Optimizing implementation of an evidence-based self-help intervention program for people living with HIV (PLWH) with depressive symptoms in Botswana.

Abstract

An evidence-based self-help program in booklet format has been developed to reduce depressive symptoms among people living with HIV (PLWH) in Botswana. Its effectiveness was evaluated in a Randomized Controlled Trial (RCT), with a sample of 72 PLWH. The program was shown to be effective in reducing depressive symptoms (d = 0.76). Good implementation is an important step. This paper aims to present an evidence-based implementation strategy for the booklet self-help intervention. A reflexive methodology was adopted. An implementation model based on the stepwise approach of Versluis et al. ([2020]. SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation. European Journal of General Practice, 26(1), 140-145.) was applied to the present study. Barriers were identified and deductively coded based on the Consolidated Framework for Implementation Research (CFIR) categories. The Expert Recommendations for Implementing Change (ERIC) framework was used to develop implementation strategies to address the identified barriers. Barriers encountered during implementation included costs, lack of screening, lack of trained professionals, etc., with the most important and changeable barrier being the lack of screening and referral into the self-help program. The most important implementation strategies include good collaboration with stakeholders and training of staff and coaches. Standard screening for depressive symptoms is critical to accessing the intervention. A coordinated strategy including stakeholder engagement and ongoing training and support, and structural support is necessary.