Building Capacity for Transformative Change: Enhancing Implementation Leadership in Southern HIV Service Organizations

Background and Purpose: Community-based HIV service organizations (HSOs) fill critical gaps in formal healthcare systems, particularly in the Southern U.S. However, these organizations often lack access to funding and training opportunities to enhance their capacity to provide evidence-based interventions (EBIs). Given that organizational leaders are key to the successful implementation of EBIs but are often ill-equipped, there is a critical need to develop their implementation leadership skills to foster transformative change and sustainable social impact. The SUSTAIN Center addresses these gaps by administering capacity-building interventions that include in-depth training on equity-centered implementation science to advance health justice and structured implementation coaching (Stanton et al., 2023). SUSTAIN does this work in ways that address power dynamics and model a collaborative approach with community partners. This study investigates changes in implementation leadership among leaders in HSOs after participating in a SUSTAIN capacity-building intervention.

Methods: Pre/post-program evaluation data were collected from 98 leaders from 58 HSOs that participated in one of SUSTAIN’s four capacity-building interventions. The survey included the Implementation Leadership Scale (ILS) and the Collective Leadership Scale (CLS). Analysis consisted of Repeated Measures Analysis of Covariance (RANOVA) to investigate changes in leadership capacity after participating in the intervention.

Results: RANOVA results showed an overall significant pre/post difference in ILS scores (F(df=1, 42)=83.02, p< .001), with nearly 70% of the variance accounted for by within-subjects differences (n2=.66). The Sidak pairwise comparison showed that ILS scores were significantly different across interventions; post-scores were significantly greater than pre-scores for three out of four interventions (p<.001). RANOVA results showed an overall non-significant pre/post difference in CLS scores (F(df=1, 52)=2.66, p= .11), with 5% of the variance accounted for by within-subjects differences (n2=.05). The Sidak pairwise comparison showed that CLS scores were not significantly different across interventions; post-scores were not significantly greater than pre-scores for any intervention (p=.97-1.00).

Conclusion and Implications: Building implementation leadership capacity lays a sustainable organizational foundation to support all subsequent programming and practice. These findings corroborate our prior qualitative work on capacity building, providing quantitative evidence that our programs are effective in measurably enhancing SHSO leaders’ implementation leadership capacity. Though we implemented a number of strategies across programs that may have facilitated such changes (Stanton et al., 2023), we speculate that three specific strategies were key to enhancing participants’ implementation leadership: 1) facilitating a non-judgmental learning environment that is free of fear associated with lack of knowledge and fosters psychological safety and introspection; 2) trusting partners as experts in their own experiences and empowering them to make decisions that are best for their organization; and 3) being trustworthy through consistent, transparent, and responsive communication practices with partners. However, non-significant changes in CLS scores underscore the complexities of leadership dynamics in HSOs. Study findings emphasize the importance of continued support and resources for HSOs, as such efforts are essential for achieving sustainable social impact in the U.S. South.