Table 3.

Provider‐reported challenges to implementing the one‐stop shop (OSS) model

TICD determinant a	Implementation challenge	Adjustments made
Scheduling Delegation of tasks Workload Domain knowledge	Staffing Initially, only one clinician worked at the OSS, making PrEP delivery difficult when that clinician was on leave or unavailable (clinics A and B)	Clinics implemented a rotating schedule whereby different clinicians were assigned to attend to OSS clients on a weekly or monthly basis
	Initially, OSS clinician was stationed at the OSS and responsible for attending only to PrEP clients; but after COVID‐19, s/he was stationed at the CCC and also responsible for ART clients. S/he found it hard to move back and forth between CCC and OSS (clinics A and B)	Non‐clinician OSS staff began attending to refill‐only clients and completing majority of steps for new and follow‐up clients on their own, calling the clinician over to the OSS only as needed (e.g., for prescription writing).
	Initial pushback from provider designated to deliver PrEP at OSS who felt unprepared to deliver PrEP and that the workload was too heavy for a single provider (clinic C)	Additional PrEP training provided; hospital administration increased the number of providers at OSS to two and implemented a rotating schedule
Regulation, rules, and policies Resource proximity	HIV testing HTS point closest to OSS temporarily closed as part of COVID‐19 precautions (clinics A and B) In‐room HIV testing not implemented as planned because no existing system for OSS to order HIV testing kits from clinic store and HTS department opposed HIV testing outside of designated HTS points (clinic D)	OSS clients sent to HTS point in other hospital department; OSS providers often tried to attend to other clients in the meantime, though this sometimes led to clients waiting upon return from HTS
Patient preferences	Stigma Due to COVID‐19, OSS relocated to the CCC, where some PrEP clients feel HIV‐related stigma (clinic B)	OSS clients are fast‐tracked to a separate room in the corner of the CCC

Abbreviations: ART, antiretroviral therapy; CCC, comprehensive care clinic; HTS, HIV testing services; OSS, one‐stop shop; PITC, provider‐initiated testing and counseling; PrEP, pre‐exposure prophylaxis; TICD, Tailored Implementation in Chronic Diseases checklist.

^a Determinants of implementation from Squires et al.’s modified version of the Tailored Implementation in Chronic Diseases (TICD) checklist, originally developed by Flottorp et al. (2013) [43].