A systemic, multistakeholder participatory approach to research, innovation and action agenda setting for more integrated and effective prevention of HIV and other STIs: the case of Catalonia, Spain.

Introduction: It is increasingly acknowledged that transformative change is needed to effectively address the complex and persistent health challenges facing society today. Realizing transformative change requires multistakeholder processes that co-define and implement research and innovation (R&I) priorities and actions that better respond to the complexity of these challenges in a contextualized manner. However, there is limited insight into the operationalization of participatory systems approaches for identifying the systemic elements of these complex challenges and for defining and implementing R&I topics and action agendas to address them. In this paper, we therefore aimed to analyze the results of a participatory agenda-setting process on the prevention of HIV and other sexually transmitted infections (STIs) that used a systems approach and took place in Catalonia, Spain. Methods: For the agenda-setting process, the innovative System-oriented Dialogue Model (SDM) was used, focusing on the exploration, consultation and integration phases of the model. It involved a wide variety of participants ( Results: The participants identified a wide range of needs, barriers and solutions covering multiple relevant R&I topics and actions in relation to prevention strategies, healthcare access, community-based activities and policy development. The results were compiled in a final agenda structured around eight missions. Two were related to health services and products: "access to prevention, diagnosis, treatment and services" and "development of biomedical tools for prevention and diagnosis." Others were related to systemic elements such as "assessment of stakeholders' needs and interventions," "resources for R&I, prevention, interventions and health inequalities" and "governance, regulation and human rights." Discussion: Using the SDM phases exploration, consultation and integration, we generated a shared agenda for prevention of HIV and other STIs, covering multiple areas with key systemic elements within (underserved) R&I topics and actions. To guarantee subsequent implementation of the resulting agenda with sustained participatory, systems approaches, we recommend implementing the next phases of the SDM with participatory research with specific attention for governance, accountability and funding constraints. This may require mixed-methods research involving the stakeholders that may already agree on the ownership of the missions and taking into account key quantitative studies on benchmarks, realistic implementation pathways and opportunity costs.