Janet Saul

Bridging the Gap Between Prevention Research and Practice: The Interactive Systems Framework for Dissemination and Implementation

If we keep on doing what we have been doing, we are going to keep on getting what we have been getting. Concerns about the gap between science and practice are longstanding. There is a need for new approaches to supplement the existing approaches of research to practice models and the evolving community-centered models for bridging this gap. In this article, we present the Interactive Systems Framework for Dissemination and Implementation (ISF) that uses aspects of research to practice models and of community-centered models. The framework presents three systems: the Prevention Synthesis and Translation System (which distills information about innovations and translates it into user-friendly formats); the Prevention Support System (which provides training, technical assistance or other support to users in the field); and the Prevention Delivery System (which implements innovations in the world of practice). The framework is intended to be used by different types of stakeholders (e.g., funders, practitioners, researchers) who can use it to see prevention not only through the lens of their own needs and perspectives, but also as a way to better understand the needs of other stakeholders and systems. It provides a heuristic for understanding the needs, barriers, and resources of the different systems, as well as a structure for summarizing existing research and for illuminating priority areas for new research and action.

Sexual risk behaviors among heterosexual HIV serodiscordant couples in the era of post-exposure prevention and viral suppressive therapy.

ObjectivesTo describe awareness and use of antiretroviral treatments, viral load monitoring, and post-exposure prevention; to assess changing concerns about HIV transmission; and to examine the effect of these advances on sexual behavior in HIV-serodiscordant heterosexual couples. MethodsCross-sectional analysis of a baseline sample of 104 couples (n = 208 individuals) from the California Partners Study II, an intervention trial for HIV-serodiscordant couples in California. Questions on sexual practices, viral load testing, HIV treatment, post-exposure prevention, and their effect on sexual behaviors, risk taking and transmission concerns were measured at intake. ResultsOver two-thirds of couple members surveyed reported unprotected sex with their partner in the past 6 months. Among seropositive respondents, 37% were taking protease inhibitor therapy, 92% had undergone viral load testing, and of those, 40% said it had ben undetectable at their most recent test. Most respondents, regardless of serostatus, said that viral load testing and awareness of post-exposure prevention had no effect on their condom use. In addition, perceiving that their partner had an undetectable viral load was associated with having protected sex among seronegative subjects (P < 0.05). Seropositive respondent taking protease inhibitors were 2.4 times less likely to report unprotected sex compared with those not taking protease inhibitors (P = 0.05). However, up to 33% of seropositive and 40% of seronegative respondents acknowledged decreased transmission concerns in the light of the new HIV treatments. In comparison with their seropositive partners, seronegative individuals were more likely to acknowledge increased risk taking and decreased HIV transmission concerns (P < 0.05). ConclusionsNew medical advances were not associated with unprotected sex in HIV-serodiscordant couples. However, new treatment options may decrease concerns about HIV transmission, particularly among seronegative partners. Providers should discuss the effect of antiretroviral treatments on sexual transmission risk with their patients. The inclusion of seronegative partners in counseling interventions may decrease risk taking in serodiscordant couples.

Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples.

&NA; We examined sociodemographic, behavioral, and clinical characteristics associated with inconsistent condom use in a cross‐sectional analysis of 145 sexually active HIV‐serodiscordant heterosexual couples who participated in the California Partners Study II. All couples were aware of their HIV‐serodiscordant status. Fortyfive percent of couples reported having had unprotected vaginal or anal sex in the previous 6 months. In the multivariate couple‐level analyses, factors independently associated with inconsistent (i.e., <100%) condom use in the previous 6 months included lower educational level, unemployment, African‐American ethnicity, and practice of anal sex by the couple. Injection drug use was associated with inconsistent condom use among couples with younger HIV‐infected partners. In addition, couples with HIV‐infected partners who had higher CD4 cell counts and couples in which the HIV‐infected male partner ever had sex with a man were more likely to use condoms inconsistently. Consistency of condom use did not depend on the gender of the HIVinfected partner or duration of sexual relationship. The findings suggest that many HIV‐serodiscordant heterosexual couples remain at high risk of HIV transmission and may benefit not only from behavioral interventions but also from structural interventions aimed at improving their social and economic conditions.

Heterosexual Risk for HIV Among Puerto Rican Women: Does Power Influence Self-Protective Behavior?

Lack of power in relationships has been offered as an explanation for why women do not always engage in safer sex behavior with male partners. However, few studies have empirically tested the association between power and self-protective behavior. Causal modeling procedures were used to examine the interrelations of seven measures of power and to examine the effects of power on womens HIV-related communication and condom use with male partners. Power was measured by education, employment, decision making, perceived alternatives to the relationship, commitment to the relationship, investment in the relationship, and absence of abuse in the relationship. The sample comprised 187 Puerto Rican women, aged 18–35 years, attending a comprehensive health clinic in the Bronx, New York, who were at risk for heterosexual transmission of HIV. Women who were currently employed and those who were more committed to their relationships reported less HIV-related communication. Condom use was predicted by shorter length of the relationship, more education, current employment, less investment in the relationship, and more HIV-related communication.

Bridging Science and Practice in Violence Prevention: Addressing Ten Key Challenges

This article illustrates ideas for bridging science and practice generated during the Division of Violence Prevention’s (DVP) dissemination/implementation planning process. The difficulty of moving what is known about what works into broader use is near universal, and this planning process pushed us to look beyond the common explanations (e.g., providers were resistant/unwilling to change practice) and think about the multiple layers and systems involved. As part of this planning process, the Interactive Systems Framework for Dissemination and Implementation (ISF) was developed and then applied to the fields of child maltreatment and youth violence prevention. Challenges for each of the three systems in the ISF are discussed as well as and action and research ideas to address the challenges. Also described are actions taken by DVP in response to the planning process to illustrate how a funder can use the ISF to bridge science and practice.

Research and Action for Bridging Science and Practice in Prevention

There is a well-known gap between science and practice. To address this gap in the areas of Child Maltreatment (CM) and Youth Violence (Y/V), the Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention (CDC) embarked on a Dissemination/Implementation (D/I) planning project. The project was aimed at identifying better ways to connect research and practice through reviews of the literature as well as through discussions with experts on violence prevention and research utilization. This introductory article sets the stage for the rest of the special issue by defining terms, providing a rationale for the planning project, describing the planning process, and summarizing what is to come in the rest of the issue.

Predicting long-term outcomes for children affected by HIV and AIDS: perspectives from the scientific study of children's development

The immediate and short-term consequences of adult HIV for affected children are well documented. Little research has examined the long-term implications of childhood adversity stemming from caregiver HIV infection. Through overviews provided by experts in the field, together with an iterative process of consultation and refinement, we have extracted insights from the broader field of child development of relevance to predicting the long-term consequences to children affected by HIV and AIDS. We focus on what is known about the impact of adversities similar to those experienced by HIV-affected children, and for which there is longitudinal evidence. Cautioning that findings are not directly transferable across children or contexts, we examine findings from the study of parental death, divorce, poor parental mental health, institutionalization, undernutrition, and exposure to violence. Regardless of the type of adversity, the majority of children manifest resilience and do not experience any long-term negative consequences. However, a significant minority do and these children experience not one, but multiple problems, which frequently endure over time in the absence of support and opportunities for recovery. As a result, they are highly likely to suffer numerous and enduring impacts. These insights suggest a new strategic approach to interventions for children affected by HIV and AIDS, one that effectively combines a universal lattice of protection with intensive intervention targeted to selected children and families.

Relationship Violence and Women's Reactions to Male- and Female-Controlled HIV Prevention Methods

This study examined the association of relationship violence and preference for three HIV prevention methods among 104 African American and Hispanic women who were at some risk for heterosexual transmission of HIV and other sexually transmitted diseases (STDs). Women completed a brief questionnaire on sexual behaviors and history of relationship violence. All women then watched a video describing three HIV/STD prevention methods (male condoms, female condoms, and vaginal spermicide) that included a discussion of method effectiveness, how to use each method, and their benefits and limitations. Participants then completed a questionnaire assessing their reactions to each of the three HIV prevention methods discussed in the video. Women in violent relationships indicated less likelihood of using male condoms and greater likelihood of using female-controlled methods, particularly vaginal spermicide, than women in nonviolent relationships. In addition, a higher percentage of women in violent compared to nonviolent relationships expected their partners to prefer the vaginal spermicide and a lower percentage expected partners to prefer male condoms. These data suggest that the current focus on finding alternative HIV prevention methods for women in violent relationships is warranted and that a vaginal microbicidal product may be the preferred alternative for this group of women and their male partners.

Policy statement - Child abuse, confidentiality, and the health insurance portability and accountability act

The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 has significantly affected clinical practice, particularly with regard to how patient information is shared. HIPAA addresses the security and privacy of patient health data, ensuring that information is released appropriately with patient or guardian consent and knowledge. However, when child abuse or neglect is suspected in a clinical setting, the physician may determine that release of information without consent is necessary to ensure the health and safety of the child. This policy statement provides an overview of HIPAA regulations with regard to the role of the pediatrician in releasing or reviewing patient health information when the patient is a child who is a suspected victim of abuse or neglect. This statement is based on the most current regulations provided by the US Department of Health and Human Services and is subject to future changes and clarifications as updates are provided.

Employment, Social Support, and HIV Sexual-Risk Behavior in Puerto Rican Women

This study examined psychosocial factors associated with HIV-risk behavior among Latina women at self-disclosed heterosexual risk for HIV infection. Data were collected via structured interviews for 187 Puerto Rican women, aged 18–35, who attended a health clinic in the Bronx, New York. Over 64% of all participants reported unprotected vaginal sex with primary sexual partners. Higher levels of unprotected vaginal sex were associated with living with the partner, residing with children, current employment, heightened negative mood, and greater social support from the partner. The relationship between increased negative mood and increased unprotected vaginal sex use was mediated by employment, after controlling for educational level, living with the partner, and residing with children. The findings suggest that interventions designed to facilitate HIV-protective behaviors may need to consider that employment may supercede relationship factors among populations of urban women identified at increased heterosexual risk for HIV infection.