Innovations in Implementing Decentralized HIV Services in Peru

The project proposes to combine NIATx, an evidence-informed implementation strategy, with Project ECHO, a tele-educational strategy, to scale up evidence-based practices for decentralized HIV services. The initial phase involves using the Delphi method to establish guidelines for safe decentralization of PWH using a hub-and-spoke model and to define minimal quality health indicators for primary health centers. Following this, a rapid, multi-level assessment of barriers and facilitators to decentralizing HIV care will be conducted. Implementation will then proceed in a stepped wedge design over 24 months across four hub and spoke regions. The primary effectiveness outcome will be the proportionate change of PWH receiving HIV care in PHCs, with secondary outcomes including retention in care and viral suppression. Primary implementation outcomes will focus on confidence in managing PWH at PHCs, and other measures will include collaboration, workplace climate, and adoption of HIV care at new PHC sites.