National Implementation of an evidence-based HIV prevention program: multilevel scale-up strategies and precision prevention

Univ Of Massachusetts Med Sch Worcester, Worcester MA

Investigators

Linked publications & trials

Abstract

Over the past two decades, the Bahamian Ministries of Education (MOE) and Health (MOH) and our research team have adapted a CDC “Best Evidence” HIV Prevention Program to produce the “Focus on Youth in the Caribbean (FOYC) and Caribbean Informed Parents and Children Together” (CImPACT) risk reduction program to address the HIV epidemic in The Bahamas. Randomized controlled trials of FOYC+CImPACT found the programs to be effective in improving youth’s HIV knowledge, condom-use skills, and self-reported risk behaviors. In 2010, the MOE decided to include FOYC+CImPACT in the government grade-6 curriculum nationwide, with booster sessions for students in grades 7 and 8. The MOE and MOH collaborated with our research team to assess factors influencing teachers’ fidelity of implementation and to develop effective implementation strategies through two national studies (R01HD064350, R01 HD095765). We successfully developed several culturally appropriate strategies (including biweekly monitoring/feedback [BMF] and site- based assistance and mentorship [SAM]), achieving substantial levels of implementation with positive student outcomes. For example, in New Providence (>70% of the Bahamian population), teachers taught >80% of the curriculum on average despite the massive interruptions caused by COVID-19. However, approximately 30% of teachers did not meet the implementation benchmarks. Our team has co-developed (with school communities) new sustainability strategies (i.e., enhanced SAM and enhanced decision-making platform). We are in the final year of a large implementation R01 trial with positive expected outcomes and deepening interest from educational stakeholders to further scale and sustain FOYC+CImPACT nationally. The newly proposed study will target 156 grade six teachers (and 3,500 students) in 65 government primary schools and 49 junior high school teachers in 30 middle schools in 12 Bahamian islands. Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) model and the integrated sustainability framework, this study will leverage our NIH-funded decade-long implementation research to pursue the following specific aims: 1) Using a SMART implementation trial, we will evaluate the value of multilevel strategies to sustain FOYC+CImPACT in schools. 2) Harness advanced machine learning (ML) to promote the FOYC+CImPACT sustainability by iteratively enriching national implementation strategies; 3) Examine underlying mechanisms of sustained implementation to inform an integrated sustainability framework using a mixed methods design. Our primary outcomes include sustainability of implementation, teachers’ fidelity of implementation, and student condom use skills and condom use. This proposed study offers unprecedented opportunities to identify efficient, cost- effective, and novel approaches for sustainability in a successful, nationwide HIV risk-reduction strategy. It has great potential to advance school-based HIV prevention research and implementation science.