A Mixed Methods Assessment of the Effect of Organizational Characteristics on Intervention Scale-Up Success in 42 HIV...

Organizational characteristics, including structures, culture, and climate, are important determinants of intervention scale-up success. Little is known about which characteristics are most important for HIV intervention scale-up success in low and middle-income countries (LMICs), and how they influence implementation in these contexts.

We sought to examine the relationship between organizational characteristics and scale-up success within an implementation trial testing strategies to scale up Systems Navigation and Psychosocial Counselling (SNaP) for people who inject drugs (PWID) with HIV in Vietnam.

This study was conducted in 42 HIV testing clinics in Vietnam. Informed by the Exploration, Preparation, Implementation, and Sustainment Framework, we assessed the association between five organizational characteristics and SNaP scale-up success: (1) implementation leadership; (2) staff workload; (3) percent PWID; (4) implementation climate; and (5) organizational readiness. We conducted a mixed methods study including surveys at baseline and endline with clinic staff and PWID participants in all clinics and interviews with clinic staff (n = 48) in six high and six low-performing clinics. To develop a context-driven scale-up success index for our outcome measure, we undertook a modified Delphi process with 14 experts in HIV, PWID, and implementation science. We assessed the relationship between our organizational characteristics and scale-up success using thematic and multiple linear regression analyses and explored the convergence of results.

Greater implementation leadership (ß = 12.20, p = 0.004), high staff workload (ß = 4.71, p = 0.008), and lower implementation climate scores (ß = -6.23, p = 0.046) were significantly associated with scale-up success. Qualitatively, participants described the importance of implementation leadership, particularly during COVID-19, and, to a lesser extent, implementation climate and organizational readiness for scale-up success. Some also described how more time spent on SNaP delivery improved fidelity but exacerbated workload. These findings demonstrate that prioritizing implementation leadership-focused strategies for the scale-up of HIV interventions like SNaP could improve implementation outcomes.