Abstract
Background
Implementation of the World Health Organization (WHO) recommended Advanced HIV Disease screening package, remains poor in most settings with limited resources compared with centers of excellence in Malawi. More than 50% of newly diagnosed-HIV clients are missed on screening as a result of implementation barriers. It is important to mitigate the existing barriers and leverage enablers’ inorder to maximize uptake of the advanced HIV disease screening in resource limited settings. This study aimed to co-design strategies for scaling up implementation of advanced HIV disease screening among newly HIV-diagnosed clients in pre-ART phase using a Consolidated Framework for Implementation Research-Expert Recommendation for Implementing Change (CFIR-ERIC) guiding tool.
Methods
A qualitative study was conducted at Rumphi district hospital in Malawi (August – September, 2023). In-depth interviews and stakeholders’ meetings were facilitated to identify and co-design specific strategies for mitigating implementation barriers to advanced HIV disease screening. Participants comprised healthcare providers, purposively selected from key hospital departments. Transcripts and other information were analyzed using Nvivo software followed by mapping of barriers and specific strategies using CFIR-ERIC Matching tool version 1.0.
Findings:
Ten In-depth interviews and 2 stakeholders meetings comprising 25 participants were conducted. Overall, 6 Level 1 strategies (≥ 50% expert endorsement score) and 11 Level 2 strategies (≥ 20%, ≤ 49% expert endorsement score) were identified, targeting barriers associated with availability of resources, intervention complexity, access to knowledge and information, communication and networks; and implementation leads. Most of the reported strategies were cross-cutting and aimed at enhancing clinical knowledge of the intervention (train & educate stakeholders, develop training materials, educational meetings), developing stakeholders interrelations (network weaving, visits to site of Excellency) as well as improving clinical workflow (physical and work structure). Use of evaluative and iterative strategies (identification of barriers, audit & feedback) were also recommended as part of continuous improvement.
Conclusion
Through the involvement of key stakeholders and the use of CFIR-ERIC matching tool, this study has identified cross-cutting strategies that if well implemented, can help to mitigate contextual barriers and leverage enablers for an improved delivery of AHD screening package.