A Structural HIV Prevention Intervention to Help CBOs

A Structural HIV Prevention Intervention to Help CBOs Implement Evidence-Based Interventions Effectively Susan M. Kegeles, Ph. D, Gregory Rebchook, Ph. D, & the TRIP team CAPS/University of California, San Francisco Funded by NIMH

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”

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

Time for a New Type of Intervention • Previous approach to influencing epidemic: develop an intervention to help change young MSM’s 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 MP’s core elements and guiding principles

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 (CDC’s REP project - “Replicating Effective Programs”) & tested it with CBO

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 can’t always afford up-to-date technology – Need to build rapport, over time, so that trust develops – CBOs don’t 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

Lessons Learned (cont. ) • CBOs want to hear what worked and didn’t work when we conducted research on MP • Staff often don’t 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

• 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

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 followups, 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

The Mpowerment Project Technology Exchange System (MPTES) • 7 components: – Program Manual – Program Overview Video – Small group facilitator’s manual – Small group training video – 3 -day training – Technical Assistance (TA) – Internet Resources (website focused on here)

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

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 facilitator’s manual for small groups

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

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

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

Evaluation of Program Manual • • their “purple bible”. . . they used it to Range of use: 0 - 41 times, help them recruit staff, to keep on median = 9. 25 track with the community assessment, to keep the goals and objectives in the forefront of their thinking. . . it has been attitude scales, 1 - 6, with indispensable for them 1= strongly disagree and • “the keystone training prevention 6= strongly agree (medians) manual that all prevention manuals should be measured against in the future. . . and I look at a lot of Helpful to set up: 5. 46 manuals…” Helpful reference: 6. 00 • he knows that Joey doesn’t like it because it is overwhelming. . . Jason Still use it over time: 6. 00 tries to get him to look at it more. . . but Helpful at tailoring: 5. 00 he doesn’t

Evaluation of Overview Video • 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 • 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. . . it’s 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 didn’t think that some of the stuff was right for their culture. . . the African American guy in the film wasn’t like they are. . . he thinks we could make it better by seeking more information from the inner city. . .

Evaluation of Training • • • training was excellent. . . it kept his Range: 0 - 1 times, median attention for the entire three days = 0 (but most went to • it was great to touch base with all the training before baseline) people who were implementing and make those connections. . . have always wanted a training version 2. 0 Helpful to talk with others where the groups addressed issues doing MP 6. 00 that they encountered through implementation and adaptation in Helped to decide to their communities implement: 5. 50 Enjoyed 5. 75 • the training didn’t address organizational issues. . It didn’t Adjusted approach encourage you to get organizational because of training 5. 75 buy in, and that’s important to have as well

Evaluation of TA by phone • when TA provider called, it was a • Range: 0 - 10 times, median huge relief on a psychological level to have someone on the phone who had = 2. 00 implemented the project before. . . if someone calls occasionally from the • TA receive when call CAPS outside, it makes him feel less isolated. . is helpful 6. 00 • they would like TA provider to visit • Helped in obtaining the program. . the guys get a little additional funding 4. 00 frustrated because sometimes the • Like getting TA information that is provided doesn’t always hit the mark. . it would be by phone 5. 55 helpful if the TA provider came out to • Helpful when CAPS visit and saw the community and the initiates calls 5. 58 program

Evaluation of Website • 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 • 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) • doesn’t really use it. . . it’s hard to find time to fit it all in • gets more out of speaking with TA provider than the web site

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

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