Translating HIV Evidence-Based Interventions in Practice

M. Margaret Dolcini, UC San Francisco; Christoper Hall, Public Health Foundation Enterprises, Inc.
Social and Behavioral

Evidence-based HIV interventions (EBIs) are increasingly being recommended for implementation by many funding agencies, including the Centers for Disease Control and Prevention (CDC). The EBIs recommended by CDC are based on research conducted in controlled settings, rigorously evaluated, and found to be effective. A large-scale diffusion of evidence-based interventions (known as DEBI) is currently underway, and fifteen agencies in California were recently funded by CDC to implement one or more DEBIs. Using a framework developed by CDC called ADAPT, the proposed project will follow four agencies as they implement an EBI. This pilot study will enhance our understanding of the translation process and help lay the groundwork for future studies on the effectiveness of translation of EBIs to practice. The long-term goal of this work is to increase effectiveness of interventions in practice settings.

The proposed study aims to: 1) Document the process of translating EBIs in four community based agencies in California, using the ADAPT framework, and examine the extent to which assessment, preparation, and implementation of the EBI are carried out by each agency; 2) Identify barriers and facilitators to maintaining core elements of EBIs as they are translated into practice settings, using in-depth interviews with agency staff and observation of the program implementation; 3) Document the strategies agencies employ to meet challenges of implementing these EBIs; and 4) Use findings from the pilot study to develop a preliminary model that informs effectiveness studies in the practice setting, and seek additional funding to evaluate and expand the model through demonstration projects and other mechanisms.

The proposed descriptive study uses qualitative methods, primarily in-depth interviews and observation. Four agencies, funded to deliver two different EBIs, will participate in the study. The two interventions being delivered are Healthy Relationships, a group-level intervention for persons living with HIV, and Safety Counts, a combination individual and group-level intervention for injection drug users. Both interventions target populations in California heavily affected by HIV. We will use key informant interviews with agency directors (n=4 interviews) and frontline staff (n=12 interviews) and observation of program implementation at all four agencies to achieve the specific aims of the study. Our longstanding relationships with community agencies and extensive research and practice backgrounds enhance our ability to carry out the study. Qualitative analyses will include descriptive, thematic and comparative approaches with the final step being model building. The end result will be the development of a preliminary model that describes the process of translating EBIs and which can be used as a guide for future research in this area.