Improving NGOs' participation in implementing HIV preventive interventions: a case of adolescents with high-risk behaviors in Iran.

BACKGROUND

The study aimed to identify the obstacles that NGOs face in their participation in implementing HIV preventive interventions among adolescents with high-risk behaviors in Iran and to propose interventions to enhance their involvement.

METHODS

The study employed a qualitative approach in three phases to identify barriers and solutions to NGOs' participation in HIV preventive interventions. First, 56 semi-structured interviews, four focus group discussions (FGDs), and a document review were conducted with diverse stakeholders, using a purposive sampling strategy combining maximum variation sampling with a snowballing approach. Participants were sampled from relevant backgrounds in health policymaking, public participation, or communicable disease. Data from interviews and FGDs were audio-recorded, transcribed, and analyzed using an inductive content analysis. Second, a scoping review was performed, utilizing databases such as PubMed, Web of Science, ProQuest, and Google Scholar. A policy brief from the first two phases informed a one-day multi-stakeholder policy dialogue with 16 selected policy actors. This session was audio-recorded, transcribed, and analyzed through content analysis.

RESULTS

We identified various challenges faced by NGOs, including those related to the unique features of HIV services, such as difficulty in case finding and constant provision of preventive care. Severe challenges included weak NGOs' performance, insufficient capabilities, and insufficient support from the government, resulting in undesirable constructive collaboration. Tailored strategies were developed, such as the empowerment of NGOs, enhancing public health literacy, modifying the process of identifying eligible NGOs, clarifying key processes for NGOs' involvement, response to COVID-19, increasing adolescent engagement, advocating for removing the stigma from active NGOs, increasing support for active NGOs, organizing communication networks and collaboration, and strengthening governance arrangements.

CONCLUSIONS

NGOs' participation in HIV prevention can facilitate the alignment of interventions with the specific needs of at-risk populations. However, there are obstacles to full NGOs' participation from both NGO and government perspectives, necessitating several measures to address these challenges. These measures are imperative for fostering constructive and sustained collaboration between NGOs and the government. The significance of this study lies in its emphasis on such collaboration, particularly in low-resource settings, which is crucial for nations committed to authentically realizing the goal of 'health for all, by all,' alongside genuine community participation.

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