Preimplementation Factors for a Mobile Decision Support Tool for Cervical Cancer Screening Among Dominican Women Living With HIV: Qualitative Study

ABSTRACT: Women living with HIV (WLH) have a sixfold greater risk of cervical cancer. In the Dominican Republic, cervical cancer and HIV remain prevalent, yet screening rates are low. The World Health Organization recommends a same-day screening, triage, and treatment protocol for WLH, but implementation faces persistent barriers. This study examined barriers and facilitators to implementing iSTAR, a mobile clinical decision support tool designed to guide providers through the screening, triage, and treatment protocol through rapid human papillomavirus DNA testing and results interpretation. We conducted a secondary qualitative analysis guided by the Health Equity Implementation Framework of transcripts from 16 providers and 25 WLH across formative interviews and usability testing. Societal, clinic-level, patient, and provider factors intersected during clinical encounters to shape implementation, indicating that neither protocol adoption nor technology alone will sustain implementation. Findings support multilevel strategies for successful initial and sustained implementation.