# Exploring the Impact of Organizational Readiness and Inner Setting on Implementation of HIV Programming in South African Health Clinics

> **NIH NIH R21** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $221,344

## Abstract

PROJECT SUMMARY/ABSTRACT
In South Africa there are more people on treatment for HIV than ever before, placing a growing burden on
health systems. While strategies for effective disease management exist for those who engage in care for HIV,
the challenge of implementing best-practice at scale in the context of increasingly complex care remains.
Implementation science (IS) seeks to bridge the gap between research and practice to ensure that efficacious
interventions translate into effective implementation at scale. The theory of Organizational Readiness for
Change (ORC) is an IS theory that posits that organizational members' shared resolve to implement a change
(change commitment) and shared belief in their collective capability to do so (change efficacy) impacts
successful program uptake. The Consolidated Framework for Implementation Research (CFIR), an IS
framework, specifies elements in the facility inner setting that affect change commitment and efficacy. We
propose to adapt scales assessing of ORC and of CFIR inner setting to the South African context to better
measure the factors that should be addressed for successful translation of evidence-based interventions into
clinical practice, specifically focusing on HIV, in order to close the gap towards optimized delivery of health
programs in high disease burden settings. Specifically, we will use cognitive interviewing and expert
consultations to culturally adapt measures of organizational readiness for implementing change (ORIC) and
inner setting (CFIR) that have been developed in Western contexts (Aim 1). We will then implement the refined
measures with 168 providers and 14 clinic managers in 14 South African primary care facilities in KwaZulu
Natal (KZN), South Africa (Aim 2). We will assess which elements of ORC and CFIR are associated with
successful implementation of a) new HIV treatment initiation and ART guidelines, and b) national decongestion
programming for expedited care and medication dispensing for stable HIV patients. Results will be shared in a
feedback process with experts, providers and clinic managers to validate findings. This developmental,
exploratory R21 leverages an experienced research site, an established collaboration, and a multidisciplinary
team of South African and US investigators to address the NIH priority of advancing research on factors
associated with the successful implementation of evidence-based interventions and guidelines. This proposal
can lead to targeted interventions advancing HIV program implementation and integrated care in primary care
settings in high disease burden areas where scaled programming is vital.

## Key facts

- **NIH application ID:** 10245282
- **Project number:** 5R21MH123389-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Sheri Ann Lippman
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $221,344
- **Award type:** 5
- **Project period:** 2020-08-21 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10245282

## Citation

> US National Institutes of Health, RePORTER application 10245282, Exploring the Impact of Organizational Readiness and Inner Setting on Implementation of HIV Programming in South African Health Clinics (5R21MH123389-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10245282. Licensed CC0.

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