Sustainability of a gender-focused HIV and alcohol risk-reduction intervention in usual care settings in South Africa: a mixed methods analysis

ABSTRACT

Intervention sustainability is a critical yet understudied aspect of implementation science research. To address this gap, we examined the sustainability of the Women’s Health CoOp (WHC), a gender-focused, evidence-based, HIV and alcohol risk-reduction intervention, after an implementation trial. We used a mixed methods design consisting of questionnaires (n = 12), 3 focus groups (n = 11), and a semistructured interview conducted with interventionists implementing the WHC in clinics and substance use treatment programs in Cape Town, South Africa. Five out of 8 facilities implemented the WHC beyond the 6-month implementation period, and 4 were still implementing the WHC as of October 2019. Sustainability ranged from approximately 8 months to more than 3 years. At the most recent assessment, interventionists delivered the intervention to 0–20 participants in the past month. Qualitative findings indicate that long-term sustainability would require support from upper management, staff dedicated to the WHC, and booster trainings. The WHC was sustained postimplementation. Integrating the program into usual care would be feasible; however, human resources, financial, and institutional support would be needed for sustainability. To move implementation science forward, it is essential to determine sustainability beyond the presence and involvement of researchers.

KEYWORDS:

• Sustainability
• implementation science
• HIV
• alcohol use
• women
• risk-reduction intervention

Acknowledgements

The findings and conclusions presented in this article are those of the authors and do not necessarily represent the views of the NIAAA. We thank all the study participants and project staff for their dedication and contributions to the study. We also thank Jeffrey Novey for his editorial assistance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was conducted with support from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [grant number R01AA022882] (PI: Wechsberg).