); (2) quantitative analysis of staff survey data (<i>n</i> = 69); and (3) thematic coding of technical assistance meeting minutes/programme monitoring data (document <i>n</i> = 771). This paper presents an analysis of the impact of the strategy on 19 funded agencies, focusing on implementation outcomes and applying the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators to the implementation process.</p> </section> <section> <h3> Results</h3> <p>The quality-focused implementation strategies were rated as highly acceptable, feasible and appropriate. Agencies reported multiple relative advantages of quality-focused implementation: more holistic care, increased access to services, integration of mental health and sexually transmitted infection testing into HIV prevention, reduced stigma and improved client rapport. Acceptability and feasibility ratings were strongly associated with both adoption and sustainment. Implementation barriers were clustered in the inner setting, individual and innovation CFIR domains, and focused on available resources, innovation recipients and innovation design constructs. The biggest challenges to feasibility were related to constraints in the overall care delivery system, including time pressure, service delivery limitations, restricted resources and competing demands.</p> </section> <section> <h3> Conclusions</h3> <p>Analyses indicate that health departments can develop quality-based PLS that are acceptable, appropriate, and feasible
{"title":"Implementation Outcomes and Lessons From a Health-Department-Driven Quality-Based Financing Approach to HIV Prevention Programmes in New York City, United States: A Mixed Methods Analysis","authors":"Sarit A. Golub, Ariel M. de Roche, Lila Starbuck, Imani K. Hall, Brittany C. Wilbourn","doi":"10.1002/jia2.70194","DOIUrl":"https://doi.org/10.1002/jia2.70194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In 2021, the New York City Health Department (NYCHD) became one of the first jurisdictions in the United States to adopt a quality-based financing (QBF) approach to HIV prevention programming, shifting away from the traditional fee-for-service model. NYCHD used a multi-level approach that defined quality through three programme-level implementation strategies (PLS): universal screening; holistic care provision; and sex-positive, “risk-free” HIV prevention conversations. By focusing their QBF programme on implementation strategies in addition to service delivery outcomes, NYCHD held agencies accountable for both <i>what</i> was provided and <i>how</i> services were delivered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Project PACE is a CDC-funded implementation science (IS) partnership between a public university and the NYCHD designed to document and evaluate their QBF approach. Data collected May 2023–September 2024 include: (1) thematic coding of qualitative interviews with agency staff (<i>n</i> = 29); (2) quantitative analysis of staff survey data (<i>n</i> = 69); and (3) thematic coding of technical assistance meeting minutes/programme monitoring data (document <i>n</i> = 771). This paper presents an analysis of the impact of the strategy on 19 funded agencies, focusing on implementation outcomes and applying the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators to the implementation process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The quality-focused implementation strategies were rated as highly acceptable, feasible and appropriate. Agencies reported multiple relative advantages of quality-focused implementation: more holistic care, increased access to services, integration of mental health and sexually transmitted infection testing into HIV prevention, reduced stigma and improved client rapport. Acceptability and feasibility ratings were strongly associated with both adoption and sustainment. Implementation barriers were clustered in the inner setting, individual and innovation CFIR domains, and focused on available resources, innovation recipients and innovation design constructs. The biggest challenges to feasibility were related to constraints in the overall care delivery system, including time pressure, service delivery limitations, restricted resources and competing demands.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Analyses indicate that health departments can develop quality-based PLS that are acceptable, appropriate, and feasible ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tongying Zhao, Laura K. Beres, Elena P. Rosenberg-Carlson, Joseph Kenny, Wilson Gomez, Alithia Zamantakis, Cathleen E. Willging, Russell A. Brewer, Jill S. Blumenthal, Joyce L. Jones, Uyen Kao, Tequetta Valeriano, Aadia I. Rana, Sung-Jae Lee, Maile Y. Karris, Ana M. Pachicano, Jessica Kassanits, Alison B. Hamilton, Robin G. Lanzi, LaRon E. Nelson, Lipin Lukose, Donna J. Smith, Nanette D. Benbow, Sheree R. Schwartz, Joseph G. Rosen, the NISH 001 Study Team
<div> <section> <h3> Introduction</h3> <p>Status-neutral approaches to HIV treatment and prevention, which link all individuals to tailored, comprehensive services following HIV testing, are promising strategies for reducing HIV service delivery inequities and improving clinical outcomes. However, transferable, feasible models of status-neutral service delivery are poorly understood, particularly in the United States, where implementation contexts are geographically and institutionally disparate. To guide expanded implementation, we identified difference-making attributes of status-neutral implementation workflows in a diverse sample of public sector-funded HIV clinical organizations in U.S. jurisdictions prioritized in the Ending the HIV Epidemic (EHE) Initiative.</p> </section> <section> <h3> Methods</h3> <p>In March−June 2024, we invited frontline HIV service providers across six EHE jurisdictions (Alabama, Baltimore, Chicago, Dallas, Los Angeles, San Diego) to participate in virtual focus group discussions (FGDs), segmented by ongoing or planned status-neutral implementation. We depicted an HIV status-neutral workflow and elicited discussants’ perspectives on (in)consistencies between the illustration and their implementation practices. Applying comparative workflow modelling, we re-illustrated status-neutral implementation pathways and identified workstream features distinguishing service delivery across clinical organizations.</p> </section> <section> <h3> Results</h3> <p>We facilitated eight FGDs with 56 providers across 20 organizations. Status-neutral implementation processes varied substantially across clinical organizations—distinguished by the roles and responsibilities of clinical (i.e. physicians, nurses) and non-clinical (i.e. navigators, case managers) staff as well as by the sequence and timing of activities within workflows. We identified four workflow attributes that distinguished clinical organizations: (1) the timing of health insurance review (whether insurance assessments and navigation occurred earlier vs. later in the implementation pathway); (2) the magnitude of activity integration (whether services were delivered concurrently vs. sequentially); (3) the presence of implementation partnerships (whether HIV testing was conducted in-house vs. externally); and (4) the extent of workforce task-shifting (whether services were primarily delivered by clinical vs. non-clinical staff).</p> </section> <section> <h3> Conclusions</h3> <p>Workflow heterogeneities reflected jurisdictional and organizational differences in funding, staff
{"title":"Comparative Workflow Modelling of HIV Status-Neutral Care Implementation in Six High-Burden Jurisdictions in the United States: A Qualitative Study","authors":"Tongying Zhao, Laura K. Beres, Elena P. Rosenberg-Carlson, Joseph Kenny, Wilson Gomez, Alithia Zamantakis, Cathleen E. Willging, Russell A. Brewer, Jill S. Blumenthal, Joyce L. Jones, Uyen Kao, Tequetta Valeriano, Aadia I. Rana, Sung-Jae Lee, Maile Y. Karris, Ana M. Pachicano, Jessica Kassanits, Alison B. Hamilton, Robin G. Lanzi, LaRon E. Nelson, Lipin Lukose, Donna J. Smith, Nanette D. Benbow, Sheree R. Schwartz, Joseph G. Rosen, the NISH 001 Study Team","doi":"10.1002/jia2.70158","DOIUrl":"https://doi.org/10.1002/jia2.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Status-neutral approaches to HIV treatment and prevention, which link all individuals to tailored, comprehensive services following HIV testing, are promising strategies for reducing HIV service delivery inequities and improving clinical outcomes. However, transferable, feasible models of status-neutral service delivery are poorly understood, particularly in the United States, where implementation contexts are geographically and institutionally disparate. To guide expanded implementation, we identified difference-making attributes of status-neutral implementation workflows in a diverse sample of public sector-funded HIV clinical organizations in U.S. jurisdictions prioritized in the Ending the HIV Epidemic (EHE) Initiative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In March−June 2024, we invited frontline HIV service providers across six EHE jurisdictions (Alabama, Baltimore, Chicago, Dallas, Los Angeles, San Diego) to participate in virtual focus group discussions (FGDs), segmented by ongoing or planned status-neutral implementation. We depicted an HIV status-neutral workflow and elicited discussants’ perspectives on (in)consistencies between the illustration and their implementation practices. Applying comparative workflow modelling, we re-illustrated status-neutral implementation pathways and identified workstream features distinguishing service delivery across clinical organizations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We facilitated eight FGDs with 56 providers across 20 organizations. Status-neutral implementation processes varied substantially across clinical organizations—distinguished by the roles and responsibilities of clinical (i.e. physicians, nurses) and non-clinical (i.e. navigators, case managers) staff as well as by the sequence and timing of activities within workflows. We identified four workflow attributes that distinguished clinical organizations: (1) the timing of health insurance review (whether insurance assessments and navigation occurred earlier vs. later in the implementation pathway); (2) the magnitude of activity integration (whether services were delivered concurrently vs. sequentially); (3) the presence of implementation partnerships (whether HIV testing was conducted in-house vs. externally); and (4) the extent of workforce task-shifting (whether services were primarily delivered by clinical vs. non-clinical staff).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Workflow heterogeneities reflected jurisdictional and organizational differences in funding, staff","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah M. Wilson, Judith Montenegro, Lisvel A. Matos, Carrie B. Dombeck, Carolina Mejia, Jamilah Taylor, Aleida Espinal, Megan A. Reaves, Cristofer Navas, Samantha Fortier, Reeva Kandel, Amy Corneli
<div> <section> <h3> Introduction</h3> <p>Despite systemic inequities in pre-exposure prophylaxis (PrEP) uptake among Latines (a gender-inclusive term for people of Latin American descent, used to promote inclusivity and language justice), clinic-level implementation strategies addressing health equity-related PrEP barriers are underutilized. This multi-method study assessed the feasibility and acceptability of community-co-designed, equity-focused strategies to improve PrEP uptake among Latines in the Southern United States.</p> </section> <section> <h3> Methods</h3> <p>Facilitated by a community-based organization (CBO)/academic partnership, a workgroup of local community and public health constituents with HIV/PrEP experience from Mecklenburg County, North Carolina, co-developed PrEP implementation strategies over 6 months (March−August 2023), using implementation mapping, human-centred design and participatory methods. The resulting strategies were pilot-tested at a federally qualified health centre and a non-profit community healthcare organization (March−August 2024). Process measures included quantitative implementation strategy fidelity and descriptive strategy modifications. Outcomes included: quantitative acceptability of the workgroup process (using exit surveys) and qualitative feasibility and acceptability of the implementation strategies (using 23 qualitative key informant interviews conducted October 2024−February 2025).</p> </section> <section> <h3> Results</h3> <p>Ten exit surveys were collected from workgroup members, with 60% identifying as Latine and 40% with HIV lived experience. Members reported high satisfaction with workgroup activities. The workgroup developed three health equity-focused strategies: (1) a needs assessment; (2) blended implementation facilitation (weekly facilitation meetings between a CBO external facilitator and clinic-based internal facilitator); and (3) a bilingual, culturally tailored PrEP awareness mass media campaign. Process data indicated: 100% fidelity to the needs assessment, 88% average completion of facilitation meetings and delayed campaign dissemination. Adaptations included fewer facilitation meetings, increased leadership engagement and a sustainability planning workshop. Key informant interviews included six pilot implementers and 17 potential adopters. Notable themes centred on strategy feasibility (e.g. concrete/actionable feedback, staffing challenges impacted feasibility), acceptability (e.g. an approachable implementation team) and perceived strategy benefits (e.g. improved patient outreach and engagement).</p> </section> <section>
{"title":"Acción PrEP: A Multi-Method Pilot Design to Assess the Feasibility of Community Co-Designed Implementation Strategies to Advance PrEP Uptake Among Latines in the U.S. South","authors":"Sarah M. Wilson, Judith Montenegro, Lisvel A. Matos, Carrie B. Dombeck, Carolina Mejia, Jamilah Taylor, Aleida Espinal, Megan A. Reaves, Cristofer Navas, Samantha Fortier, Reeva Kandel, Amy Corneli","doi":"10.1002/jia2.70196","DOIUrl":"https://doi.org/10.1002/jia2.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite systemic inequities in pre-exposure prophylaxis (PrEP) uptake among Latines (a gender-inclusive term for people of Latin American descent, used to promote inclusivity and language justice), clinic-level implementation strategies addressing health equity-related PrEP barriers are underutilized. This multi-method study assessed the feasibility and acceptability of community-co-designed, equity-focused strategies to improve PrEP uptake among Latines in the Southern United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Facilitated by a community-based organization (CBO)/academic partnership, a workgroup of local community and public health constituents with HIV/PrEP experience from Mecklenburg County, North Carolina, co-developed PrEP implementation strategies over 6 months (March−August 2023), using implementation mapping, human-centred design and participatory methods. The resulting strategies were pilot-tested at a federally qualified health centre and a non-profit community healthcare organization (March−August 2024). Process measures included quantitative implementation strategy fidelity and descriptive strategy modifications. Outcomes included: quantitative acceptability of the workgroup process (using exit surveys) and qualitative feasibility and acceptability of the implementation strategies (using 23 qualitative key informant interviews conducted October 2024−February 2025).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten exit surveys were collected from workgroup members, with 60% identifying as Latine and 40% with HIV lived experience. Members reported high satisfaction with workgroup activities. The workgroup developed three health equity-focused strategies: (1) a needs assessment; (2) blended implementation facilitation (weekly facilitation meetings between a CBO external facilitator and clinic-based internal facilitator); and (3) a bilingual, culturally tailored PrEP awareness mass media campaign. Process data indicated: 100% fidelity to the needs assessment, 88% average completion of facilitation meetings and delayed campaign dissemination. Adaptations included fewer facilitation meetings, increased leadership engagement and a sustainability planning workshop. Key informant interviews included six pilot implementers and 17 potential adopters. Notable themes centred on strategy feasibility (e.g. concrete/actionable feedback, staffing challenges impacted feasibility), acceptability (e.g. an approachable implementation team) and perceived strategy benefits (e.g. improved patient outreach and engagement).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70196","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathrine Meyers, Nadia Nguyen, Charlie Ferrusi, Jason Zucker, Sarit A. Golub, Bryan A. Kutner, Mamta Karani, Cody A. Chastain, Marilyn Blasingame, Moya Brown-Lopez, Jennifer Burdge, Delivette Castor, Caroline Carnevale, Jenna Eldib, Elizabeth Furuya, Omolola Akolo, Kelly Bastien, Melissa Curry, Will Holt, Bijou R. Hunt, Shin Ly, Carlotta Starks, Fabriel Torres jr., Marlene Matosky
<div> <section> <h3> Introduction</h3> <p>Long-acting injectable antiretroviral therapy (LAI ART) represents a transformative development in HIV care because it may mitigate longstanding barriers that contribute to gaps in health outcomes. Providing LAI ART to people not consistently on HIV treatment or lacking treatment options requires intentional programme planning to overcome implementation barriers, without which only well-resourced patients benefit, worsening health outcome gaps. The ALAI UP Project delivered clinic-level implementation strategies to support eight clinics across Ending the HIV Epidemic jurisdictions to implement injectable cabotegravir and rilpivirine (iCAB/RPV).</p> </section> <section> <h3> Methods</h3> <p>We specified seven implementation strategies and assessed their impact on clinic achievement of three key programme outcomes: (a) access to information about iCAB/RPV for all patients regardless of clinical eligibility; (b) access to iCAB/RPV regardless of healthcare coverage; and (c) access to iCAB/RPV for those who can clinically benefit the most, including patients who are unable to achieve durable viral suppression on oral ART for reasons other than cabotegravir or rilpivirine resistance. Implementation strategies were delivered from March 2023 through February 2025, and results are reported at the end of year 2 of the 3-year project. We developed causal pathway diagrams (CPDs) for each strategy, identifying determinants, preconditions, moderators, mechanisms and outcomes.</p> </section> <section> <h3> Results</h3> <p>ALAI UP strategies supported clinic progress towards all three outcomes: six clinics had partially or fully achieved access to information about iCAB/RPV for all patients, seven clinics had partially or fully achieved access to iCAB/RPV for patients regardless of healthcare coverage, and six clinics had provided access to iCAB/RPV for those who could benefit the most clinically. By developing CPDs for each strategy, we explicated how strategies operated across different clinical contexts. Through this process, we identified mechanisms of action that needed to be activated, moderators that impacted strategy strength and preconditions that needed to be in place for the strategy to function. These insights informed changes to strategies in the final year of the project.</p> </section> <section> <h3> Conclusion</h3> <p>This work demonstrates that applying implementation science tools to service delivery projects can enhance precision and reproducibility of strategies, identify intervention points for improvi
{"title":"Specification and Causal Pathway Diagramming of Implementation Strategies to Support Development of Access-Enhancing Injectable HIV Treatment Programmes at Eight Diverse Health Clinics Across the United States","authors":"Kathrine Meyers, Nadia Nguyen, Charlie Ferrusi, Jason Zucker, Sarit A. Golub, Bryan A. Kutner, Mamta Karani, Cody A. Chastain, Marilyn Blasingame, Moya Brown-Lopez, Jennifer Burdge, Delivette Castor, Caroline Carnevale, Jenna Eldib, Elizabeth Furuya, Omolola Akolo, Kelly Bastien, Melissa Curry, Will Holt, Bijou R. Hunt, Shin Ly, Carlotta Starks, Fabriel Torres jr., Marlene Matosky","doi":"10.1002/jia2.70190","DOIUrl":"https://doi.org/10.1002/jia2.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting injectable antiretroviral therapy (LAI ART) represents a transformative development in HIV care because it may mitigate longstanding barriers that contribute to gaps in health outcomes. Providing LAI ART to people not consistently on HIV treatment or lacking treatment options requires intentional programme planning to overcome implementation barriers, without which only well-resourced patients benefit, worsening health outcome gaps. The ALAI UP Project delivered clinic-level implementation strategies to support eight clinics across Ending the HIV Epidemic jurisdictions to implement injectable cabotegravir and rilpivirine (iCAB/RPV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We specified seven implementation strategies and assessed their impact on clinic achievement of three key programme outcomes: (a) access to information about iCAB/RPV for all patients regardless of clinical eligibility; (b) access to iCAB/RPV regardless of healthcare coverage; and (c) access to iCAB/RPV for those who can clinically benefit the most, including patients who are unable to achieve durable viral suppression on oral ART for reasons other than cabotegravir or rilpivirine resistance. Implementation strategies were delivered from March 2023 through February 2025, and results are reported at the end of year 2 of the 3-year project. We developed causal pathway diagrams (CPDs) for each strategy, identifying determinants, preconditions, moderators, mechanisms and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ALAI UP strategies supported clinic progress towards all three outcomes: six clinics had partially or fully achieved access to information about iCAB/RPV for all patients, seven clinics had partially or fully achieved access to iCAB/RPV for patients regardless of healthcare coverage, and six clinics had provided access to iCAB/RPV for those who could benefit the most clinically. By developing CPDs for each strategy, we explicated how strategies operated across different clinical contexts. Through this process, we identified mechanisms of action that needed to be activated, moderators that impacted strategy strength and preconditions that needed to be in place for the strategy to function. These insights informed changes to strategies in the final year of the project.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This work demonstrates that applying implementation science tools to service delivery projects can enhance precision and reproducibility of strategies, identify intervention points for improvi","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica M. Sales, Katherine M. Anderson, Deja Er, Peyton Williams, Sara Sullivan, Michael W. Brooks, Melissa Kottke, Anandi Sheth
<div> <section> <h3> Introduction</h3> <p>Pre-exposure prophylaxis (PrEP) remains underutilized by women in the United States, in part because PrEP is not widely available in women's healthcare settings. We developed a bundle of tailored implementation strategies (trainings, technical assistance [TA], resources) to support HIV prevention delivery in Title X-funded family planning clinics across Atlanta, Georgia (GA). Guided by the interactive systems framework, we partnered with GA's largest Title X grant holder to provide these strategies to this network. We conducted an evaluation of clinic strategy use and described pre- and post-strategy engagement HIV prevention/PrEP practices.</p> </section> <section> <h3> Methods</h3> <p>Using a qualitative descriptive design, between January 2022 and November 2023, 47 staff, providers and leadership from 11 clinical groups representing 22 of 31 Atlanta Title X clinics (71%) separately participated in baseline (pre-strategy) focus groups (FGs); 10 groups participated in FGs 1-year post-strategy(s). Rapid qualitative analysis of FGs was performed. Chart-abstracted measures were used to describe clinical group-aggregate HIV testing numbers 1 year prior to and 1 year after implementation strategy engagement.</p> </section> <section> <h3> Results</h3> <p>Twenty-two trainings were provided (<i>n</i> = 358 participants), with two TA and 53 requests received across 11 clinical groups. Clinics reported training and resource implementation strategies were acceptable and helped increase their readiness/capacity to provide PrEP, but scheduling trainings was sometimes challenging. Due to significant staff turnover, many noted that refresher trainings were or would be beneficial. TA was underutilized despite its potential need by clinical groups. At baseline, few clinics (<5; 22%) were providing PrEP. At follow-up, eight clinical groups were offering PrEP; one offered referrals to a PrEP-specific clinic. Three groups were able to provide injectable PrEP; two groups were not offering PrEP consistently or at all. Most groups (8 of 11; 73%) reported increases in total HIV tests in the 12 months after strategy engagement.</p> </section> <section> <h3> Conclusions</h3> <p>Implementation strategies were utilized by clinics. Tailored trainings and resources were perceived as helpful for improving HIV testing, and PrEP provision in family planning settings and sustainable access to them via a centralized agency may be necessary to overcome ongoing capacity-related barriers. Additional strategies are necessary to ensure clinic
{"title":"Evaluating an Implementation Strategy Bundle in Title X-Funded Safety-Net Family Planning Clinics to Increase HIV Testing and PrEP Access Among Cis-Gender Women in Atlanta, United States: Lessons Learned From Provider Focus Groups","authors":"Jessica M. Sales, Katherine M. Anderson, Deja Er, Peyton Williams, Sara Sullivan, Michael W. Brooks, Melissa Kottke, Anandi Sheth","doi":"10.1002/jia2.70212","DOIUrl":"https://doi.org/10.1002/jia2.70212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pre-exposure prophylaxis (PrEP) remains underutilized by women in the United States, in part because PrEP is not widely available in women's healthcare settings. We developed a bundle of tailored implementation strategies (trainings, technical assistance [TA], resources) to support HIV prevention delivery in Title X-funded family planning clinics across Atlanta, Georgia (GA). Guided by the interactive systems framework, we partnered with GA's largest Title X grant holder to provide these strategies to this network. We conducted an evaluation of clinic strategy use and described pre- and post-strategy engagement HIV prevention/PrEP practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a qualitative descriptive design, between January 2022 and November 2023, 47 staff, providers and leadership from 11 clinical groups representing 22 of 31 Atlanta Title X clinics (71%) separately participated in baseline (pre-strategy) focus groups (FGs); 10 groups participated in FGs 1-year post-strategy(s). Rapid qualitative analysis of FGs was performed. Chart-abstracted measures were used to describe clinical group-aggregate HIV testing numbers 1 year prior to and 1 year after implementation strategy engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two trainings were provided (<i>n</i> = 358 participants), with two TA and 53 requests received across 11 clinical groups. Clinics reported training and resource implementation strategies were acceptable and helped increase their readiness/capacity to provide PrEP, but scheduling trainings was sometimes challenging. Due to significant staff turnover, many noted that refresher trainings were or would be beneficial. TA was underutilized despite its potential need by clinical groups. At baseline, few clinics (<5; 22%) were providing PrEP. At follow-up, eight clinical groups were offering PrEP; one offered referrals to a PrEP-specific clinic. Three groups were able to provide injectable PrEP; two groups were not offering PrEP consistently or at all. Most groups (8 of 11; 73%) reported increases in total HIV tests in the 12 months after strategy engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementation strategies were utilized by clinics. Tailored trainings and resources were perceived as helpful for improving HIV testing, and PrEP provision in family planning settings and sustainable access to them via a centralized agency may be necessary to overcome ongoing capacity-related barriers. Additional strategies are necessary to ensure clinic","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irene N. Mukui, Sandra Urusaro, John Kinuthia, Daniel Matemo, Jennifer F. Morton, Kenneth K. Mugwanya, for the FP Plus Project
<div> <section> <h3> Introduction</h3> <p>Integrating HIV pre-exposure prophylaxis (PrEP) into family planning (FP) services offers a strategic opportunity to reach women at risk of HIV acquisition. We assessed fidelity to core components of oral PrEP delivery in real-world FP clinics in Kenya.</p> </section> <section> <h3> Methods</h3> <p>Data are from the FP Plus Project, a stepped-wedge cluster-randomized trial integrating oral PrEP into 12 public FP clinics in Kisumu, Kenya, where trained FP healthcare providers delivered PrEP services within routine services. Standardized unannounced client actor visits conducted between December 2021 and April 2022, and cross-sectional exit surveys conducted between July 2021 and July 2024 among FP clients were used to evaluate whether the core components of PrEP services were delivered as intended and to assess service quality. Client actors were trained on three case scripts depicting young women in different scenarios: PrEP initiation, PrEP continuation and PrEP during routine FP visits. After each unannounced visit, client actors completed checklists documenting delivery of PrEP services, including behavioural risk assessment, HIV testing, HIV prevention and PrEP counselling, safety assessment, PrEP dispensing and quality-of-care. Data were analysed descriptively.</p> </section> <section> <h3> Results</h3> <p>Overall, 28 client actor visits were completed across participating FP clinics; 12 initiation, 12 continuation and 4 integrated FP–PrEP initiation. Providers assessed at least one HIV risk behaviour in 85.7% (24/28) of visits and discussed at least one HIV prevention strategy in all visits (100%, 28/28). At least one PrEP counselling topic was discussed in 64.3% (18/28) of visits, and one medical safety area was assessed in 42.9% (12/28) of visits. Unprompted PrEP promotion was low at 28.6% (8/28) of visits. Completion of individual items within service components varied widely. Providers were respectful, non-judgemental and used easy-to-understand language in all (28/28) client actor encounters. Of 1801 exit interview participants, 99.8% (1797/1801) discussed at least one HIV prevention strategy and 96.5% (1737/1801) expressed trust in the FP providers.</p> </section> <section> <h3> Conclusions</h3> <p>Integration of oral PrEP provision into routine FP clinics was achieved with varied fidelity across service components. While engagement occurred across PrEP service components, gaps remained in completeness of counselling, PrEP promotion and medical safety assessment, highlighting the need for contin
{"title":"Fidelity of Implementation of Oral Pre-Exposure Prophylaxis for HIV in Public Family Planning Clinics in Kenya: Results From a Stepped-Wedge Cluster Randomized Trial","authors":"Irene N. Mukui, Sandra Urusaro, John Kinuthia, Daniel Matemo, Jennifer F. Morton, Kenneth K. Mugwanya, for the FP Plus Project","doi":"10.1002/jia2.70189","DOIUrl":"https://doi.org/10.1002/jia2.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Integrating HIV pre-exposure prophylaxis (PrEP) into family planning (FP) services offers a strategic opportunity to reach women at risk of HIV acquisition. We assessed fidelity to core components of oral PrEP delivery in real-world FP clinics in Kenya.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data are from the FP Plus Project, a stepped-wedge cluster-randomized trial integrating oral PrEP into 12 public FP clinics in Kisumu, Kenya, where trained FP healthcare providers delivered PrEP services within routine services. Standardized unannounced client actor visits conducted between December 2021 and April 2022, and cross-sectional exit surveys conducted between July 2021 and July 2024 among FP clients were used to evaluate whether the core components of PrEP services were delivered as intended and to assess service quality. Client actors were trained on three case scripts depicting young women in different scenarios: PrEP initiation, PrEP continuation and PrEP during routine FP visits. After each unannounced visit, client actors completed checklists documenting delivery of PrEP services, including behavioural risk assessment, HIV testing, HIV prevention and PrEP counselling, safety assessment, PrEP dispensing and quality-of-care. Data were analysed descriptively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 28 client actor visits were completed across participating FP clinics; 12 initiation, 12 continuation and 4 integrated FP–PrEP initiation. Providers assessed at least one HIV risk behaviour in 85.7% (24/28) of visits and discussed at least one HIV prevention strategy in all visits (100%, 28/28). At least one PrEP counselling topic was discussed in 64.3% (18/28) of visits, and one medical safety area was assessed in 42.9% (12/28) of visits. Unprompted PrEP promotion was low at 28.6% (8/28) of visits. Completion of individual items within service components varied widely. Providers were respectful, non-judgemental and used easy-to-understand language in all (28/28) client actor encounters. Of 1801 exit interview participants, 99.8% (1797/1801) discussed at least one HIV prevention strategy and 96.5% (1737/1801) expressed trust in the FP providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integration of oral PrEP provision into routine FP clinics was achieved with varied fidelity across service components. While engagement occurred across PrEP service components, gaps remained in completeness of counselling, PrEP promotion and medical safety assessment, highlighting the need for contin","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Geri R. Donenberg, Daniel E. Murphy, Amber Wilson, Robert C. Cregg, Melissa Herrera, Mohini Bhakta, Hayatt Mohamed, Mary T. Glenshaw
<div> <section> <h3> Introduction</h3> <p>Research supported by the National Institutes of Health (NIH) has revolutionized HIV prevention and treatment, but not all people have benefited from these advancements. Implementation science seeks to bridge the gap between a discovery and when it is applied in the real world, by elucidating the methods that promote the adoption, uptake and integration of evidence-based strategies into routine care. Disparities in who benefits from the advancements have prompted calls to accelerate HIV implementation science. This paper provides a snapshot of research funded by the NIH at the intersection of HIV and implementation science.</p> </section> <section> <h3> Methods</h3> <p>The NIH Office of AIDS Research conducted portfolio analyses using the Information for Management Planning Analysis and Coordination (IMPAC II) database; the Research, Condition, and Disease Categorization (RCDC) system; and manual coding to describe select award characteristics. We examined awards coded as both RCDC categories HIV and Dissemination and Implementation Research (D&IR) from fiscal years (FY) 2021–2024, followed by more detailed analyses of awards made in FY2024.</p> </section> <section> <h3> Results</h3> <p>NIH invested USD 697 million in 1569 awards at the intersection of HIV and D&IR from FY2021–2024. During this period, funding for D&IR and HIV increased by 65%. In FY24 alone, 407 awards were made in D&IR and HIV, representing 7% of the total NIH HIV budget appropriated by Congress. Led by the National Institute of Mental Health, support for D&IR in HIV was represented by 15 NIH institutes, centres and offices. Among a subset of 226 FY24 awards consisting of R-mechanisms, studies spanned the HIV prevention and treatment cascade and focused on multiple age groups. Forty-one percent of the awards included hybrid effectiveness-implementation designs, and the Consolidated Framework for Implementation Research (CFIR) was the most frequently cited framework (<i>n</i> = 82; 37%). Over 93% of awards employed both quantitative and qualitative methods.</p> </section> <section> <h3> Conclusions</h3> <p>The NIH investment in HIV-related implementation science is growing, but it made up a small portion (7%) of the total HIV budget in FY24. Challenges characterizing awards on key implementation science factors underscore opportunities to strengthen the science. These data support NIH's commitment to accelerate implementation research to end HIV and ensure its full public health benefit.</p> </section>
{"title":"NIH Investment in HIV and Implementation Science","authors":"Geri R. Donenberg, Daniel E. Murphy, Amber Wilson, Robert C. Cregg, Melissa Herrera, Mohini Bhakta, Hayatt Mohamed, Mary T. Glenshaw","doi":"10.1002/jia2.70148","DOIUrl":"https://doi.org/10.1002/jia2.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Research supported by the National Institutes of Health (NIH) has revolutionized HIV prevention and treatment, but not all people have benefited from these advancements. Implementation science seeks to bridge the gap between a discovery and when it is applied in the real world, by elucidating the methods that promote the adoption, uptake and integration of evidence-based strategies into routine care. Disparities in who benefits from the advancements have prompted calls to accelerate HIV implementation science. This paper provides a snapshot of research funded by the NIH at the intersection of HIV and implementation science.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The NIH Office of AIDS Research conducted portfolio analyses using the Information for Management Planning Analysis and Coordination (IMPAC II) database; the Research, Condition, and Disease Categorization (RCDC) system; and manual coding to describe select award characteristics. We examined awards coded as both RCDC categories HIV and Dissemination and Implementation Research (D&IR) from fiscal years (FY) 2021–2024, followed by more detailed analyses of awards made in FY2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NIH invested USD 697 million in 1569 awards at the intersection of HIV and D&IR from FY2021–2024. During this period, funding for D&IR and HIV increased by 65%. In FY24 alone, 407 awards were made in D&IR and HIV, representing 7% of the total NIH HIV budget appropriated by Congress. Led by the National Institute of Mental Health, support for D&IR in HIV was represented by 15 NIH institutes, centres and offices. Among a subset of 226 FY24 awards consisting of R-mechanisms, studies spanned the HIV prevention and treatment cascade and focused on multiple age groups. Forty-one percent of the awards included hybrid effectiveness-implementation designs, and the Consolidated Framework for Implementation Research (CFIR) was the most frequently cited framework (<i>n</i> = 82; 37%). Over 93% of awards employed both quantitative and qualitative methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The NIH investment in HIV-related implementation science is growing, but it made up a small portion (7%) of the total HIV budget in FY24. Challenges characterizing awards on key implementation science factors underscore opportunities to strengthen the science. These data support NIH's commitment to accelerate implementation research to end HIV and ensure its full public health benefit.</p>\u0000 </section>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natsayi Chimbindi, Ursula Ngema, Janet Seeley, Andrew Gibbs, Abigail Harrison, Alun Davies, Stefan Baral, A. Rani Elwy, Maryam Shahmanesh
<div> <section> <h3> Introduction</h3> <p>We co-adapted and evaluated a multi-component whole-school health-promotion Safer Choices programme to improve sexual and reproductive health (SRH) and uptake of HIV-prevention among learners in rural uMkhanyakude district, KwaZulu-Natal, South Africa.</p> </section> <section> <h3> Methods</h3> <p>From January 2023 to June 2025, we used the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to guide and document Safer Choices adaptations. We used participatory qualitative approaches and a process evaluation to assess intervention acceptability and feasibility. Co-adapting involved a 3-day workshop with 16 learners aged 15–19 (Grade 9–10), four discussions with school leadership and two focus group discussions (FGDs) with parents/guardians, to understand the context and social validity of the programme. Intervention acceptability was assessed through five in-depth interviews with teachers/school leadership and three with peer leaders, two workshops with intervention and clinical delivery teams, two FGDs with community members and five with learners. Interactions were audio-recorded, transcribed and analysed using thematic analysis.</p> </section> <section> <h3> Results</h3> <p>Schools were described as learning spaces providing opportunities for health promotion through health and well-being lessons. Teachers and parents/guardians noted a need for Safer Choices to provide SRH/HIV services in schools, as most learners were already sexually active. Provision of mobile SRH/HIV services in schools was perceived to be feasible if negotiated with the school and HIV-status neutral services were provided to minimize stigma. Adaptations to Safer Choices were focused on optimizing intervention delivery or emphasizing social validity of the programme. During implementation of Safer Choices, myths and misconceptions around HIV and pregnancy were addressed. Challenges such as no electricity and large classes made it difficult to deliver Safer Choices. Peer navigators (lay youth-workers) were engaged to help deliver the intervention.</p> </section> <section> <h3> Conclusions</h3> <p>In a context of high sexual risk and vulnerability, it was feasible to co-adapt and deliver the Safer Choices programme, which provided accurate and accessible SRH information and services to address adolescent SRH needs of learners in our rural schools. Adaptation challenges included balancing fidelity to intervention with both the “real-world” context and the practicality of peer navigators supporting intervention deliver
{"title":"Adaptation and Evaluation of a Multi-Component School-Based Sexual Reproductive Health Intervention Safer Choices Programme in Rural KwaZulu-Natal, South Africa – A Process Evaluation","authors":"Natsayi Chimbindi, Ursula Ngema, Janet Seeley, Andrew Gibbs, Abigail Harrison, Alun Davies, Stefan Baral, A. Rani Elwy, Maryam Shahmanesh","doi":"10.1002/jia2.70192","DOIUrl":"https://doi.org/10.1002/jia2.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We co-adapted and evaluated a multi-component whole-school health-promotion Safer Choices programme to improve sexual and reproductive health (SRH) and uptake of HIV-prevention among learners in rural uMkhanyakude district, KwaZulu-Natal, South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January 2023 to June 2025, we used the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to guide and document Safer Choices adaptations. We used participatory qualitative approaches and a process evaluation to assess intervention acceptability and feasibility. Co-adapting involved a 3-day workshop with 16 learners aged 15–19 (Grade 9–10), four discussions with school leadership and two focus group discussions (FGDs) with parents/guardians, to understand the context and social validity of the programme. Intervention acceptability was assessed through five in-depth interviews with teachers/school leadership and three with peer leaders, two workshops with intervention and clinical delivery teams, two FGDs with community members and five with learners. Interactions were audio-recorded, transcribed and analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Schools were described as learning spaces providing opportunities for health promotion through health and well-being lessons. Teachers and parents/guardians noted a need for Safer Choices to provide SRH/HIV services in schools, as most learners were already sexually active. Provision of mobile SRH/HIV services in schools was perceived to be feasible if negotiated with the school and HIV-status neutral services were provided to minimize stigma. Adaptations to Safer Choices were focused on optimizing intervention delivery or emphasizing social validity of the programme. During implementation of Safer Choices, myths and misconceptions around HIV and pregnancy were addressed. Challenges such as no electricity and large classes made it difficult to deliver Safer Choices. Peer navigators (lay youth-workers) were engaged to help deliver the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a context of high sexual risk and vulnerability, it was feasible to co-adapt and deliver the Safer Choices programme, which provided accurate and accessible SRH information and services to address adolescent SRH needs of learners in our rural schools. Adaptation challenges included balancing fidelity to intervention with both the “real-world” context and the practicality of peer navigators supporting intervention deliver","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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