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A Qualitative Study of Community-Based HIV/AIDS Prevention Interventions, Programs, and Projects for Rural and Remote Regions in Canada

Implementation Challenges and Lessons Learned

Worthington, Catherine PhD; Mollison, Ashley MA; Herman, Tamara MA; Johnston, Christine MPH, MA; Masching, Renée MSW; Pooyak, Sherri MSW; Lee, Rebecca MA; Loutfy, Mona MD, FRCPC, MPH

Journal of Public Health Management and Practice: November 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000878
Research Full Report: PDF Only

Context: Fifteen percent to 20% of the Canadian and American populations live outside urban areas, and despite growing regional HIV/AIDS–related health disparities, there is little published research specific to rural or remote (rural/remote) HIV/AIDS prevention programming.

Objective: To document implementation challenges, lessons learned, and evaluation approaches of promising and proven HIV/AIDS prevention programs and interventions developed and delivered by organizations with rural/remote catchment areas in Canada to provide a foundation for information sharing among agencies.

Design: Qualitative study design, using a community-based participatory research approach. We screened Canadian community-based organizations with an HIV/AIDS prevention mandate to determine whether they offered services for rural/remote populations and invited organizational representatives to participate in semistructured telephone interviews. Interviews were audio-recorded and transcribed. Content analysis was used to identify categories in the interview data.

Setting: Canada, provinces (all except Prince Edward Island), and territories (all except Nunavut).

Participants: Twenty-four community-based organizations.

Results: Screening calls were completed with 74 organizations, of which 39 met study criteria. Twenty-four (62%) interviews were conducted. Populations most frequently served were Indigenous peoples (n = 13 organizations) and people who use drugs (n = 8 organizations) (categories not mutually exclusive). Key lessons learned included the importance of involving potential communities served in program development; prioritizing community allies/partnerships; building relationships; local relevancy and appropriateness; assessing community awareness or readiness; program flexibility/adaptability; and addressing stigma. Evaluation activities were varied and used for funder reporting and organizational learning.

Conclusions: Rural/remote HIV/AIDS programs across Canada expressed similar challenges and lessons learned, suggesting that there is potential for knowledge exchange, and development of a community of practice. Top-down planning and evaluation models may fail to capture program achievements in rural/remote contexts. The long-term engagement practices that render rural/remote programs promising do not always conform to planning and implementation requirements of limited funding.

School of Public Health and Social Policy (Dr Worthington), University of Victoria (Mss Mollison and Herman), Victoria, British Columbia; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada (Drs Worthington and Loutfy and Ms Lee); CATIE (Canadian AIDS Treatment Information Exchange), Toronto, Ontario, Canada (Ms Johnston); Canadian Aboriginal AIDS Network, Halifax, Nova Scotia, Canada (Ms Masching); Canadian Aboriginal AIDS Network, Victoria, British Columbia, Canada (Ms Pooyak); Providence Health Authority, Vancouver, British Columbia, Canada (Ms Lee); Women's College Research Institute, Toronto, Ontario, Canada (Dr Loutfy); Women's College Hospital, Toronto, Ontario, Canada (Dr Loutfy); Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Loutfy); and Maple Leaf Research, Toronto, Ontario, Canada (Dr Loutfy).

Correspondence: Catherine Worthington, PhD, School of Public Health and Social Policy, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada (

The CIHR Social Research Centre (SRC) in HIV Prevention (CIHR 198597) provided grant funding for this study; the CIHR Canadian HIV Trials Network (CTN) (CIHR 316682) and CATIE provided translation and in-kind support.

No conflicts of interest were declared.

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