Implementation of a Multicomponent HIV Stigma Reduction Intervention in Rural China: A CFIR Analysis

Abstract Stigma reduction interventions often yield mixed results due to challenges in their implementation. Despite growing recognition of localized implementation, structured documentation of implementation strategies remains limited. This study retrospectively used the 2022 Consolidated Framework for Implementation Research (CFIR) to synthesize contextual challenges and implementation strategies during a multicomponent stigma reduction and mitigation intervention in a resource-limited setting in China. Fourteen implementation staff and administrators participated in semi-structured interviews in 2024. Participants were purposively selected for their involvement in delivering or coordinating the intervention. Data were thematically analyzed, with the CFIR applied retrospectively to synthesize and organize the findings. NVivo 12 supported coding, and intercoder reliability was established before thematic synthesis. Participants identified multiple implementation challenges, including the complexity of intervention content, human resource constraints, geographic dispersion, socioeconomic barriers, and HIV-related stigma. In response, project teams employed strategies, such as simplifying and contextualizing materials, redistributing responsibilities through task-shifting, leadership buy-in, offering travel support, and modifying session logistics. Added value of the intervention to project sites, community-based trust-building, and horizontal communication across sites were also key to fostering implementation momentum and alignment. This study demonstrates that effective implementation of complex psychosocial interventions in low- and middle-income countries requires deliberate, context-driven implementation strategies supported by structured frameworks. Key lessons include treating adaptation as a mechanism for maintaining fidelity, integrating facilitator training into existing capacity-building systems, and investing in internal implementation infrastructure for sustained delivery. These findings offer practical guidance for advancing the scalable and sustainable implementation of psychosocial interventions in resource-constrained settings.