Text for Figures and Slides in TB Behavioral and Social Science Research Forum Proceedings

REPLICATING EFFECTIVE PROGRAMS: TURNING RESEARCH INTO PRACTICE

Agatha Eke, Ph.D.
Behavioral Scientist,
Division of HIV/AIDS Prevention,
Centers for Disease Control and Prevention

Slide #1: Replicating Effective Programs:
Turning Research Into Practice

Agatha N. Eke, PhD
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia, USA

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Slide #2: Institute of Medicine Report

The IOM Report on HIV prevention recommended:
Key DHHS agencies that fund HIV prevention research and interventions should invest in strengthening local-level capacity to develop, evaluate, implement, and support effective programs in the community.

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Slide #3: HIV Prevention Strategic Plan

Goal 4: By 2005, strengthen the capacity nationwide to monitor the epidemic, develop and implement effective HIV prevention interventions and evaluate prevention programs.

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Slide #4: Goals

• HIV prevention agencies should conduct interventions that are science-based.
• Research-based HIV prevention behavioral interventions should be made available for use by prevention agencies.

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Slide #5: Experience

Our experience in the Centers for Disease Control and Prevention’s (CDC) Replicating Effective Programs (REP) project has taught us valuable lessons on what researchers & prevention agencies need to do to achieve these goals.

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Slide #6: A New Model of Behavioral Research

• Old Model = Research project ends with publication of articles that present research findings
• The research community has a responsibility to translate and transfer the fruits of research in ways that are useful to society [A shift in paradigm].
• New Model = Active partnership among researchers, prevention agencies, & communities at all stages of research & transfer into practice

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Slide #7: The REP Project: Part of the New Model

• Started in 1996 as a 2-year project
• US$400,000 for each effective, research-based intervention
• Converts interventions into packages (kits) for use by local HIV prevention agencies
• Funds researchers to collaborate with community advisors to prepare the intervention packages
• Other prevention agency collaborators conduct trials/case studies of implementing the intervention using the packages, training, & TA

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Slide #8: The REP Project: Continued

• So far, REP has:
  • converted 7 interventions into packages
  • 3 packages in formal preparation
  • 1 package in informal preparation (CITY)

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Slide #9: REP Criteria to Determine An Intervention’s Effectiveness

• Completed research study
• Measured behavioral or biologic outcomes
• Collected pre- and post-test data
• Used treatment & control/comparison groups
• Retained > 70% of participants
• Evaluated using quantitative statistics
• Found to have statistically significant positive effects

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Slide #10: Translation and Transfer Steps for Researchers

Year 1 of REP

• Form advisory committee of HIV prevention providers and community members
• Translate science into lay language
• Develop package contents & format with advisory committee
• Find other HIV prevention agencies to field test package

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Slide #11: Translation and Transfer Steps for Researchers (cont’)

Year 2 of REP

• Orient agency to intervention and collaboratively tailor & adapt it
• Train agency staff in technical skills & intervention delivery
• Provide technical assistance on implementation and problem-solving
• Evaluate the process & debrief the agency staff
• Refine package based on agency input & produce final version

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Slide #12: Transfer and Implementation Phases for HIV Prevention Agencies

Pre-Implementation Phase

• Obtain administrative, agency staff, & community buy-in
• Line up resources & designate responsibilities
• Orient gatekeepers
• Get training for staff who will conduct the intervention

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Slide #13: Transfer and Implementation Phases for HIV Prevention Agencies (cont’)

Implementation Phase

• Tailor delivery to agency & local circumstances
• Adapt intervention for population & setting
• Schedule start-up steps
• Assure quality of delivery & fidelity to Core Elements
• Obtain technical assistance

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Slide #14: Transfer and Implementation Phases for HIV Prevention Agencies (cont’)

Maintenance Phase

• Dedicate sufficient resources
• Institutionalize as part of agency’s mission
• Re-adapt to changing circumstances
• Obtain gatekeepers’ acceptance of intervention modifications

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Slide #15: Lessons for Converting Research into Prevention Practice

• Keep detailed, accessible records of interventions
• Identify “core elements” of interventions to simplify implementation by prevention agencies
• Researchers should work with prevention agencies in converting research into practice
• Develop simple, clear packages of “How to” materials designed for prevention agencies
• Shorter & simpler interventions are easier to implement

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Slide #16: Records of intervention

• Intervention’s design & protocol
• Copies of original posters, brochures, videos, & other materials
• Details of procedures & logistics
• Costs of intervention separate from costs of research

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Slide #17: Identify “core elements” of intervention

• Critical features of an intervention’s intent & design
• Thought to be responsible for an intervention’s effectiveness
• Identified by operationalization of the underlying theory & experience in using the intervention

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Slide #18: Researcher and prevention agency collaboration

• Have researchers, agencies, and communities design & test packages together
• Adapt interventions to agency resources, community needs, & local priorities
• Provide training & technical assistance along with packaged intervention protocols
• Collaborate until agency is comfortable with the intervention

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Slide #19: Packages of “How to” materials

Protocol manual

• Sufficient detail but concise
• Non-technical language
• Clearly written
• Practical
• Appealing & easy to use

Sample posters, brochures, videos, and other materials

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Slide #20: Short and simple interventions

• Few components
• Brief
• Easy delivery skills
• Simple technology
• No monetary incentives

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Slide #21: New Model = Active partnership among researchers, prevention agencies, and communities at all stages of research and transfer into practice

If this perspective is accepted as the model for putting science-based interventions into practice,

• Researchers should design interventions that can be conducted by prevention agencies
• Researchers need to plan ahead for the transfer process during their research studies
• Funders need to pay for all stages of the research, transfer, and implementation process

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Slide #22: Conclusions

• REP is a part of a new model for researchers & funders.
• Transfer is complex and expensive but possible.
• Transfer requires alliance between researchers & prevention agencies.
• Infrastructure & support for conversion, dissemination, & implementation are needed.
• Challenges will be compounded when transfer becomes nationwide.
• Challenges of wide-scale transfer of effective behavioral interventions must be met to impact the AIDS epidemic.

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Slide #23: For more information

Visit the Replicating Effective Programs plus (REP+) website at:www.cdc.gov/hiv/projects/rep/default.htm

Consult CDC’s special journal supplement on technology transfer:
Turning HIV Prevention Research Into Practice, AIDS Education and Prevention, 12, Supplement A, 2000

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