1. Zotti, Marianne E. DrPH, MS
  2. Pringle, Johanna MPH
  3. Stuart, Gary MEd
  4. Boyd, William A. MA
  5. Brantley, Dabo MPH
  6. de Ravello, Lori MPH


Context: This article describes results of a process evaluation of a cooperative agreement between the Centers for Disease Control and Prevention's Division of Reproductive Health and 10 regional training centers to increase the number ofreproductive health (RH) settings that integrate human immunodeficiency virus (HIV) prevention services at an appropriate level intoroutine care.


Objective: Our goal was to learn about the process of integrating HIV prevention into RH settings.


Design: We conducted a retrospective evaluation, using qualitative methods.


Setting: The clinics were from 10 USDepartment of Health and Human Services regions.


Participants: We interviewed 16 key informants from 10 selected modelclinics.


Main Outcome Measures: The main outcome was organization change.


Results: The most common obstaclesto integration were staff issues, logistics barriers, inadequate clinic structure to support integration, and staff training barriers. Using the transtheoretical model (TTM) applied to organizations, we documented organizational change as informants described theirclinics' progression to integration and overcoming obstacles. All model clinics began in the contemplation stage oftranstheoretical model. Every clinic exhibited at least 1 process of change for every stage. In the contemplation stage, most informantsdiscussed fears about not changing, stated that the integration was consistent with the agency's mission, and described thinkingabout commitment to the change. In the preparation stage, all informants described building teams that supported integration of HIVprevention. During the action stage, informants talked about assessments of facilities, staff and protocols, commitments through grantsor agreements, and then using training to support new behaviors and adopting new cognitions. In the maintenance stage, all reportedchanging policies, procedures, or protocols, most promoted helping relationships among the staff, and nearly all reported rewards forthe new ways of working.


Conclusions: RH settings were able to integrate HIV prevention services by employing a systematicprocess.