Determinants and strategies for implementation of an adapted data to care vertical HIV prevention intervention in a South African context

Abstract

Despite progress in preventing new HIV infections in children, retention in vertical transmission prevention (VTP) remains a challenge in low-resource settings. The REMInD intervention used an adapted Data to Care (D2C) approach with tracing to support mother-infant pairs in completing VTP care. This qualitative study aimed to explore the potential implementation determinants and strategies to enhance the successful implementation of the REMInD intervention in Gugulethu, South Africa. Interviews were conducted with nurses, policy implementers, and mothers who had participated in the REMInD proof-of-concept study. We applied the Consolidated Framework for Implementation Research (CFIR) to identify determinants that could influence future implementation. Data were analysed using inductive thematic analysis. Key potential implementation determinants were identified across multiple CFIR domains. Within the Inner setting domain, limited availability of human resources and infrastructure posed key barriers. Under the Individual domain, the capability to retrieve and use data reports was a central concern. The Innovation domain was reflected in the perceived complexity of data retrieval and tracing procedures, particularly in informal settlements with poor infrastructure. Finally, in the Outer setting domain, HIV-related stigma emerged as a potential barrier. To address these challenges, several strategies were proposed by participants: (i) train and give access to the intervention for all nurses to mitigate staffing shortages, (ii) partnerships with NGOs to enhance patient tracing and support service delivery, (iii) collaboration within the health system to sustain support and resource availability, and (iv) dedicated champions to drive implementation. These findings highlight intersecting systemic, contextual, and individual factors influencing REMInD and similar D2C implementation. Strategies addressing staffing, infrastructure, and tracing gaps could enhance implementation success and HIV retention in low-resource settings.