Amanda L Sanchez1,2,3, Katelin Hoskins1,2,3, Amy R Pettit4, Florence Momplaisir5,6, Robert Gross5,6, Kathleen A Brady7, Carlin Hoffacker8, Kelly Zentgraf1,2, Rinad S Beidas1,2,3,9,10,11. 1. Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA. 2. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 3. Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA. 4. Independent Consultant, Boston, MA. 5. Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 6. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, Philadelphia, PA. 7. AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA. 8. Department of Counseling and Educational Psychology, Indiana University, Bloomington, IN. 9. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 10. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and. 11. Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA.
Abstract
BACKGROUND: Managed problem solving (MAPS) is an evidence-based intervention that can boost HIV medication adherence and increase viral suppression, but it is not widely used in community clinics. Deploying community health workers to deliver MAPS could facilitate broader implementation, in support of the Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections in the US by 90% by 2030. SETTING: Ryan White-funded clinics in Philadelphia, 1 of 48 US counties prioritized in the EHE. METHODS: Semistructured stakeholder interviews were conducted with 13 clinics and 4 stakeholder groups: prescribing clinicians, nonprescribing clinical team members (eg, medical case managers), clinic administrators, and policymakers. Interviews were based on the Consolidated Framework for Implementation Research and investigated perceived barriers to and facilitators of MAPS delivery by community health workers. Rapid qualitative analytic techniques were used to synthesize interview data and identify key categories along an implementation pathway. Core determinants (ie, barriers and facilitators) of MAPS implementation were grouped within each category. RESULTS: Stakeholders were receptive to CHW-delivered MAPS and offered critical information on potential implementation determinants including preferences for identification and referral of patients, and the importance of integration and communication within the care team. CONCLUSIONS: This study elucidates insights regarding barriers and facilitators to delivering an evidence-based behavioral intervention in clinics serving people with HIV (PWH) and extends a rapid qualitative approach to HIV care that rigorously incorporates stakeholder data into the development of implementation strategies. It also offers insights for national implementation efforts associated with EHE.
BACKGROUND: Managed problem solving (MAPS) is an evidence-based intervention that can boost HIV medication adherence and increase viral suppression, but it is not widely used in community clinics. Deploying community health workers to deliver MAPS could facilitate broader implementation, in support of the Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections in the US by 90% by 2030. SETTING: Ryan White-funded clinics in Philadelphia, 1 of 48 US counties prioritized in the EHE. METHODS: Semistructured stakeholder interviews were conducted with 13 clinics and 4 stakeholder groups: prescribing clinicians, nonprescribing clinical team members (eg, medical case managers), clinic administrators, and policymakers. Interviews were based on the Consolidated Framework for Implementation Research and investigated perceived barriers to and facilitators of MAPS delivery by community health workers. Rapid qualitative analytic techniques were used to synthesize interview data and identify key categories along an implementation pathway. Core determinants (ie, barriers and facilitators) of MAPS implementation were grouped within each category. RESULTS: Stakeholders were receptive to CHW-delivered MAPS and offered critical information on potential implementation determinants including preferences for identification and referral of patients, and the importance of integration and communication within the care team. CONCLUSIONS: This study elucidates insights regarding barriers and facilitators to delivering an evidence-based behavioral intervention in clinics serving people with HIV (PWH) and extends a rapid qualitative approach to HIV care that rigorously incorporates stakeholder data into the development of implementation strategies. It also offers insights for national implementation efforts associated with EHE.
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