How programmes, people, places and processes interact: An example of the implementation of a community-based pilot programme for women living with HIV in Montreal, Canada

Background: Community-university collaborators developed and implemented “Pouvoir Partager/Pouvoirs Partagés”, a community-based pilot programme helping women living with HIV in Montreal, Canada to effectively manage the disclosure of their HIV status. Objective: To assess how the programme was implemented, and to explain how factors relating to the programme, its development and evaluation processes, its implementation context, as well as to the target population, participants and other stakeholders influenced programme implementation. Methods: We used a multiple-embedded case study approach, with cases consisting of each of the 8 settings in which the programme was foreseen to be implemented (6 community organizations, 1 hospital and 1 community clinic). Process analysis was undertaken. Interviews with the head researcher, programme coordinators, representatives of organizations and interventionists (n = 22), focus groups with programme participants (n = 4) and committee meeting observations were conducted. Results: Four out of eight settings implemented the programme. Organizational characteristics and capacity, programme fit with the implementing setting, and stakeholder attitudes influenced the decision to implement. Programme promotion was difficult for all settings; social representations of HIV/AIDS, organizational characteristics and reach into the target population, relevance of recruitment strategies, recruiter characteristics and programme characteristics influenced the recruitment process. Programme relevance and participants’ readiness to participate, convenient programme modalities and women’s implication in the research process influenced women’s participation in the programme. Extent of programme coverage was similar across the four implementation settings; the research context, participant characteristics and programme modalities were influential at this stage. Conclusion: Successfully implementing programmes for women living with HIV requires recognizing the different levels of factors that are at play, their interconnections, and how different combinations of factors are influential at each stage of the programme’s life. Such an understanding will facilitate the process of mutual adaptation between the programme and its context, thus maximising successful implementation.