Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention

Implementation Science

The TRIP Team¹  Emily Arnold¹  Scott Tebbetts¹  Gregory Rebchook¹  Susan M Kegeles¹ 

[1] Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, San Francisco 94158-2549, , CA, USA

关键词: Community-based participatory research;    Fidelity;    Community mobilization;    Community level interventions;    Structural interventions;    Young men who have sex with men;    Young gay men;    Implementation science;    Gay men;    Translational science, HIV prevention interventions;    Translating research into practice;   

Others  :  1219042
DOI  :  10.1186/s13012-015-0216-2

 received in 2013-07-25, accepted in 2015-02-02,  发布年份 2015

【 摘 要 】

Background

Since the scale-up of HIV/AIDS prevention evidence-based interventions (EBIs) has not been simple, it is important to examine processes that occur in the translation of the EBIs into practice that affect successful implementation. The goal of this paper is to examine facilitators and barriers to effective implementation that arose among 72 community-based organizations as they moved into practice a multilevel HIV prevention intervention EBI, the Mpowerment Project, for young gay and bisexual men.

Methods

CBOs that were implementing the Mpowerment Project participated in this study and were assessed at baseline, and 6-months, 1 year, and 2 years post-baseline. Semi-structured telephone interviews were conducted separately with individuals at each CBO. Study data came from 647 semi-structured interviews and extensive notes and commentaries from technical assistance providers. Framework Analysis guided the analytic process. Barriers and facilitators to implementation was the overarching thematic framework used across all the cases in our analysis.

Results

Thirteen themes emerged regarding factors that influence the successful implementation of the MP. These were organized into three overarching themes: HIV Prevention System Factors, Community Factors, and Intervention Factors. The entire HIV Prevention System, including coordinators, supervisors, executive directors, funders, and national HIV prevention policies, all influenced implementation success. Other Prevention System Factors that affected the effective translation of the EBI into practice include Knowledge About Intervention, Belief in the Efficacy of the Intervention, Desire to Change Existing Prevention Approach, Planning for Intervention Before Implementation, Accountability, Appropriateness of Individuals for Coordinator Positions, Evaluation of Intervention, and Organizational Stability. Community Factors included Geography and Sociopolitical Climate. Intervention Factors included Intervention Characteristics and Adaptation Issues.

Conclusions

The entire ecological system in which an EBI occurs affects implementation. It is imperative to focus capacity-building efforts on getting individuals at different levels of the HIV Prevention System into alignment regarding understanding and believing in the program’s goals and methods. For a Prevention Support System to be maximally useful, it must address facilitators or barriers to implementation, address the right people, and use modalities to convey information that are acceptable for users of the system.

【 授权许可】

   
2015 Kegeles et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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