Multi-method Analysis of Implementation Determinants and Strategies to Support the Implementation of Contingency...

Methamphetamine use is prevalent among people with HIV (PWH) and complicates HIV care. Integrated substance use and HIV care services are recommended, yet rarely available. Contingency management (CM) is an evidence-based treatment for methamphetamine use, but its implementation within HIV primary care is limited. This study identified determinants and strategies to support CM implementation in HIV care. Key informants from an HIV clinic at an academic medical center (n = 15 patients; n = 15 providers) completed semi-structured interviews and a survey. A rapid qualitative analysis guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework identified implementation determinants, and potential strategies were classified using the Expert Recommendations for Implementing Change (ERIC) compilation. Both patient and provider participants rated CM as acceptable (M = 3.72 and 4.55/5) and appropriate (M = 3.85 and 4.54/5). Providers also rated CM as feasible (M = 4.08/5) and reported strong support for integrating CM into HIV care, citing the high priority of addressing methamphetamine use. Facilitators included the clinic's person-centered culture and providers' familiarity with substance use treatment. Barriers included perceptions that reinforcer values in standard CM protocols were low, limited staffing, and competing provider demands. Suggested implementation strategies included adapting CM (e.g., increasing reinforcer value), patient-directed outreach/advertisements, and provider education and support (e.g., reminders about CM availability and referral processes). Findings indicate strong support for integrating CM into HIV primary care, while noting challenges to implementation. Addressing these determinants through targeted multi-level implementation strategies may enhance CM adoption and sustainment in HIV care settings.