The Tuberculosis Behavioral and Social Science Research Forum Proceedings
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Section II. Presentations and Panel Discussions
Two CDC Models from HIV Prevention: Replicating Effective Programs and Diffusion of Effective Behavioral Interventions
Agatha Eke, Ph.D.
Behavioral Scientist, Behavioral Intervention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
Day 2, Afternoon Session
Dr. Eke described two sequential CDC initiatives to translate research into practice: Replicating Effective Programs (REP) and Diffusion of Effective Behavioral Interventions (DEBI). REP is involved with translation and packaging of science-based HIV interventions, while DEBI supports the diffusion of the translated interventions into practice. Both models are generally applicable to interventions on other public health topics such as TB.
The REP project is in line with the recommendations made in the Institute of Medicine HIV prevention report of September 2000 and CDC’s HIV Prevention Strategic Plan; both spoke to the need for development and use of effective, evidence-based HIV prevention interventions at all levels. REP sought to move HIV prevention beyond the endpoint of researchers publishing their results to a new paradigm in which researchers, practitioners, and communities are in active collaboration to translate research into improved prevention practice. Initiated in 1996, REP has thus far produced packages for seven HIV prevention interventions whose effectiveness has been documented through rigorous research methods. Four more intervention packages are currently in development. These intervention packages are then selected and implemented by local agencies.
Some important lessons emerged from the implementation phase of the initial REP packages:
- Importance of keeping the interventions as simple as possible, focusing on “core elements”;
- Flexibility to allow adaptation to local contexts;
- Need for maintaining detailed records and documentation of implementation;
- Value of clear “how to” materials;
- Importance of collaboration among researchers, practitioners, and communities; and
- Value of technical assistance during implementation.
DEBI represents the next step along the continuum of CDC’s technology transfer and dissemination efforts in HIV prevention. It develops and coordinates a national strategy for diffusing science-based HIV interventions to state- and community-level programs. DEBI objectives for each intervention are accomplished in three phases that involve planning and development of curricula and related materials; implementation of an institute for master trainers; and larger scale roll-out in which up to 700 facilitators at state and local levels are trained and provided technical assistance and individualized coaching. Additional mechanisms for diffusing science-based interventions include satellite broadcasts, newsletters, Web-based discussion forums, and conference calls.
The DEBI model represents a further important effort to bridge the gap that commonly exists between public health researchers and practitioners. In the funding process for this initiative, there were specific requirements and incentives for the collaborations among researchers who have developed and evaluated the interventions, the front-line practitioners who will be trained to replicate or adapt these interventions, and the communities in which they will be implemented. Lessons learned from DEBI include:
- Active partnership and clear communication among all stakeholders are very important to a successful translation of research into practice;
- Multiple disciplines and skills are needed for the process to succeed;
- Implementing interventions with fidelity is important, but local adaptation may also be necessary to maximize effectiveness;
- Differences between researchers’ and communities’ definitions of “effective” interventions must be harmonized; and
- Successful diffusion may help to overcome myths about lack of capacity and inability to collaborate across sectors.
A member of the audience noted that the TB field is far behind the HIV field in such translation of research into practice, and that this represents very important work in which there is much to learn from the HIV experience.