Table 2 Overall iCARE Nigeria testing implementation strategies mapped to barriers and outcomes to inform the Implementation Research Logic Model
Overall iCARE Nigeria testing | Examples of barriers addressed or facilitators leveraged | Implementation outcomes supported |
|---|---|---|
Stakeholder engagement including community organizations, serving the targeted community, healthcare workers, clinic managers. This occurred during the formative adaptation phase, throughout the study and for input into planning for scale-up | Barriers Stigma (provider) Health system barriers Program isolation or estrangement from other work designed to engage the target population Facilitators Presence of organizations working with the targeted population | Acceptability, feasibility |
Hiring criteria for peers (members and non-members of the YMSM community, and requiring experience working with MSM) | Barriers Stigma (community) Legal barriers Confidentiality needs YMSM fear and distrust of non-YMSM members Facilitators Presence of Youth clubs (facilitator) | Reach, acceptability, feasibility, adoption, maintenance |
Peer navigator training | Barriers Safety and confidentiality needs Fear of disclosure Facilitators Knowledge of YMSM concerns and needs | Reach, feasibility, adoption, fidelity, acceptability |
Ongoing supervision | Barriers Distraction by areas of focus outside the protocol and personal agenda Safety, and confidentiality needs Emerging challenges (ex. COVID) | Feasibility, adoption, fidelity, maintenance |
Data audit and continual feedback of recruitment and testing numbers and results to the team and individual PNS to inform strategy adaptation and improve and data quality and implementation | Barriers Incomplete, missing, or flawed data Need to adapt strategies (ex. use of different social media apps) | Feasibility, adoption, fidelity |
Team-based problem solving and support | Barriers Stigma Safety Staff burn out and risk of attrition | Feasibility, adoption, fidelity, maintenance |
Social media outreach | Â | Â |
 Selection of existing social media sites and apps with free access and use for different goals (initial engagement (Grindr, Facebook) or connection to online chat community (WhatsApp) | Barriers YMSM fear and distrust of non-community members Security needs Cost of internet access Facilitator Comfort in engaging on existing social media platforms including those which were MSM-specific | Reach, acceptability, maintenance |
 Use of both YMSM-specific and generic social media where participants were already engaging | ||
 Use of both open and closed group social media | ||
 Adapting online content to target population needs and online costs and capacity, (e.g., refraining from sharing images or videos that would consume scarce resources during the downloading or streaming process) | Barriers Lack of existing knowledge resources responsive to YMSM needs Limited participant financial resources for maintaining online activities | Reach, acceptability, maintenance |
 Use of flexible and informal communication methods responsive to needs of the YMSM by PNs | Barriers Lack of trust by YMSM in engaging with new individuals Different needs based on individual readiness to test | Reach, acceptability |
Testing and linkage navigation | Â | Â |
 Establishing a process to confirm client identity before meeting with PN | Barrier Legal challenge PN safety False claims of YMSM status by participants | Feasibility, reach, acceptability, adoption |
 Flexibility in testing site locations and timing of encounters | Barriers Stigma (community) Legal barriers YMSM distrust of providers PN safety Client unavailability for testing during regular hours Safety and feasibility of social settings for pretest/post-test counseling | Feasibility, reach, acceptability, adoption |
 Training PNs in safety and protocols | ||
 Active peer navigation for linkage to care for clients who test positive for HIV | Barriers Stigma (community, HCWs) Health system barriers (structure, location) Client denial of diagnosis and/or need for care Low self-efficacy for serostatus disclosure | Reach, acceptability, adoption |
 Provision of needed supplies through the grant (test kits, personal protective equipment, cellular data on mobile devices) | Barriers COVID YMSM risk-reduction needs Cost and availability of Smart phones for PNs | Reach, feasibility, acceptability, adoption |
 Navigation of clinets testing positive for HIV to preferred care site perceived as YMSM-friendly | Barriers Perceived high barrier for linkage to HIV care by YMSMs Stigma (community, HCWs) Facilitator Presence of YMSM-friendly sites | Acceptability, feasibility, adoption |
 Provision of identification (ID) cards to the PN | Barriers Legal barriers PN safety risks | Feasibility, adoption, maintenance |
 Documentation integrated into national testing system including reporting forms | Barriers Fear of disclosure | Acceptability, maintenance |