Factors Influencing the Success of Community-Based Participatory Approach in Implementing an HIV Stigma Reduction Intervention in Indonesia

BackgroundHIV-related stigma among healthcare providers hinders service delivery and patient engagement, especially in low- and middle-income countries. The Intervensi Penghapusan Stigma dan Diskriminasi (IPSD) intervention employs a Community-Based Participatory Approach (CBPA) to reduce stigma among healthcare workers (HCWs) in Indonesia by involving people with HIV (PWH) and key populations (KP) as co-developers and co-implementers. MethodsThis cross-sectional study evaluated the implementation outcomes of adoption and fidelity, as defined by Proctor et al., using a validated 5-point Likert scale survey developed based on the Consolidated Framework for Implementation Research (CFIR) and Proctor et al. framework. A total of 120 physicians, nurses, midwives, and laboratory technicians from 31 primary health centres (PHCs) in Greater Jakarta participated in the survey. PHCs were categorised as either high- or average-performing based on triangulated data from PWH networks and evaluations by the Ministry of Health. Descriptive statistics and bivariate analyses, including chi-square and t-tests, were conducted at a significance level of p < 0.05. ResultsSignificant association was found between occupational role and PHC performance (p=0.012). High-performing PHCs reported stronger technical expertise (p=0.033) and better HIV/STI epidemiological knowledge (p=0.033). Organisational incentives influenced fidelity (p=0.032), with higher-performing PHCs reporting greater institutional support. ConclusionFindings underscore the need to reduce stigma through equitable services and supportive organisational climates. Agreement across PHCs showed shared recognition of involving PWH and KP as co-implementers and facilitated intervention adoption, aligning with evidence for contact-based stigma reduction. Differences between PHCs were shaped by capacity and knowledge, with higher-performing facilities showing stronger intervention fidelity. Organisational incentives facilitated sustained fidelity, while national mandates ensured adoption. By examining CFIR constructs and Proctor outcomes, this study informs scalable stigma reduction in primary healthcare. Limitations include small sample size, limited scope, self-reported data, and cross-sectional design, precluding multivariable modelling, making findings exploratory.