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Background <p>As substance use rises in low- and middle-income countries, the burden of SUD increasingly intersects with poverty, unemployment, and infectious disease, creating the need for multi-component interventions. This study explores perceptions of the acceptability, appropriateness, and feasibility of the CHIMES intervention, which is designed to improve substance use recovery and HIV-related outcomes while increasing post-treatment employment opportunities.</p> Methods <p>We conducted 48 in-depth interviews with residents (<i>n</i> = 38) and staff (<i>n</i> = 10) at four sober houses in Dar es Salaam, Tanzania. Interviews were guided by the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0), with findings organized using a multi-level ecological model. Responses were coded deductively using CFIR-based codes.</p> Results <p>Analysis guided by CFIR 2.0 identified key implementation factors across all domains. Participants strongly endorsed the intervention’s compatibility with sober house operations, specifically its alignment with existing daily schedules and the facility’s emphasis on reducing idleness through structured programming. Relative priority was affirmed by both staff and residents, who viewed HIV prevention and microenterprise training as directly supporting the core sober house mission of successful community reintegration. Within the Individuals domain, staff demonstrated high organizational capability, including prior experience hosting skills workshops. A major enabling factor in the Outer Setting was the pre-existing Nurse-Initiated Management of Antiretroviral Therapy (NIMART) policy, which empowers specialized nurses to provide status-neutral HIV testing and treatment, offering a feasible service-delivery model for the HIV prevention component. Key barriers included available resources (Inner Setting), such as limited funding and unstable physical infrastructure, and structural characteristics (Outer Setting), such as systemic corruption affecting small businesses.</p> Conclusion <p>Our results suggest that implementing the CHIMES intervention is perceived as highly acceptable and feasible among sober house residents and staff, providing critical insights across the intervention’s ecological context. These findings have informed specific adaptations, such as leveraging the NIMART framework and tailoring educational content and have directly shaped the protocol for an upcoming single-arm feasibility trial. This next study will systematically assess the real-world implementation parameters, including recruitment, retention, and acceptability, in preparation for a future effectiveness trial.</p>

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The combined HIV services and microenterprise for equitable and sustainable recovery (CHIMES) intervention for sober living home residents: a CFIR-guided qualitative study to inform a pilot assessment in Tanzania

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Samuel Janson,
  • Wiljeana Glover,
  • Stella E. Mushy,
  • Larissa Jennings Mayo-Wilson,
  • Haneefa Saleem,
  • Justin Knox,
  • Frank Mhando,
  • Mecca McPherson,
  • Masunga K. Iseselo,
  • Victor Shirima,
  • Gaspar Mbita,
  • Ivan Teri,
  • Faustine Ndugulile,
  • Donaldson F. Conserve

摘要

Background

As substance use rises in low- and middle-income countries, the burden of SUD increasingly intersects with poverty, unemployment, and infectious disease, creating the need for multi-component interventions. This study explores perceptions of the acceptability, appropriateness, and feasibility of the CHIMES intervention, which is designed to improve substance use recovery and HIV-related outcomes while increasing post-treatment employment opportunities.

Methods

We conducted 48 in-depth interviews with residents (n = 38) and staff (n = 10) at four sober houses in Dar es Salaam, Tanzania. Interviews were guided by the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0), with findings organized using a multi-level ecological model. Responses were coded deductively using CFIR-based codes.

Results

Analysis guided by CFIR 2.0 identified key implementation factors across all domains. Participants strongly endorsed the intervention’s compatibility with sober house operations, specifically its alignment with existing daily schedules and the facility’s emphasis on reducing idleness through structured programming. Relative priority was affirmed by both staff and residents, who viewed HIV prevention and microenterprise training as directly supporting the core sober house mission of successful community reintegration. Within the Individuals domain, staff demonstrated high organizational capability, including prior experience hosting skills workshops. A major enabling factor in the Outer Setting was the pre-existing Nurse-Initiated Management of Antiretroviral Therapy (NIMART) policy, which empowers specialized nurses to provide status-neutral HIV testing and treatment, offering a feasible service-delivery model for the HIV prevention component. Key barriers included available resources (Inner Setting), such as limited funding and unstable physical infrastructure, and structural characteristics (Outer Setting), such as systemic corruption affecting small businesses.

Conclusion

Our results suggest that implementing the CHIMES intervention is perceived as highly acceptable and feasible among sober house residents and staff, providing critical insights across the intervention’s ecological context. These findings have informed specific adaptations, such as leveraging the NIMART framework and tailoring educational content and have directly shaped the protocol for an upcoming single-arm feasibility trial. This next study will systematically assess the real-world implementation parameters, including recruitment, retention, and acceptability, in preparation for a future effectiveness trial.