Moving a Research-based Intervention into Practice

在制定和科学测试艾滋病毒预防干预措施方面已经做出了大量努力，但这些措施 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（CBO）。不幸的是，很少有研究探讨如何成功地 加强社区组织实施循证干预措施。我们花了很多年的时间 并测试社区一级针对年轻同性恋/双性恋者的艾滋病预防干预计划的有效性 男性，一个艾滋病高危群体，被称为赋权项目。最近，我们一直在进行一项 主要是描述性的，定性的前瞻性研究，73个社区组织如何努力实施赋权 项目我们还开发并提供了一个材料、培训和技术系统， 援助（增强能力项目技术交流系统，或MPTES），以帮助社区组织实施 干预与原始模型的保真度。我们发现：（1）有相当大的可变性， 社区组织之间和社区组织内部随着时间的推移，在执行增强能力项目方面;（2） 组织系统一级的问题在执行效力方面发挥了大得多的作用 比我们预期的要多;（3）CBO之外的过程（例如，资助者和社区问题）经常发生冲突 （4）需要加强MPTES，以便 对存在于多个层面的执行障碍/促进因素的生态作出反应。基础上 根据这些发现，我们开发了一个实施有效性的概念模型， 组织内部和外部的复杂系统如何影响执行效力。 我们建议对80个正在努力实施增强能力的社区组织进行前瞻性研究 项目，并通过定量的方法，将测试模型。每个CBO将在4个时间点进行评估 两年多来，通过在线自填问卷和电话调查 关于干预的实施。我们亦会制订和推行经改良的最高收费电子服务计划， 解决了我们的概念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、主管、执行董事和资助者加强MPTES， 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.