Abstract #254  -  Title: Challenges of disseminating, adapting, and implementing an evidence-based HIV risk-reduction intervention for PLWHA in different cultural contexts
Authors:   Presenting Author:   Dr. Deborah Cornman - University of Connecticut
Additional Authors:
Aim: Aim: Based on the findings from 4 different countries, this presentation will highlight and discuss the multilevel challenges of disseminating, adapting, and implementing evidence-based HIV risk reduction programs for PLWHA in clinical care.
Method / Issue: Issue: Despite significant advances in the development of evidence-based HIV risk-reduction interventions, such interventions are oftentimes not disseminated and implemented in real-world settings beyond initial efficacy trials. In order to have a sustainable impact on HIV transmission, we must be able to more effectively and efficiently move interventions from research into practice. Identifying multilevel barriers to program dissemination, adaptation, and implementation is a critical first step in this process.
Results / Comments: Project: Options is a theory-based, clinician-delivered HIV risk reduction intervention that was rigorously evaluated and found to be effective at reducing unprotected sexual behavior among HIV+ patients in clinical care in Connecticut, U.S. The intervention was adapted for use in other states in the U.S. as well as for Ethiopia, Mozambique, and South Africa. In New York, Options was implemented by clinicians in 3 different clinics, and the training was expanded to include additional information about recreational drug use. In South Africa, the intervention is being implemented by lay counselors in 8 clinics, and the training has been increased from 1 to 5 days. Peer educators conduct the intervention in Mozambique, and nurses do it in Ethiopia; the training in both countries is 5 days long and is tailored to each country’s culture and the needs of the individual patients. The challenges of disseminating, adapting, and implementing Options in each country have been identified and compared.
Discussion: Lessons Learned: Translating an evidence-based, individual-level HIV risk-reduction intervention for use in other cultural contexts requires a thorough understanding of the specific challenges and relevant factors at each level of implementation for each context. At the individual level, it is critical to understand the informational, motivational, behavioral skills, and other barriers that prevent the client from consistently engaging in safer sex; some of these barriers are common across all countries, and others are unique to a particular country (e.g., some people in South Africa believe that drinking potato water cures HIV). Again at the individual level, it is important to understand the specific barriers (e.g., lack of time, poor self-efficacy, inadequate counseling skills) that get in the way of the intervener (i.e., doctor, peer educator, etc.) implementing the intervention. At the organizational level, one must understand what resources are available and how the intervention can be integrated into ongoing care, given the resources. Organizational level challenges also include how to garner organizational and staff buy-in to the intervention. One must also examine factors at the community level to determine if they are relevant to intervention implementation, and if so, what they are and how they impact on implementation (e.g., Department of Health in South Africa must give approval for lay counselors to receive additional training). In order to facilitate effective dissemination, adaptation, and implementation of evidence-based HIV risk-reduction interventions, identification and careful consideration of the relevant multilevel factors must be considered. Recommendations for how to more effectively translate evidence-based HIV risk-reduction interventions into “real-world” settings will be discussed.
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