Policy Impact – CHIPTS – Center for HIV Identification, Prevention and Treatment Services

26Oct

Implementation Science for Intervention Delivery in Healthcare Settings

Abstract: Implementation science examines the efficiency of intervention implementation and to translate the existing efficacious intervention models to real world services. It could potentially enhance the effectiveness and sustainability of the behavioral intervention projects. I received my PhD in epidemiology from the University of California, Los Angeles (UCLA) in 2009. Through my involvement in several large-scale HIV behavioral intervention projects and my doctoral dissertation study, I realized the importance of implementation science in intervention delivery and determined long-term career goal to become an implementation science researcher to bridge the gap between existing knowledge and service delivery. To fill in the gap between my current skill set and the career goal, I will receive training in areas related to implementation science, including health policy, intervention adaptation, and healthcare management. The health policy training will familiarize me with the process of policy development and its influence on the intervention adaptation and implementation; the intervention adaptation courses will inform me with the general concept and framework to design the study ensuring all aspects of intervention implementation are addressed; and the health management training will provide me with analytical tools to model leadership decision making and to evaluate the implementation flow in healthcare settings. The mentor team members, Drs. Li Li, Mary-Jane Rotheram-Borus, Thomas J. Coates and Zunyou Wu, are all internationally reorganized experts in behavioral intervention implementation and adaptation. My institute, the UCLA Semel Center for Community Health (CCH) and the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), UCLA, provide me with support from a multidisciplinary team of top researchers. Collaborating with the National Center for AIDS/STD Control and Prevention (NCAIDS), China CDC, I will conduct a mentored research using an intervention trial with significant yet heterogeneous outcome to investigate multilevel factors influencing the intervention implementation and outcome, and to find the optimal approach to incorporate the intervention model into the current healthcare settings. The study will be conducted in three phases. Phase 1 will be review of related policies and in-depth interviews with healthcare administrators and hospital directors, with the aim to explore the policy barriers and facilitators in adaptation of the intervention model. Phase 2 will be conjoint analysis with hospital directors to model the decision-making in intervention adaptation and routinization in the healthcare facilities. Phase 3 will be bottleneck analysis to locate structure bottlenecks in compliance with the intervention component. The finding will provide implications for future intervention delivery in healthcare settings. Application of some analytical tools in other fields, including conjoint analysis and bottleneck analysis, will potentially contribute to the development of implementation science methodology. Based on the data achieved from the study, I will prepare for a R01 application in implementation science in Year 4 of the K award period.

Project Number: 5K01MH1021447-05

23Jan

HIV Technology Transfer in Los Angeles

The aims of the HIV Technology Transfer in Los Angeles project are to document and develop resources for technology transfer among HIV/AIDS community-based organizations (CBOs) serving Los Angeles communities. Several CBOs have publicly commented on the gap between current mandates to implement and evaluate evidence-based HIV interventions and the resources that are available to meet these requirements. A long-term objective is to share CBOs insights into using science-based interventions and to increase the training, materials and other resources they need to carry out HIV prevention. CHIPTS and the City of Los Angeles AIDS Coordinator (ACO) seek to assist CBOs in meeting these objectives. The potential impact of the study is enhanced implementation of evidence-based interventions in Los Angeles and throughout California.

The process of adapting evidence-based interventions into CBO settings is known as technology transfer. The Technology Transfer Model (TTM) outlines three primary phases of this process: pre-implementation, implementation, maintenance and evolution. The pre-implementation phase consists of identifying the need for an intervention, acquiring information, assessing the fit between an intervention and the goals and activities of the organization, and preparing the organizational staff. Implementation includes obtaining technical assistance and conducting process evaluation of the interventions. Finally, maintenance and evolution includes ensuring the presence of staff that can continue to implement the intervention, organizational change, and program evolution.

CBO staff who have been involved in the three phases of technology transfer can offer rich insights on best practices and lessons learned in their communities. Up to 18 science-based programs have been or are being implemented in Los Angeles. Up to two staff from each of these programs are eligible to participate (N = 36). Eligible participants for this study completed close-ended background surveys regarding their organization’s characteristics and were interviewed for up to 90 minutes. Participants were paid $30 for each interview completed. Interviews were conducted twice with staff from these programs. The first wave of interviews asked about pre-implementation and implementation phases of technology transfer. The second wave of interviews, scheduled when many of the programs finished at least one cycle of implementation, asked about maintenance and evolution. Surveys were summarized and used to describe the general organizational characteristics of CBOs using evidence-based programs. Interviews were transcribed, coded and analyzed for techniques, challenges, strategies, and resources used or needed by the CBOs.

Interventions, Training Manuals, etc. :

HIV Technology Transfer in LA (developing resources for technology transfer among HIV/AIDS community-based organizations)- Interview Questions
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20Jan

China Provider Project

China has one-fifth of the world’s population (1.4 billion people); the risk of an HIV pandemic is substantial. In 2005, AIDS surpassed hepatitis B to become the third deadliest infectious disease in China in 2005. The Chinese government has implemented a national program, “Four Frees and One Care,” which mandates access to free HIV testing and free anti-retroviral (ARV) treatment to AIDS patients in China.

As the demand for HIV treatment and care increases rapidly, service providers in China are at a critical point with growing responsibilities to deliver adequate services and care for patients living with HIV/AIDS (PLH). However, experiences of unwelcoming treatment often discourage PLH from seeking care from providers who exhibit discriminatory attitudes and behaviors. HIV-related stigma has a tremendous impact on PLH’s health outcomes, health seeking behavior, and treatment adherence. Only when patients’ fears of discrimination are reduced will they be more willing to participate in HIV testing and treatment.

The National Institute of Mental Health funds this four-year randomized controlled trial that addresses both individual and structural components to reduce HIV-related stigma among service providers in China. This intervention trial builds on a three-year pilot study that we conducted among 1,344 service providers in China from 2003 to 2006. From the pilot, we recognized the need to address HIV-related stigma by building social norms of acceptance and focusing on the well-being of all patients as well as service providers. This Popular Opinion Leader [POL] and access to universal precautions intervention integrates the behavioral level with the structural level and incorporates all core elements of the POL model with four training sessions and bi-monthly reunion sessions. We plan to train 600 POL providers in 40 county hospitals in Yunnan and Fujian, China.

The intervention trial will proceed in two phases. In Phase 1, we will develop and finalize the intervention, assessment instruments and implementation procedures. In Phase 2, we will randomly assign 40 hospitals to either: 1) an intervention group, or 2) a standard care group. The impact of the proposed intervention will be assessed over 12 months (baseline, 6 & 12 months), with 1,760 service providers and 1,000 patients. The provider outcomes are providers’ attitude and behavior changes toward patients and their universal precaution practice. The patient outcomes are patients’ perceived stigma, medical service utilization, and satisfaction and treatment adherence.

Published Journal Articles :

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20Jan

China CPOL (Community Popular Opinion Leaders) Project

This 8-year study was part of the National Institute of Mental Health (NIMH) Collaborative HIV/Sexually Transmitted Disease (STD) Prevention Trial in international settings, including China, India, Peru, Russia, and Zimbabwe. The trial was designed to identify, recruit, train, and engage community popular opinion leaders (C-POL) in a defined population to convey HIV risk reduction messages. The primary objective was to reduce HIV/STD incidence and risky sexual behaviors.

Intervention model:

Community Popular Opinion Leader (CPOL) HIV prevention intervention

Research Methods:

• Ethnographic studies to identify social networks
• Pre-baseline assessment for risk estimates
• 4,510 market workers from 40 food markets participated in the baseline
• Behavioral and biological assessments
• Longitudinal analyses with 12 and 24 month follow-ups

Local Significance:

The project has provided an opportunity to communicate with policy makers at all administrative levels in China about HIV prevention and intervention strategies. The POL model was adapted by other intervention studies in China.

International Significance:

This is the first test of the efficacy of a similar intervention in multiple international sites. China is the first of the five countries that has begun the baseline assessment and intervention activities. More than 15 peer-reviewed papers have been published.

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