Determinants and Strategies for Implementation of the HOPE Self-Sampling Cervical Screening Intervention for Women Living with HIV in Ghana: A Context Assessment and Implementation Mapping Study

In Ghana, fewer than 5% of women eligible for cervical screening access this intervention. This screening gap has significant implications for early detection and treatment, especially for women living with HIV (WLWH), who are at higher risk of developing and dying from cervical cancer.The HOPE-in-Ghana (HOPE-inG) study aimed to identify determinants of implementation for the HOPE self-sampling cervical screening intervention in Ghana's Central Region and to select implementation strategies to optimize its implementation in this context.

We applied the nominal group technique in a rapid context assessment with four purposively sampled stakeholder groups. Participants independently generated ideas on determinants of HOPE implementation, shared their ideas, provided clarifications, and voted to prioritize them. The Consolidated Framework for Implementation Research (CFIR) was used to categorize nominal group data as follows: determinants relevant to the Innovation (HOPE intervention); Inner setting (health facility sites of implementation); Outer setting (policy); Individuals (intervention recipients, deliverers, and decision-makers) and the Implementation Process. Prioritized determinants judged addressable within the study's scope were then mapped to implementation strategies listed in the Expert Recommendations for Implementing Change (ERIC) taxonomy and specified using published reporting guidance.

We conducted four nominal groups among 65 participants, including WLWH, healthcare workers, clinic managers and government officials that identified determinants largely concentrated in the CFIR Inner Setting, Outer Setting and Implementation Process domains. Analysis yielded 29 prioritized and addressable determinants (14 facilitators and 15 barriers) which were mapped to 24 strategies, with focus on training and educating stakeholders, using evaluative and iterative strategies, stakeholder engagement, and providing interactive assistance, leading to the development of targeted job aids.

Bridging the gap between evidence and practice requires consideration of both context and stakeholder interests. Our context assessment highlighted key changes in policy, health facility staff and environment, and implementation processes as critical to the successful integration of HPV self-sampling into Ghana's HIV program and health system. Accordingly, we identified relevant implementation strategies to inform actionable job aids. We will evaluate whether these implementation support strategies improve adoption, cost, fidelity, penetration, and sustainability of the HOPE cervical screening intervention in our study setting.

ClinicalTrials.gov NCT06800664. Registered on 29 January 2025.