Designing a stigma reduction intervention in Zambia: perspectives of young people with HIV and key stakeholders using the consolidated framework for implementation research.

BACKGROUND: Young people with HIV (YPWH) in Zambia and other low-income settings in Africa experience the compounded effects of intersecting HIV and poverty stigma. Meanwhile, limited research using structured implementation science frameworks has informed the development of interventions to address this intersectional stigma. We sought to address this gap by applying the Consolidated Framework for Implementation Research (CFIR) to explore perspectives of YPWH and key stakeholders (service providers, local government representatives) on the design and implementation of interventions to reduce intersectional stigma.

METHODS: This study employed a qualitative case study design using in-depth interviews with 54 purposively sampled participants, including 32 young people with HIV (YPWH) and 22 key informants comprising stakeholders involved in implementing HIV-related services. Thematic analysis was used to analyze the data.

RESULTS: Proposed intervention elements within the CFIR Innovation domain included compatibility with the local context, integration with health education, and the inclusion of psychosocial support and economic components, such as vocational training, small business development, and loans and savings groups. Outer Setting domains included engaging community leaders and stakeholders and leveraging existing community structures and resources to disrupt HIV and poverty stigma. Inner Setting domains comprised a supportive institutional climate, such as youth-friendly spaces, and support groups that foster experience-sharing and solidarity among YPWH. Characteristics of Individuals included strategies for improving knowledge, attitudes, and skills, as well as peer-led dialogues and role modeling. Finally, the Process domains included adopting participatory approaches and using digital platforms and social media to enhance communication.

CONCLUSION: This study builds on existing stigma-reduction interventions by offering actionable guidance for implementing intersectional HIV and poverty stigma interventions informed by YPWH and stakeholders. This study advances implementation science by integrating economic empowerment and HIV stigma reduction within an intersectional framework and using the CFIR to elucidate contextual determinants shaping intervention uptake, delivery, and outcomes.