Session: Reducing stigma and improving care for sexual minorities and other vulnerable populations
O12.3 - TXTXT Implementation Preparation: Identifying Contextual Barriers and Facilitators to HIV Medication Adherence Among Youth Across 12 Clinics Nationwide
Background: As local context is often a driver of variation in intervention outcomes it is imperative to understand context prior to implementing an evidence-based intervention (EBI). Implementation Science provides a framework to assess contextual barriers and facilitators that may warrant intervention adaptation. The Consolidated Framework for Implementation Research (CFIR) includes five domains: Innovation, Outer setting, Inner setting, Individuals, and Implementation Process. CFIR was used as a framework to collect data about the context of local clinics in scaling-up Treatment Text (TXTXT), an EBI to support adherence and retention in HIV care among young people across 12 clinics in the United States. Six clinics were in the South (Florida, Louisiana, North Carolina, Texas) and six in the Midwest (Illinois, Indiana, Michigan, Missouri, Ohio). Methods: We developed a guide to document each clinic’s existing HIV care program including identification of barriers and facilitators prior to TXTXT implementation. Virtual interviews were conducted with clinic staff and audio recorded with detailed notes. Data was organized by CFIR domain, and geographic location. Themes were identified within each domain as an implementation barrier or facilitator and compared across geography.
Results: All 12 clinics described similar themes within the five CFIR domains, however, responses differed across geography (Figure 1). Barriers (-) included patient difficulty with life needs (Innovations), transportation and mental health services (Outer Setting), navigating large healthcare systems (Inner Setting), HIV stigma (Individual Setting), and young adult engagement (Implementation Process). Facilitators (+) included rapid start and wraparound services (Innovations), incentives (Outer Setting), team culture and interdisciplinary collaboration (Inner Setting), support group participation (Individual Setting), and stakeholder engagement (Implementation Process). While most Midwest clinics noted transportation, mental health services, and young adult engagement as barriers, more Southern clinics identified HIV stigma as a barrier. For facilitators, more Midwest clinics identified rapid start programs, incentives, and team collaboration while more Southern clinics identified support group participation and stakeholder engagement. Conclusions: Assessing and understanding contextual factors is critical in the planning process to scale up EBIs. Our results highlight differences in contextual barriers and facilitators across CFIR domains that may influence EBI outcomes, inform needed adaptations to TXTXT, and impact scale up.
