Adapting HIV prevention evidence-based interventions in practice settings: an interview study

Abstract

BackgroundEvidence-based interventions that are being delivered in real-world settings are adapted to enhance the external validity of these interventions. The purpose of this study was to examine multiple intervention adaptations made during pre-implementation, implementation, maintenance, and evolution phases of human immunodeficiency virus HIV prevention technology transfer. We examined two important categories of adaptations -- modifications to key characteristics, such as activities or delivery methods of interventions and reinvention of the interventions including addition and deletion of core elements.MethodsStudy participants were thirty-four community-based organization staff who were implementing evidence-based interventions in Los Angeles, California. Participants were interviewed twice and interviews were professionally transcribed. Transcriptions were coded by two coders with good inter-rater reliability (kappa coefficient = 0.73). Sixty-two open-ended codes for adaptation activities, which were linked to 229 transcript segments, were categorized as modifications of key characteristics or reinvention.ResultsParticipants described activities considered modifications to key characteristics and reinvention of evidence-based interventions during pre-implementation, implementation, and maintenance phases. None of the participants reported accessing technical assistance or guidance when reinventing their interventions. Staff executed many of the recommended steps for sound adaptation of these interventions for new populations and settings.ConclusionStaff reported modifying and reinventing interventions when translating HIV prevention programs into practice. Targeted technical assistance for formative evaluation should be focused on the pre-implementation phase during which frequent modifications occur. Continuous or repeated measurements of fidelity are recommended. Increased technical assistance and guidance are needed to ensure that reinventions are evaluated and consistent with the aims of the original interventions. Providing strategic technical assistance and written guidance can facilitate effective HIV prevention technology transfer of evidence-based interventions.

Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study

“…Hirschhorn et al [13] have called for an appropriate balance between adaptation and flexibility in the scale-up of HIV interventions [46]. In contrast with a previous study [45], we found that most modifications to ART were made at the organization level as opposed to individual clinicians.…”

Evaluation of an HIV Prevention Intervention for African Americans and Hispanics: Findings from the VOICES/VOCES Community-Based Organization Behavioral Outcomes Project

“…Furthermore, the same videos/video clips were not shown at all CBOs. Previous research has reported CBO staff frequently make such modifications to VOICES/VOCES to accommodate specific target populations, such as MSM [24,31]. CDC supports making changes to key characteristics of an EBI as long as the relevant core element (show a culturally specific video that portrays condom negotiation) is not altered.…”

Adaptations in a Community-Based Family Intervention: Replication of Two Coding Schemes

“…The primary adaptation types reported in those few studies are changes to program content, format, and delivery context. Studies also commonly report that facilitators provide additional information or resources; change the program's target population; add rewards, prizes, or celebrations; and modify training or evaluation processes (Cohen et al, 2008;Lara et al, 2011;Miller-Day et al, 2013;Moore, Bumbarger, & Cooper, 2013;Stirman, Miller, Toder, & Calloway, 2013;Veniegas, Kao, & Rosales, 2009).…”