Community expert insights on anticipated implementation challenges for an evidence-based adherence intervention for...

Black people in the US are highly affected by HIV and other health disparities. Rise, a culturally congruent Motivational Interviewing-based adherence intervention for Black adults with HIV, is included in the CDC's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention (NCT03331978, clinicaltrials.gov, 10-30-2017). Rise was developed and tested in a community-based organization in Los Angeles County, California. We aimed to understand how interventions such as Rise could be modified to be status-neutral (for people with and without HIV) for national dissemination in community-based settings. We conducted focus groups with 40 community experts in two US Ending the HIV Epidemic Initiative jurisdictions (Los Angeles County; Birmingham and Montgomery, Alabama) and an online discussion with 14 community experts in Los Angeles County. Consistent with the Health Equity Implementation Framework, participants identified multiple levels of barriers to national community-based implementation related to the: External Environment (HIV stigma, restrictive policies, access to resources, and poor public infrastructure, especially in communities in the rural US South); Inner Setting (low community-based organization trustworthiness and understaffing); and Rise Program (need for cultural tailoring at the community and organizational level, inadequate resources to address social determinants of health, and insufficient incentives). To effectively reduce health disparities, evidence-based interventions designed in higher-resource communities may need substantial tailoring for lower-resource and rural communities prior to implementation. Key words: Black/African American; community-based participatory research; health disparities; implementation science; Motivational Interviewing.