NDLI: Using nominal group technique to identify and prioritize barriers to decentralizing HIV care to primary health centers in Lima, Peru

Content Provider	Springer Nature : BioMed Central
Author	Oliveros, David Konda, Kelika A. Madden, Lynn M. Montenegro-Idrogo, Juan José Tafur Quintanilla, Karla T. Sosa Barbarán, Karin Nikitin, Benjamin M. Ponticiello, Matthew Benites, Carlos M. Sánchez, Jorge Altice, Frederick L.
Abstract	Background Decentralizing HIV services is an evidence-based strategy recommended by the World Health Organization to expand healthcare access by shifting most HIV care from specialty (SHCs) to primary health centers (PHCs) with the goal of maximizing health outcomes. To accelerate Peru Ministry of Health’s 2020 priority to transition from specialty to primary health centers, we assessed multilevel stakeholders’ perspectives on barriers and opportunities for scaling-up decentralization of HIV care. Methods Between January and March 2024, we used nominal group technique (NGT), a mixed-methods research strategy, to rapidly identify barriers and rank potential solutions to decentralizing HIV services among two groups of patients (N = 16) and four groups of healthcare providers (N = 49) in Lima, Peru. Patient groups were those who: (1) were established in HIV care at a SHC; and (2) transferred from a SHC to a PHC. Three provider groups were mixed and included individuals from PHCs and SHCs while one was from a SHC in Central Lima. After listing all perceived barriers and solutions, participants in each group rank-ordered responses to generate potentially actionable responses. Results Among 195 votes from 65 participants, multilevel HIV stigma was the highest priority barrier to decentralizing HIV care among both patients and providers (34.4%). While patients and providers prioritized different issues, all NGT groups highlighted a general lack of confidence in the expertise of PHCs (21.0%), system-level or transfer logistic challenges (19.0%), insufficient infrastructure and capacity of PHCs to provide HIV treatment (15.9%), and a lack of patient-level support (9.7%) as other major barriers to HIV decentralization. Conclusions While the Peruvian Ministry of Health has prioritized HIV care decentralization, achieving this goal remains challenging. Identified barriers require a range of implementation strategies to achieve decentralization goals, such as process improvement strategies to address stigma and logistical barriers to transferring patients, while educational meetings, including tele-mentoring or expert feedback, may address a lack of confidence in provider expertise at PHCs. Deployment of hub-and-spoke treatment models could enhance communication between experts at SHCs and PHCs and ensure that patient continuity of care is achieved.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-025-12618-8.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-025-12618-8
Journal	BMC Health Services Research
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2025-03-29
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Decentralization HIV Implementation science Nominal group technique RE-AIM framework
Content Type	Text
Resource Type	Article
Subject	Health Policy

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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