The implementation of a peer educator HIV intervention in community settings

描述(申请人提供)：艾滋病流行三十年了，艾滋病毒仍然是一个主要的公共卫生问题。许多行为干预已被证明在受控研究环境中改变危险行为是有效的。作为联邦倡议的一部分，也加大了将循证干预(EBI)从研究转移到实践的努力，这些倡议包括疾控中心的有效行为干预传播和SAMHSA的基于有效的方案和做法国家登记。有限的研究审查了这些干预措施的实施过程，特别是社区环境中的同伴教育干预措施。重要的是要了解哪些干预措施可以在现实世界环境中有效和具有成本效益地实施EBI。在我职业生涯的这一点上，我的研究重点是确定社会环境中的艾滋病毒风险和保护因素，特别是社会网络。此外，我还为高危人群开发和评估了行为干预措施。我的长期职业目标是与社区机构合作，制定和传播具有成本效益的、可持续的干预措施，并研究其实施过程。我的短期目标是获得理论、研究设计和方法方面的指导、知识和实践经验，在以下方面：1)传播和实施科学，以确定在真实世界环境中传播和研究循证干预措施实施的策略；2)社区参与研究，与社区机构合作制定、传播和实施干预措施；以及3)经济评估方法，评估实施干预措施的成本。我的培训目标是1)获得指导社区环境中行为干预传播和实施的实证文献和理论/框架的背景。2)获得方法论方面的技能和知识，如研究设计、测量和数据收集，以研究社区环境中干预措施的实施。3)获得社区参与研究的理论和方法的知识和应用，并为传播和实施干预措施发展社区伙伴关系。4)精通在社区环境中实施行为干预所需成本的经济评估。这些目标将通过导师会议、课程作业和教程、网络研讨会/研讨会、定向阅读、会议和期刊俱乐部来实现。作为这个职业发展奖的结果，我将成为一名独立研究员，通过与社区机构的合作制定和传播艾滋病毒预防干预措施，以便在实际环境中实施。拟议的研究项目将侧重于针对以前和现在的吸毒者的同伴教育者干预(盾牌干预)，该干预已由疾控中心在全国范围内传播。其具体目标是：1)审查与基于社会网络的同伴教育干预措施(盾牌干预)实施阶段相关的组织、提供者/工作人员和干预因素；2)调查障碍和促进者之间的关系以及实施阶段，并探索克服实施障碍的战略；以及3)分析与在社区环境中实施同伴教育干预措施相关的机构和客户成本。这些目标将通过审查接受过盾牌干预培训的具有全国代表性的社区机构样本(n=60)的执行情况来实现。将与各机构的组织领导人(即执行主任)进行电话面谈，以评估盾牌的实施阶段和与实施有关的多层次特点，以及障碍和促进者。还将评估与参与盾牌干预相关的成本分析。

DESCRIPTION (provided by applicant): Three decades into the epidemic, HIV continues to be a major public health problem. Many behavioral interventions have been shown to be effective at changing risk behaviors in controlled research environments. Efforts have also increased for moving evidence-based interventions (EBIs) from research to practice as part of federal initiatives such as the CDC's Diffusion of Effective Behavioral Interventions and SAMHSA's National Registry of Effective- based Programs and Practices. Limited research has examined the implementation processes of these interventions, especially peer education interventions in community settings. It is important to understand which interventions can effectively and cost-effectively implement the EBIs in real-world settings Up until this point in my career, my research has focused on identifying risk and protective factors for HIV in the social environment, specifically social networks. In addition, I have developed and evaluated behavioral interventions for at risk groups. My long-term career goal is to develop and disseminate cost-effective, sustainable interventions, in partnership with community agencies and to study their implementation process. My short-term goal, which is discussed in this Mentored Scientist K01 application, is to acquire mentoring, knowledge, and practical experience in the theories, study designs, and methodologies of 1) dissemination and implementation science to identify strategies to disseminate and study the implementation of evidenced-based interventions in real-world settings; 2) community engagement research to partner with community agencies in intervention development, dissemination, and implementation; and 3) economic evaluation methods to assess the costs of implementing interventions. My training goals are to 1) Obtain background in the empirical literature and theories/framework that guide dissemination and implementation of behavioral interventions in community settings. 2) Gain skills and knowledge in methodology, such as study design, measurement, and data collection, to study the implementation of interventions in community settings. 3) Acquire knowledge and application of theories and methods for community-engaged research and developing community partnerships for dissemination and implementation of interventions. 4) Become proficient in economic evaluations of the costs required to implement behavioral interventions in community settings. These goals will be achieved through mentor meetings, coursework and tutorials, webinars/seminars, directed readings, conferences, and a journal club. As a result of this career development award, I will become an independent researcher who develops and disseminates HIV prevention interventions through collaborations with community agencies for implementation in practical settings. The proposed research project will focus on a peer educator intervention for former and current drug users (The SHIELD intervention) that has been nationally disseminated by the CDC. The specific aims are to 1) examine organization, provider/staff, and intervention factors associated with stages of implementation of a social- network based peer education interventions (the SHIELD intervention); 2) investigate the relationships between barriers and facilitators and stages of implementation and explore strategies to overcome barriers to implementation; and 3) conduct an analysis of the agency and client costs associated with implementing a peer education intervention in community- based settings. These aims will be achieved by examining implementation among a nationally representative sample of community agencies (n=60) that have been trained to conduct the SHIELD intervention. Telephone interviews will be conducted with the Organization Leaders (i.e. Executive Directors) of agencies to assess stages of implementation of SHIELD and multi-level features associated with implementation as well as barriers and facilitators. An analysis of the costs associated with participation in the SHIELD intervention will also be assessed.