Integrating a Resilience Framework to Assess Implementation of a Novel HIV Care Re-engagement Model in NYC.

Abstract

The Bottom Up Project, a collaboration of clinical, community, and academic partners, consists of 7 major steps that leverages a health information exchange, a system for sharing patient health information, with real-time alerts to mobilize peer outreach workers to find and re-engage persons with HIV disconnected from care. Bottom Up faced implementation challenges in its start-up phase as well as produced effective responses leading to project maturation, which we explore using a novel implementation science framework incorporating resilience. We conducted semi-structured interviews of implementation staff (N=6) and meeting minutes and protocols document reviews (N=35). The Consolidated Framework for Implementation Research (CFIR) and a novel resilience framework (RF) guided thematic and process analyses. The RF consisted of three resilience types: absorptive to cope with adversity, adaptive to adjust as a short-term solution, and transformative to structurally change. The Project experienced 20 major challenges, and 2-5 challenges per step. Challenges were multi-level and of chronic and crisis intensities. Implementers selectively overcame some challenges by leveraging multi-level factors and used absorptive, adaptive (most common), and transformative resilience response types. Bottom Up matured by practicing consistency and flexibility. The Project maintained core operations while under crisis-level stress by strategically simplifying or 'downshifting' activities. Transformational responses suggest that specific initiatives can catalyze organizational change. Bottom Up implementation demonstrates using diverse tactics to respond to challenges, thereby shaping project development and in turn organizations. Applying resilience to CFIR helps build awareness of active and dynamic processes promoting or impeding the growth and success of intervention-oriented projects.