Applying human-centered design to adapt a multifaceted implementation strategy for integrating HIV and NCD services...

There has been limited research reporting approaches used in the adaptation of implementation strategies for integrating HIV and NCD services that involve healthcare providers in low- and middle-income country (LMIC) settings. This paper describes how human-centered design (HCD) was used to 1) adapt a multifaceted implementation strategy for integrating HIV and NCD services through end-user engagement and 2) share insights from the specific suggestions made through the HCD process with healthcare providers. As part of the TASKPEN an implementation science-driven intervention aimed at task shifting and integrating the evidence-based WHO Package of Essential NCDs Interventions (WHO-PEN) approach into routine healthcare settings for PLHIV, we co-designed implementation strategy components (i.e., "sub-components") to strengthen HIV/NCD integration in four HIV clinics in Lusaka, Zambia. The HCD process involved qualitative approaches with healthcare providers, namely lay and non-physician healthcare workers (NPHWs) such as nurses and community healthcare workers (CHWs). A four-phased approach of exploration through formative qualitative work, ideation with intervention deliverers, analysis, and refinement was used to develop strategy sub-components. Rapid thematic data analysis was used to synthesise the data. Applying HCD to a locally-informed intervention for screening and managing cardio-metabolic co-morbidities for Zambian PLHIV informed the addition of sub-components to the multi-faceted implementation strategy to improve adoption, appropriateness, and feasibility. Through co-design workshops, healthcare providers suggested specific sub-components be added to enhance the intervention. Specifically, four sub-component strategy ideas were produced: introducing NCD/HIV champions, circulating a weekly facility NCD medication bulletin, dashboard reporting of HIV/NCD cases, and community sensitization. The use of HCD in implementation science is a promising approach to refining implementation strategies that are likely to result in the success of HIV/NCD integration in Zambia and similar LMIC settings.