Moving a Research-based Intervention into Practice

在开发和科学测试艾滋病毒预防干预措施方面付出了大量努力，但这些 干预措施不会影响流行病的传播，除非在社区有效实施-- 基于组织的组织(CBO)。不幸的是，很少有研究研究如何成功地 加强社区组织实施循证干预措施。我们花了很多年的时间开发 并测试针对年轻同性恋/双性恋者的社区层面的艾滋病毒预防干预计划的有效性 男性是艾滋病毒的高危群体，他们被称为赋权项目。最近我们一直在进行一项 对73个CBO如何努力实施授权进行了主要描述性、定性的前瞻性研究 项目。我们还开发并一直在提供材料、培训和技术系统 协助(赋权项目技术交流系统或MPTES)帮助CBO实施 忠实于原始模式的干预。我们发现：(1)存在相当大的变异性， 随着时间的推移，在社区组织之间和社区组织内部实施赋权项目；(2) 组织系统一级的问题在执行效果方面发挥着更大的作用 超出我们的预期；(3)CBO之外的流程(例如，资助者和社区问题)经常发生冲突 实施创新的干预措施；和(4)需要增强MPTES才能 应对存在于多个层面的执行障碍/促进者的生态。在基础上建设 根据这些发现，我们开发了一个实施有效性的概念模型，总结了 组织内部和外部的复杂系统如何影响执行效果。 我们建议对80个正在努力实施授权的CBO进行前瞻性研究 项目，并将通过量化的方法，对模型进行检验。每个CBO将在4个时间点进行评估 两年多来，通过在线自我管理问卷和电话管理调查 关于干预措施的实施情况。我们还将开发和实施增强的MPTES 解决了我们的设想模型中潜在的可变变量，并研究了如何利用 国会预算办公室一线工作人员、监事、执行董事和资助者增强的MPTES改善了他们的 支持有效实施干预措施的各自能力。

Substantial effort has gone into developing and scientifically testing HIV prevention interventions, but these interventions do not affect the spread of the epidemic unless they are implemented effectively at community- based organizations (CBOs). Unfortunately, there has been little research examining how to successfully nhance the implementation of evidence-based interventions by CBOs. We spent many years developing and testing the efficacy of a community-level, HIV prevention intervention program for young gay/bisexual men, a group at high risk for HIV, called the Mpowerment Project. More recently we have been conducting a largely descriptive, qualitative prospective study of how 73 CBOs strive to implement the Mpowerment Project. We have also developed and have been providing a system of materials, training, and technical assistance (the Mpowerment Project Technology Exchange System, or MPTES) to help CBOs implement the intervention with fidelity to the original model. We have found that: (1) There is considerable variability, both between CBOs and within CBOs over time, in their implementation of the Mpowerment Project; (2) Issues at the organizational systems level play a substantially larger role in implementation effectiveness than we had anticipated; (3) Processes outside of the CBO (e.g., funder and community issues) often conflict with implementation of an innovative intervention; and (4) MPTES enhancements are required in order to be responsive to the ecology of barriers/facilitators to implementation that exist at multiple levels. Building on these findings, we have developed a conceptual model of implementation effectiveness that summarizes how complex systems, both internal and external to the organization, influence implementation effectiveness. We propose to conduct a prospective study of 80 CBOs that are striving to implement the Mpowerment Project, and, through quantitative methods, will test the model. Each CBO will be assessed at 4 time-points over two years, through online self-administered questionnaires and via telephone-administered surveys about the implementation of the intervention. We will also develop and implement an enhanced MPTES that addresses the potentially mutable variables in our conceputal model, and examine how utilization of the enhanced MPTES by CBO front-line staff, supervisors, Executive Directors, and funders improves their respective capacities to support effective implementation of the intervention.