A pragmatic approach to identifying implementation barriers and facilitators for a novel pre-exposure prophylaxis (PrEP) delivery model at public facilities in urban Uganda
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Implementation Science Communications
Abstract
Scalable HIV pre-exposure prophylaxis (PrEP) delivery models for resource-limited settings are critical
for improving PrEP coverage and interrupting HIV transmission. This research uses technical assistance (TA) reports to
evaluate implementation barriers and facilitators for a novel delivery model integrating PrEP and antiretroviral therapy
(ART) delivery for HIV sero-different couples in public health facilities in Kampala, Uganda.
Methods: We used data from the Partners PrEP Program (PPP)—a stepped-wedge cluster randomized trial that is
launching PrEP delivery through an integrated model of oral PrEP and antiretroviral therapy (ART) delivery for HIV
sero-different couples at public health facilities in Kampala and Wakiso, Uganda (NCT03586128). Technical assistance
teams, comprised of PPP program staff, conducted monthly TA visits to implementing facilities where they identified
and addressed implementation challenges in collaboration with health facility staff. Findings were recorded in TA
reports, a standardized form structured using the Consolidated Framework for Implementation Research (CFIR). We
used a conceptual content analysis approach to evaluate TA reports completed from January to December 2019 and
identify implementation barriers and facilitators.
Results: Among 39 reports from the 8 implementing facilities (~ 5 per facility), we identified 11 CFIR constructs. Key
implementation facilitators included sensitizing and educating facility staff about PrEP (knowledge and beliefs about
the innovation); establishing formal and informal feedback and accountability mechanisms (reflecting and evaluating);
and empowering facility staff to address implementation challenges (self-efficacy). Key implementation barriers
were related to ineffective recruitment and referral of sero-different couples to and from nearby facilities (cosmopolitanism)
as well as stockouts of laboratory resources and testing supplies (available resources).
Conclusions: This analysis featured a robust implementation science framework to assess the relationship between
early implementation determinants and outcomes of this innovative PrEP delivery model. Further, we have provided important descriptions of early implementation barriers and facilitators that will inform scale-up efforts for PrEP delivery
within and beyond Uganda. Future work will refine the analysis of pragmatic program data, qualitatively investigate
the identified key themes, and explore strategies for addressing implementation barriers.
Description
Keywords
CFIR, HIV, PrEP, Implementation, LMIC, Barriers, Facilitators
Citation
Thomas, D., Mujugira, A., Ortblad, K., Namanda, S., Kibuuka, J., Nakitende, M., ... & Heffron, R. (2022). A pragmatic approach to identifying implementation barriers and facilitators for a novel pre-exposure prophylaxis (PrEP) delivery model at public facilities in urban Uganda. Implementation Science Communications, 3(1), 1-10. https://doi.org/10.1186/s43058-022-00254-w