A MIXED METHODS ASSESSMENT OF ORGANIZATIONAL CHARACTERISTICS ASSOCIATED WITH SUCCESSFUL SCALE-UP AND SUSTAINMENT OF SYSTEMS NAVIGATION AND PSYCHOSOCIAL COUNSELING FOR PEOPLE WHO INJECT DRUGS LIVING WITH HIV IN VIETNAM

Background: Globally, there are significant challenges to implementing and sustaining evidence-based interventions (EBIs). Organizational characteristics, organizations’ inner structures, culture, and climate, are essential in successful implementation and may be key in EBI sustainment. This dissertation’s purpose is to understand how organizational characteristics influence scale-up success, adaptation, and sustainment within the context of an implementation trial of the Systems Navigation and Psychosocial Counselling (SNaP) intervention for people who inject drugs (PWID) with HIV across 42 HIV testing clinics in Vietnam. Methods: In study 1, I conducted a mixed methods analysis to assess the relationship between five organizational characteristics, organizational readiness to change, implementation leadership, implementation climate, percent PWID, and staff workload, and successful SNaP scale-up. In study 2, I evaluated the association between these same organizational characteristics and SNaP sustainment 6-10 months post-SNaP study completion. In study 3, I analyzed interviews (n=31) with SNaP clinic staff to determine adaptations made during SNaP’s sustainment phase and identify factors influencing SNaP sustainment. Results: In study 1, greater implementation leadership and high staff workload were significantly associated with SNaP scale-up success, while implementation climate was slightly negatively associated with scale-up success (contrary to the qualitative findings). There was not a significant association between percent PWID or organizational readiness and scale-up success. In study 2, clinics with high organizational readiness had greater sustainment than clinics with low organizational readiness. None of the other organizational characteristics were associated with SNaP sustainment. In study 3, I found that most clinics adapted SNaP during the sustainment phase, including shortening and tailoring SNaP counselling sessions, integrating systems navigation sessions, and providing “SNaP for everyone.” I also identified factors, across the Integrated Sustainability Framework, that were instrumental for SNaP sustainment. Conclusions: This dissertation explored the relationship between organizational characteristics, SNaP scale-up success, adaptation, and sustainment within HIV testing clinics in Vietnam. These findings demonstrated the influence of implementation leadership and staff workload on successful SNaP implementation, and the importance of organizational readiness to change and clinic adaptations for SNaP sustainment. This work can inform future implementation and sustainment strategies to increase EBI reach and improve HIV outcomes for PWID.