Charles B. Collins

Implementing packaged HIV-prevention interventions for HIV-positive individuals: considerations for clinic-based and community-based interventions.

Providing efficacious human immunodeficiency virus (HIV) prevention services to HIV-positive individuals is an appropriate strategy to reduce new infections. The Centers for Disease Control and Prevention (CDC) has identified interventions with evidence of efficacy for prevention with positives (PwP). Through its process of disseminating evidence-based interventions (EBIs), CDC has attempted to diffuse four of these interventions into practice. One of these interventions has been diffused to community-based organizations, whereas another has been diffused to medical clinics serving HIV-positive people. A third intervention was originally developed with HIV-positive individuals using methadone, but uptake by methadone clinics has not occurred. A fourth intervention for HIV-positive adolescents and young adults has had disappointing adoption levels. Unique implementation challenges have been encountered in various intervention settings. Lessons learned in the dissemination of the first four PwP interventions will facilitate implementation of three new PwP EBIs currently being packaged for dissemination.

A Comparison of the Interactive Systems Framework (ISF) for Dissemination and Implementation and the CDC Division of HIV/AIDS Prevention's Research-to-Practice Model for Behavioral Interventions

Translating evidence-based HIV/STD prevention interventions and research findings into applicable HIV prevention practice has become an important challenge for the fields of community psychology and public health due to evidence-based interventions and evidence-based practice being given higher priority and endorsement by federal, state, and local health department funders. The Interactive Systems Framework (ISF) for Dissemination and Implementation and the Division of HIV/AIDS Prevention (DHAP) Research-to-Practice model both address this challenge. The DHAP model and the ISF are each presented with a brief history and an introduction of their features from synthesis of research findings through translation into intervention materials to implementation by prevention providers. This paper describes why the ISF and the DHAP model were developed and the similarities and differences between them. Specific examples of the use of the models to translate research to practice and the subsequent implications for support of each model are provided. The paper concludes that the ISF and the DHAP model are truly complementary with some unique differences, while both contribute substantially to addressing the gap between identifying effective programs and ensuring their widespread adoption in the field.

From Research to Community-Based Practice—Working with Latino Researchers to Translate and Diffuse a Culturally Relevant Evidence-Based Intervention: The Modelo de Intervención Psicomédica (MIP) Experience

Efforts to translate, package, and diffuse HIV/AIDS research into practice have gained momentum with the Centers for Disease Control and Preventions (CDCs) launch of three projects: the Prevention Research Synthesis Project, which identifies evidence-based interventions studies; the Replicating Effective Programs Project, which supports the translation of evidence-based interventions into materials suitable for use in local prevention programs; and the Diffusion of Effective Behavioral Interventions Project, which moves behavioral interventions into full-scale practice across the United States. This article describes the CDCs fast-track process of translation, packaging, and diffusion of an HIV intervention for Hispanic/Latino injection drug users, the Modelo de Intervención Psicomédica conducted by the Diffusion of Effective Behavioral Interventions Project in collaboration with a CBA organization and the original researchers.

Diffusion of Effective Behavioral Interventions and Hispanic/Latino populations.

The national HIV/AIDS prevention program, the Diffusion of Effective Behavioral Interventions (DEBI), is described in the context of addressing Hispanics/Latinos at risk for HIV/AIDS in the United States and Puerto Rico. The eight-step DEBI model is referenced in terms of the interventions and Division of HIV/AIDS Prevention/Capacity Building Branch (DHAP/CBB) Latino Diffusion Team activities. A summary of activities and examples addressing diffusion needs for the diverse Hispanic/Latino populations is discussed. Challenges and successes in diffusion and partner collaborations are also presented, with comment on future directions such as translations and trainings to serve the needs of the Hispanic/Latino-serving community-based organizations and their communities.

Lessons Learned From Dissemination of Evidence-Based Interventions for HIV Prevention.

In 1999, IOM issued a report that recommended that the Centers for Disease Control and Prevention should disseminate evidence-based HIV prevention interventions (EBIs) to be implemented by health departments, community-based organizations, drug treatment centers, and clinics. Based on these recommendations, the Diffusion of Effective Behavioral Interventions Project was initiated in 2000 and began disseminating interventions into public health practice. For 15 years, the Centers for Disease Control and Prevention has disseminated 29 EBIs to more than 11,300 agencies. Lessons were identified during the 15 years of implementation regarding successful methods of dissemination of EBIs. Lessons around selecting interventions for dissemination, developing a dissemination infrastructure including a resource website (https://effectiveinterventions.cdc.gov), and engagement with stakeholders are discussed. A continuous development approach ensured that intervention implementation materials, instructions, and technical assistance were all tailored to the needs of end users, focus populations, and agency capacities. Six follow-up studies demonstrated that adopters of EBIs were able to obtain comparable outcomes to those of the original efficacy research. The Diffusion of Effective Behavioral Interventions Project may offer guidance for other large, national, evidence-based public health dissemination projects.

Evidence based interventions for preventing HIV transmission: commentary on Rotheram-Borus et al. (2009).

In their article ‘‘Family Wellness, Not HIV Prevention’’ Rotheram-Borus et al. (2009) state that ‘‘sustained improvements in global health require creating a prevention infrastructure to meet the multiple health challenges experienced by local communities.’’ They then identify four fundamental shifts in HIV and disease prevention. This commentary points out that these shifts are not new but are already being implemented, and some lessons learned indicate they are not complete solutions but strategies that can be integrated with other approaches to the delivery of behavioral and biomedical prevention. The four suggested shifts are discussed in the following sections.

CDC’s dissemination of evidence-based behavioral HIV prevention interventions

The Division of HIV/AIDS Prevention at the National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention seeks to make evidence-based behavioral HIV prevention interventions (EBIs) accessible to HIV prevention providers through a systematic process of identification, packaging, and dissemination. This update synthesizes that process and describes recent efforts to expand the use of EBIs internationally through partnerships between the CDCs Global AIDS Program, academic research centers, and other international and US agencies.

The Use of Epidemiologic and Other Data in Selecting Behavioral HIV Prevention Interventions for African-American Women

ABSTRACT We describe a “research to practice” method by which public health policymakers and HIV prevention service providers can integrate the findings of national surveillance with other sources of public health data. We suggest developing a comprehensive risk profile, based on multiple sources of data, to inform the selection and implementation of evidence-based behavioral interventions (EBIs) for African-American women.

Implementation of Evidence-Based HIV Interventions for Gay, Bisexual, and Other Men Who Have Sex with Men

The Centers for Disease Control and Prevention provides trainings to support implementation of five evidence-based HIV prevention interventions (EBIs) for men who have sex with men (MSM): d-up: Defend Yourself!; Many Men, Many Voices; Mpowerment; Personalized Cognitive Counseling; and Popular Opinion Leader. We evaluated trainees’ implementation of these EBIs and, using multivariable logistic regression, examined factors associated with implementation. Approximately 43% of trainees had implemented the EBIs for which they received training. Implementation was associated with working in community-based organizations (vs. health departments or other settings); acquiring training for Mpowerment or Popular Opinion Leader (vs. Personalized Cognitive Counseling); having ≥3 funding sources (vs. one); and having (vs. not having) sufficient time and necessary EBI resources. Findings suggest that implementation may vary by trainee characteristics, especially those related to employment setting, EBI training, funding, and perceived implementation barriers. Efforts that address these factors may help to improve EBI implementation among trainees.ResumenLos Centros para el Control y Prevención de Enfermedades (CDC, por sus siglas en inglés) proveen entrenamiento para apoyar la implementación de cinco intervenciones basadas en la evidencia para la prevención del VIH entre hombres que tienen sexo con hombres: d-up: Defend Yourself!; Many Men, Many Voices; Mpowerment; Personalized Cognitive Counseling; y Popular Opinion Leader. Nosotros evaluamos la implementación de esas intervenciones por parte de quienes recibieron entrenamiento y examinamos los factores asociados con la implementación, para lo cual usamos regresión logística multivariada. Aproximadamente 43% de los participantes habían implementado la intervención para la cual fueron entrenados. La implementación se asoció con trabajar en organizaciones comunitarias (vs. departamentos de salud u otras organizaciones); haber recibido los entrenamientos Mpowerment o Popular Opinion Leader (vs. Personalized Cognitive Counseling); tener ≥3 fuentes de financiamiento (vs. una); y tener (vs. no tener) suficiente tiempo y los recursos necesarios para la intervención. Los resultados sugieren que la implementación de las intervenciones puede variar según las características de los participantes, específicamente su lugar de empleo, intervención para la que fueron entrenados, financiamiento y las barreras percibidas para la implementación. Los esfuerzos para abordar esos factores puedieran ayudar a que los participantes implementen las intervenciones basadas en la evidencia para las que fueron entrenados.

Overview of Structural Interventions to Decrease Injection Drug-Use Risk

Injection drug equipment sharing continues to contribute dramatically to the worldwide spread of human immunodeficiency virus (HIV) and other blood-borne pathogens among injection drug users (IDUs). After acquiring a blood-borne infection through contaminated injection paraphernalia, IDUs may then pass it to their drug sharing and sexual partners as well as their future offspring (Taussig, Weinstein, Burris, & Jones, 2000). HIV often spreads rapidly among IDUs, in part because very few health and social services are available to them. Internationally, as many as 92% of IDUs in low- and middle-income countries have no access to any type of HIV prevention (Fiellin, Green, & Heimer, 2008). Furthermore, on average IDUs engage in less safe sex practices than the general population, possibly due to decreased judgment when under the influence and/or unsafe sex in exchange for money or drugs.