{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:07:45Z","timestamp":1758931665870,"version":"3.44.0"},"reference-count":44,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>Organizational characteristics, including structures, culture, and climate, are important determinants of intervention scale\u2010up success. Little is known about which characteristics are most important for HIV intervention scale\u2010up success in low and middle\u2010income countries (LMICs), and how they influence implementation in these contexts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims and Objectives<\/jats:title><jats:p>We sought to examine the relationship between organizational characteristics and scale\u2010up success within an implementation trial testing strategies to scale up Systems Navigation and Psychosocial Counselling (SNaP) for people who inject drugs (PWID) with HIV in Vietnam.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was conducted in 42 HIV testing clinics in Vietnam. Informed by the Exploration, Preparation, Implementation, and Sustainment Framework, we assessed the association between five organizational characteristics and SNaP scale\u2010up success: (1) implementation leadership; (2) staff workload; (3) percent PWID; (4) implementation climate; and (5) organizational readiness. We conducted a mixed methods study including surveys at baseline and endline with clinic staff and PWID participants in all clinics and interviews with clinic staff (<jats:italic>n<\/jats:italic>\u2009=\u200948) in six high and six low\u2010performing clinics. To develop a context\u2010driven scale\u2010up success index for our outcome measure, we undertook a modified Delphi process with 14 experts in HIV, PWID, and implementation science. We assessed the relationship between our organizational characteristics and scale\u2010up success using thematic and multiple linear regression analyses and explored the convergence of results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Conclusion<\/jats:title><jats:p>Greater implementation leadership (<jats:italic>\u00df<\/jats:italic>\u2009=\u200912.20, <jats:italic>p<\/jats:italic>\u2009=\u20090.004), high staff workload (<jats:italic>\u00df<\/jats:italic>\u2009=\u20094.71, <jats:italic>p<\/jats:italic>\u2009=\u20090.008), and lower implementation climate scores (<jats:italic>\u00df\u2009<\/jats:italic>=\u2009\u22126.23, <jats:italic>p<\/jats:italic>\u2009=\u20090.046) were significantly associated with scale\u2010up success. Qualitatively, participants described the importance of implementation leadership, particularly during COVID\u201019, and, to a lesser extent, implementation climate and organizational readiness for scale\u2010up success. Some also described how more time spent on SNaP delivery improved fidelity but exacerbated workload. These findings demonstrate that prioritizing implementation leadership\u2010focused strategies for the scale\u2010up of HIV interventions like SNaP could improve implementation outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.70243","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T06:10:01Z","timestamp":1755670201000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Mixed Methods Assessment of the Effect of Organizational Characteristics on Intervention Scale\u2010Up Success in 42 HIV Testing Clinics in Vietnam"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9431-8735","authenticated-orcid":false,"given":"Sophia M.","family":"Bartels","sequence":"first","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong Linh T.","family":"Dang","sequence":"additional","affiliation":[{"name":"UNC\u2010Vietnam Hanoi Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane S.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ha T. T.","family":"Nong","sequence":"additional","affiliation":[{"name":"UNC\u2010Vietnam Hanoi Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Van Anh T.","family":"Cao","sequence":"additional","affiliation":[{"name":"UNC\u2010Vietnam Hanoi Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ha V.","family":"Tran","sequence":"additional","affiliation":[{"name":"UNC\u2010Vietnam Hanoi Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teerada","family":"Sripaipan","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byron J.","family":"Powell","sequence":"additional","affiliation":[{"name":"Brown School at Washington University in St. Louis St. Louis Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Barrington","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luz M.","family":"Reyes","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Le Minh","family":"Giang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Hanoi Medical University Hanoi Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huong T. T.","family":"Phan","sequence":"additional","affiliation":[{"name":"Vietnam Administration HIV\/AIDS Control Hanoi Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William C.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian F.","family":"Go","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"\u201cHIV and People Who Use Drugs \u201d UNAIDS published 2021."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(18)30292-3"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckad008"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-014-0928-3"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2019.04.025"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780197660690.003.0009"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-67"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0327-7"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0593-9"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1178632921999652"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-01020-z"},{"key":"e_1_2_9_13_1","unstructured":"W.Miller I.Hoffman B.Hanscom et al. \u201cImpact of Systems Navigation and Counseling on ART SUT and Death in PWID: HPTN 074 2018 \u201dhttp:\/\/www.croiconference.org\/sessions\/impact-systems-navigation-and-counseling-art-sut-and-death-pwid-hptn-074."},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31487-9"},{"key":"e_1_2_9_15_1","unstructured":"\u201cVietnam Country Factsheets 2023 \u201d UNAIDS https:\/\/www.unaids.org\/en\/regionscountries\/countries\/vietnam."},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/14659891.2018.1448473"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2014.04.012"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0314-z"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0319-7"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-018-0313-9"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.5662\/wjm.v11.i4.116"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2022.2161311"},{"volume-title":"Stata Statistical Software: Release 17","year":"2023","author":"StataCorp","key":"e_1_2_9_23_1"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.5127\/jep.008310"},{"volume-title":"NVivo Qualitative Data Analysis Software [NVivo 12]","year":"1999","key":"e_1_2_9_25_1"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090198118795019"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.4135\/9781849208574.n4"},{"journal-title":"Designing and Conducting Mixed Methods Research","year":"2017","author":"Creswell J. 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