Table 3 Summary of selected iCARE intervention facilitators and barriers for implementation according to consolidated framework for implementation research domain for both testing and treatment unless noted

Inner Setting

• Supportive institutional culture at for piloting/adopting new practices & interventions

Lack of resources to meet all client’s needs (testing)

Some clinics were not KP friendly

Intervention Characteristics

• Peer navigation is key strategy believed to be effective, and acceptable to participants

• Social media provides anonymity on platforms participants are comfortable interacting

Need for response to medication reminders resulted in some fatigue from peers

Process

• Provision of phones and data bundles for peer navigators allowed them to be effective in their roles prompting feasibility & adoption

• Stakeholder engagement especially with community-based and key population-friendly organizations promoted readiness & adoption (testing)

• Training and peer-to-peer exchange helped study staff to feel prepared for and effective in their roles

• Leveraging pilot site experience for training

• Areas with limited phone coverage or physically distant

• Financial resources for PNs

Characteristics of Individuals

• Peer navigators experienced with HIV testing and social media platforms (testing)

• Peer navigators with shared lived experience (HIV, MSM)

• Other study staff very supportive of PN work

• Ability to work as a team

Outer Setting

• Widespread community cellphone and internet coverage

• Availability of social media platforms

• Positive relationships with health facilities friendly to MSM (testing)

• Availability of clinics which were “key population friendly”^a

• Community attitudes and misinformation about HIV, required additional education before engaging in testing intervention

• Illegality of homosexuality and lack of legal protections for LGBTQ + rights created legal limitations for TMSM and YMSM friendly clinics in the testing intervention

• Limited availability of clinics which were “key population friendly”

• Variable participant access to sufficient data or IT infrastructure for engagement via mobile phone or internet

• Structural stigma/violence towards HIV and MSM

• Cellphones changed or lost by peers hindered communication