The Use of Community Engagement in Implementation: Successes and Challenges From the Implementation and Adaptation of Bundled HIV Interventions for Black Women.

introductionBlack women are disproportionately impacted by HIV in the United States, yet Black women are rarely called upon to engage in intervention development, implementation and evaluation. As a result, interventions continuously fail to reflect their priorities and needs. Incorporating the meaningful involvement of Black women with HIV and community organisations that serve them into implementation processes is necessary if interventions are going to be effective and sustained. The purpose of this paper is to examine the implementation strategies that employed community engagement to support the adaptation and uptake of bundled interventions to improve care and treatment outcomes for Black women with HIV as part of the Black Women First initiative. Successes and challenges in the use of community engagement in implementation are also explored.

methodsFor this paper, we draw on qualitative implementation data collected over the course of the Black Women First initiative from 12 demonstration sites. Data-related community engagement, patient, client, consumer engagement, implementation and challenges to engagement were extracted and analysed using directed content analysis.

resultsWe identified five types of community engagement used by sites in implementation: client advisory boards, client focus groups and surveys, peer leadership, community taskforces, and network weaving. They engaged site clients who were Black women with HIV, community members and partner organisations to inform pre-implementation design, adaptation of intervention design and delivery, and intervention and programme sustainability planning. The frequency of use of these different types of community engagement varied across sites and the project period. Maintaining engagement and quality of involvement in implementation across the different types of community engagement were key challenges for sites, especially in advisory boards and focus groups.

conclusionResearchers and HIV care practitioners should continue to utilise community engagement to enhance intervention implementation, as well as identify emergent ways to engage community members and organisations to enhance implementation and health outcomes for people with HIV. PUBLIC CONTRIBUTION: Black Women First initiative demonstration site staff who were integral to the implementation of the bundled interventions for Black women with HIV were involved in the analysis and interpretation of the data, and preparation of this manuscript.