Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting.

Bo Wang,Lynette Deveaux,Veronica Dinaj-Koci,Samiran Ghosh,Glenda Rolle,Sharon Marshall,Bonita Stanton,Sonja Lunn,Xiaoming Li,Nikkiah Forbes

doi:10.2196/14816

Abstract

BackgroundSustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs.ObjectiveThis proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time.MethodsThis study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5.ResultsIt is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023.ConclusionsThe study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy.International Registered Report Identifier (IRRID)PRR1-10.2196/14816

Highlights

BackgroundDespite great progress over the past three decades in the prevention and treatment of HIV/AIDS, the global HIV epidemic remains a major cause of morbidity and mortality
Demographic groups that have not fully benefitted from the advances in controlling the epidemic will need to be reached. The blueprint for this goal is the United Nations Programme on HIV/AIDS (UNAIDS) Fast Track strategy which states that “[v]ery high levels of coverage for programmes that promote correct and consistent condom use will be needed in all types of epidemics [1].”
All decisions regarding implementation of Focus on Youth in the Caribbean (FOYC)+Caribbean Informed Parents and Children Together (CImPACT) are being made by the Bahamian Ministry of Education (MOE) and Ministry of Health (MOH), but the researchers are available for consultation at any time and will be formally involved through the regularly scheduled Fast Track School-Term Implementation Committee which has been designed to integrate and coordinate the roles of data, operations, and decision making

Summary

Introduction

BackgroundDespite great progress over the past three decades in the prevention and treatment of HIV/AIDS, the global HIV epidemic remains a major cause of morbidity and mortality. The UN and nations across the world established Sustainable Development Goals including the ambitious but achievable goal of the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS epidemic as a global threat by the year 2030. This goal requires a 90% reduction of new HIV infections. Demographic groups that have not fully benefitted from the advances in controlling the epidemic will need to be reached The blueprint for this goal is the UNAIDS Fast Track strategy which states that “[v]ery high levels of coverage for programmes that promote correct and consistent condom use will be needed in all types of epidemics [1].”. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs

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