A Structural HIV Prevention Intervention to Help CBOs Implement EvidenceBased Interventions Effectiv

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A Structural HIV Prevention Intervention to Help
CBOs Implement Evidence-Based Interventions
Effectively

• Susan M. Kegeles, PhD,
• Gregory Rebchook, PhD,
• the TRIP team
• CAPS/University of California, San Francisco
• Funded by NIMH

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Translating Research Into Practice

• Substantial resources have been spent on
  developing and testing HIV prevention
  interventions has resulted in a number of
  evidence-based interventions
• But until interventions are effectively
  implemented, the research has little impact on
  the epidemic
• This project focuses on how to get an
  evidence-based intervention put into practice in
  the real world

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The Mpowerment Project (MP)

• Demonstrated effectiveness
• Listed in CDC Compendium of HIV prevention
  interventions with evidence of effectiveness
• Scientifically tested in several communities
• Community-level intervention with multiple
  components
• Many CBOs want to implement the MP call for
  assistance, training

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Time for a New Type of Intervention

• Previous approach to influencing epidemic
  develop an intervention to help change young
  MSMs sexual risk behavior (MP)
• Structural intervention is needed to impact the
  way that HIV prevention is conducted by CBOs
• Now develop an intervention aimed at helping
  CBOs to implement MP effectively with fidelity
  to MPs core elements and guiding principles

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Developing Intervention

• Began developing ideas about components by
  observing CBOs when we were testing the MP
• Observed CBOs that took over MP as we would leave
  the field in researching it
• Provided help to CBOs implementing MP
• Developed preliminary replication package (CDCs
  REP project - Replicating Effective Programs)
  tested it with CBO

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Lessons Learned for Intervention - partial list

• - Staff turnover is rapid
• Often there is no organizational memory of
  prevention program after staff leave
• Some staff are technologically savvy others less
  so
• CBOs cant always afford up-to-date technology
• Need to build rapport, over time, so that trust
  develops
• CBOs dont want to be told exactly what to do and
  how to do it
• Need to give suggestions, framework
• Need to be able to modify the intervention for
  community and cultural context

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Lessons Learned (cont.)

• CBOs want to hear what worked and didnt work
  when we conducted research on MP
• Staff often dont reach out for technical
  assistance (TA) early, but rather, often wait
  until crisis hits
• Staff may not recognize when need help
• Need to reach out to them, so that when crises do
  hit, can provide help
• Or better yet - avoid crises
• Diverse ways of learning
• visual information, didactic presentations,
  experiential learning - multiple methods aid in
  learning

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• This study to evaluate how well the Mpowerment
  Project Technology Exchange System (MPTES) works
  in helping organizations implement the MP
• This presentation to evaluate how the MPTES is
  utilized by CBOs and their attitudes towards its
  different components - preliminary results

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Methods

• Provide MPTES to CBOs and examine uptake of the
  various components
• N 52 CBOs data presented here
• Will follow 70 CBOs over 2 - 3 follow-ups, at 6
  month intervals
• CBOs are interviewed by phone at each assessment
• This presentation examine utilization patterns
  after CBOs have MPTES for at least 6 months
  (follow-up 1)
• Study evaluator interviews EDs, project
  supervisors, coordinators

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The Mpowerment Project Technology Exchange System
(MPTES)

• 7 components
• Program Manual
• Program Overview Video
• Small group facilitators manual
• Small group training video
• 3-day training
• Technical Assistance (TA)
• Internet Resources (website focused on here)

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Program Manual

• Developed after input by former staff, CBOs using
  it, advisory board comprised of CBOs from around
  SF/Bay Area
• Lots of visuals
• Carefully organized
• Very user friendly

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Program Overview Video Small Group Video

• To give a feel for what intervention is like
• Filmed on location when conducting intervention
  in Albuquerque
• Overview video to use with funders, boards of
  directors, agency when deciding if to implement
  MP, sometimes core groups (initially)
• Small group video to train small group
  facilitators, to be used with facilitators
  manual for small groups

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Training

• Designed for project staff and supervisors
• Experiential and interactive
• Conducted by original researchers and former
  Project Coordinators
• 3-days long
• In-depth
• Comprehensive
• Information exchange among CBOs at training

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Technical Assistance (TA)

• Collaborative Approach
• TA to coordinators supervisors
• Pro-active
• TA providers call each CBO every 2 to 3 weeks
• CBOs can request TA at other times
• Tailored
• TA helps CBOs adapt MP to the needs of their
  community
• Credible Providers
• Former MP Coordinators
• Experienced implementing MP both during the
  research period and in a CBO

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www.mpowerment.org

• Design complements the training manual
• Online modules
• HTML
• PDF
• Message board
• E-mail forum
• Chat room
• Examples of outreach materials (over 100)
• Links and team photos

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Evaluation of Program Manual

• their purple bible...they used it to help them
  recruit staff, to keep on track with the
  community assessment, to keep the goals and
  objectives in the forefront of their
  thinking...it has been indispensable for them
• the keystone training prevention manual that all
  prevention manuals should be measured against in
  the future... and I look at a lot of manuals
• he knows that Joey doesnt like it because it is
  overwhelming...Jason tries to get him to look at
  it more...but he doesnt

• Range of use 0 - 41 times, median 9.25
• attitude scales, 1 - 6, with 1 strongly disagree
  and 6 strongly agree (medians)
• Helpful to set up 5.46
• Helpful reference 6.00
• Still use it over time 6.00
• Helpful at tailoring 5.00

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Evaluation of Overview Video

• good to show in the community ...short and
  sweet...gives a good overview and good to show
  potential members of a core group, providers
• loves the video... thinks it is so cute...its
  great...he always tears up when they show the
  graphs about what impact it had...he is craving
  that so much in his work...
• he didnt think that some of the stuff was right
  for their culture...the African American guy in
  the film wasnt like they are...he thinks we
  could make it better by seeking more information
  from the inner city...

• Range of use 0 - 15 times, median 1.00
• Helpful to inform Core Group
  5.33
• Helpful to understand look of program 5.66
• Teach coordinators 5.55
• Still use 4.04

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Evaluation of Training

• training was excellent...it kept his attention
  for the entire three days
• it was great to touch base with all the people
  who were implementing and make those
  connections... have always wanted a training
  version 2.0 where the groups addressed issues
  that they encountered through implementation and
  adaptation in their communities
• the training didnt address organizational
  issues.... It didnt encourage you to get
  organizational buy in, and thats important to
  have as well

• Range 0 - 1 times, median 0 (but most went to
  training before baseline)
• Helpful to talk with others doing MP 6.00
• Helped to decide to implement 5.50
• Enjoyed 5.75
• Adjusted approach because of training 5.75

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Evaluation of TA by phone

• when TA provider called, it was a huge relief on
  a psychological level to have someone on the
  phone who had implemented the project
  before......if someone calls occasionally from
  the outside, it makes him feel less isolated....
• they would like TA provider to visit the
  program....the guys get a little frustrated
  because sometimes the information that is
  provided doesnt always hit the mark....it would
  be helpful if the TA provider came out to visit
  and saw the community and the program

• Range 0 - 10 times, median 2.00
• TA receive when call CAPS is helpful
  6.00
• Helped in obtaining additional funding 4.00
• Like getting TA by phone
  5.55
• Helpful when CAPS initiates calls
  5.58

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Evaluation of Website

• the web site is nice...as a resource, it is one
  of the easiest to navigate...it takes you to
  information quicker, and because it is on line,
  you can word search it, which is faster than
  manual
• he downloads the modules from on line and prints
  them out so he can mark them up (vs. manual)
• doesnt really use it...its hard to find time to
  fit it all in
• gets more out of speaking with TA provider than
  the web site

• Range 0 - 20 times, median 1.33
• Helpful in answering questions about MP 4.00
• Help generate ideas for events
  5.00
• Help generate ideas for outreach
  5.00

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Summary of Utilization Attitudes

• Strongly positive attitudes towards MPTES
• But utilization is substantially lower than would
  be expected by attitudes
• possibly because staff is so busy with work that
  little time to use
• Biggest issues/dissatisfactions
• Want TA providers to come to CBOs in person
• Want more help in adapting intervention
• Especially questions/concerns about MP and how to
  adapt to African American MSM and rural areas

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Acknowledgements

• The translation of research into practice
• (TRIP) team
• John Hamiga, David Sweeney,
• Scott Tebbetts Ben Zovod
• also
• Emily Arnold, Michael Foster,
• Dave Huebner, Wayne Steward
• and 70 CBOs trying to prevent HIV/AIDS
• Funding NIMH