Implementation Outcomes and Lessons From a Health‐Department‐Driven Quality‐Based Financing Approach to HIV Prevention Programmes in New York City, United States: A Mixed Methods Analysis

Abstract

INTRODUCTION: In 2021, the New York City Health Department (NYCHD) became one of the first jurisdictions in the United States to adopt a quality-based financing (QBF) approach to HIV prevention programming, shifting away from the traditional fee-for-service model. NYCHD used a multi-level approach that defined quality through three programme-level implementation strategies (PLS): universal screening; holistic care provision; and sex-positive, "risk-free" HIV prevention conversations. By focusing their QBF programme on implementation strategies in addition to service delivery outcomes, NYCHD held agencies accountable for both what was provided and how services were delivered. METHODS: Project PACE is a CDC-funded implementation science (IS) partnership between a public university and the NYCHD designed to document and evaluate their QBF approach. Data collected May 2023-September 2024 include: (1) thematic coding of qualitative interviews with agency staff (n = 29); (2) quantitative analysis of staff survey data (n = 69); and (3) thematic coding of technical assistance meeting minutes/programme monitoring data (document n = 771). This paper presents an analysis of the impact of the strategy on 19 funded agencies, focusing on implementation outcomes and applying the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators to the implementation process. RESULTS: The quality-focused implementation strategies were rated as highly acceptable, feasible and appropriate. Agencies reported multiple relative advantages of quality-focused implementation: more holistic care, increased access to services, integration of mental health and sexually transmitted infection testing into HIV prevention, reduced stigma and improved client rapport. Acceptability and feasibility ratings were strongly associated with both adoption and sustainment. Implementation barriers were clustered in the inner setting, individual and innovation CFIR domains, and focused on available resources, innovation recipients and innovation design constructs. The biggest challenges to feasibility were related to constraints in the overall care delivery system, including time pressure, service delivery limitations, restricted resources and competing demands. CONCLUSIONS: Analyses indicate that health departments can develop quality-based PLS that are acceptable, appropriate, and feasible for HIV prevention agencies and staff. This research is a case study for academic-practice IS partnership that can identify actionable barriers and facilitators to adoption and sustainment in real time.

The authors' abstract, as published at the source. Journal of the International AIDS Society, 2026 · DOI ↗