Who's Implementing HIV/STI Prevention Interventions?

Back ground & Purpose: Prevention scientists have demonstrated efficacy in HIV risk reduction approaches yet the science of program dissemination lags. We need to close the gap between research discovery and program adoption to reduce new HIV infections. There is a need for increased capacity, scale and speed for HIV prevention intervention dissemination, and interactive multimedia technologies have the potential for achieving these goals. One well systematized model for dissemination of HIV prevention strategies is the Centers for Disease Control and Prevention's (CDC) Diffusion of Effective Behavioral Intervention Programs (DEBI). It is a national-level strategy to provide high-level training and technical assistance in evidence-based behavioral interventions (EBIs). While greater than 10,000 people have received training through DEBI, there is little known about adoption and implementation fidelity or how staff attitude and self-efficacy may impact implementation. Our goal in this presentation is to describe individual and organizational level variables of HIV services organizations enrolled in an HIV prevention dissemination trial in NYS. We will examine which of the 26 DEBIs are currently being implemented, levels of implementation, and attitudes towards DEBI implementation and training.

Methods: This presentation describes an innovative randomized clinical trial (RCT) testing dissemination of a “best-evidence,” couples-based, HIV/STI prevention program, CONNECT, comparing traditional versus multimedia-based technology transfer strategies among 80 HIV service organizations in New York State. CONNECT, a traditional DEBI packaged by the CDC, has been translated into an entirely multimedia/internet-based version. This presentation will examine results from baseline and follow-up interviews collected during this trial describing organizations and staff conducting HIV prevention.

Results: HIV services agencies ranged from quite small to quite large: total number of full-time paid staff ranged from 1 to 10,000, mean 242; part-time staff ranged from 0 to 800, mean 34; total full-time paid staff conducting multiple session programs (e.g. DEBIs), mean 6. Agencies served between 68 and 1.5 million clients, of those 0 to 81,500 prevention services clients; between 0 and 16,231 clients receiving multisessions. Qualitative analysis produced evidence related to perceived innovation characteristics and organizational factors that impact decision to adopt and sustain EBI implementation.

Staff were diverse: women (n=183, 70%), heterosexual (82%) and U.S. born (n=202, 78%). Forty one percent identified as Black, 37% Latino or Hispanic, 21% White. Most had Master's degrees or higher (54%). More than half employed in the field of HIV/STI services 5 or more years (61%). While less than half had been trained on a DEBI (n=115, 44%), participants reported quite positively with respect to their beliefs about DEBIs.

Conclusion & Implications: This sample illustrates a varied, educated and experienced workforce available to implement HIV/STI prevention strategies in NY State. Although fewer than half of participants have been trained to implement at least one DEBI, attitudes tend to reflect positive attribution with regard to the contribution DEBIs are making to reduce HIV risk. An intervention “champion” remains an important determinant of agency-level adoption. Future questions to answer concern fidelity, outcome evaluation and the effectiveness of current training and technical assistance models.