Establishment and Evaluation of a Large Contact-Tracing and Case Investigation Virtual Training Academy.

During the COVID-19 pandemic, the Virtual Training Academy (VTA) was established to rapidly develop a contact-tracing workforce for California. Through June 2021, more than 10 000 trainees enrolled in a contact-tracing or case investigation course at the VTA. To evaluate program effectiveness, we analyzed trainee pre- and postassessment results using the Wilcoxon signed-rank test. There was a statistically significant (P < .001) improvement in knowledge and self-perceived skills after course completion, indicating success in training a competent contact-tracing workforce. (Am J Public Health. 2021;111(11):1934-1938. https://doi.org/10.2105/AJPH.2021.306468).

California's COVID-19 Virtual Training Academy: Rapid Scale-Up of a Statewide Contact Tracing and Case Investigation Workforce Training Program.

Case investigation (CI) and contact tracing (CT) are key to containing the COVID-19 pandemic. Widespread community transmission necessitates a large, diverse workforce with specialized knowledge and skills. The University of California, San Francisco and Los Angeles partnered with the California Department of Public Health to rapidly mobilize and train a CI/CT workforce. In April through August 2020, a team of public health practitioners and health educators constructed a training program to enable learners from diverse backgrounds to quickly acquire the competencies necessary to function effectively as CIs and CTs. Between April 27 and May 5, the team undertook a curriculum design sprint by performing a needs assessment, determining relevant goals and objectives, and developing content. The initial four-day curriculum consisted of 13 hours of synchronous live web meetings and 7 hours of asynchronous, self-directed study. Educational content emphasized the principles of COVID-19 exposure, infectious period, isolation and quarantine guidelines and the importance of prevention and control interventions. A priority was equipping learners with skills in rapport building and health coaching through facilitated web-based small group skill development sessions. The training was piloted among 31 learners and subsequently expanded to an average weekly audience of 520 persons statewide starting May 7, reaching 7,499 unique enrollees by August 31. Capacity to scale and sustain the training program was afforded by the UCLA Extension Canvas learning management system. Repeated iteration of content and format was undertaken based on feedback from learners, facilitators, and public health and community-based partners. It is feasible to rapidly train and deploy a large workforce to perform CI and CT. Interactive skills-based training with opportunity for practice and feedback are essential to develop independent, high-performing CIs and CTs. Rigorous evaluation will continue to monitor quality measures to improve the training experience and outcomes.

Use of effective training and quality assurance strategies is associated with high-fidelity EBI implementation in practice settings: a case analysis.

High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.

The National Network of Sexually Transmitted Disease Clinical Prevention Training Centers Turns 40-A Look Back, a Look Ahead.

Since 1979, the National Network of Sexually Transmitted Disease (STD) Clinical Prevention Training Centers (NNPTC) has provided state-of-the-art clinical and laboratory training for STD prevention across the United States. This article provides an overview of the history and activities of the NNPTC from its inception to present day, and emphasizes the important role the network continues to play in maintaining a high-quality STD clinical workforce. Over time, the NNPTC has responded to changing STD epidemiological patterns, technological advances, and increasing private-sector care-seeking for STDs. Its current structure of integrated regional and national training centers allows NNPTC members to provide dynamic, tailored responses to STD training needs across the country.

Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity.

The economic downturn of 2007 created significant fiscal losses for public and private agencies conducting behavioral prevention. Such macro-economic changes may influence program implementation and sustainability. We examined how public and private agencies conducting RESPECT, a brief HIV/STI (sexually transmitted infection) counseling and testing intervention, adapted to fiscal loss and how these adaptations impacted program fidelity. We collected qualitative and quantitative data in a national sample of 15 agencies experiencing fiscal loss. Using qualitative analyses, we examined how program fidelity varied with different types of adaptations. Agencies reported three levels of adaptation: agency-level, program-level, and direct fiscal remedies. Private agencies tended to use direct fiscal remedies, which were associated with higher fidelity. Some agency-level adaptations contributed to reductions in procedural fit, leading to negative staff morale and decreased confidence in program effectiveness, which in turn, contributed to poor fidelity. Findings describe a "work stress pathway" that links program fiscal losses to poor staff morale and low program fidelity.

Implementing a brief evidence-based HIV intervention: a mixed methods examination of compliance fidelity.

Dissemination of HIV behavioral prevention programs has increased the reach of evidence-based interventions, but there is a paucity of data on implementation and diffusion. The present mixed methods study focused on RESPECT, a brief counseling and testing intervention, examining compliance fidelity and the extent to which Centers for Disease Control and Prevention (CDC) policies and training have diffused to practice settings. Using client exit surveys (N = 830) and counselor interviews (N = 64), we examined implementation in 26 community-based agencies (CBOs) and public health departments (DPHs) in the USA. Multivariate analyses showed that at-risk clients, ethnic minority clients, and those who were primarily seeking services other than HIV/STI testing, were more likely to receive the program with fidelity. Counselor data suggested that multiple factors (e.g., client characteristics, agency structure) impact program adaptations. RESPECT is being delivered with good fidelity and reaching at-risk clients. The data provide support for CDC diffusion efforts. Future studies should continue to examine compliance fidelity and program sustainability.

The influence of social determinants on evidence-based behavioral interventions-considerations for implementation in community settings.

Over the last decade, the Centers for Disease Control and Prevention's Diffusion of Effective Behavioral Interventions (DEBI) program funded several hundred community-based organizations (CBOs) and health departments in a wide-scale HIV prevention national diffusion effort. We interviewed six California agencies funded to implement one of three group-level DEBIs to identify facilitators and/or challenges to effective implementation. We identified several social and structural factors affecting community members' participation in DEBIs, including language issues, stigma associated with HIV and sexual orientation, homelessness, and incarceration. Age, class, and socioeconomic status also significantly influenced member participation and CBO implementation success. Although changing individual behaviors is the ultimate measure of behavioral intervention/DEBI success, attention must be given to the larger social and structural factors that significantly affect risk for HIV. In fact, the National HIV/AIDS Strategy recognizes these factors as major barriers to HIV prevention and has developed recommendations that address health disparities. We present short-term, intermediate, and long-term strategies addressing social determinants of health and offer suggestions for adapting DEBIs to meet the broader needs of persons prioritized for DEBIs.

Translating HIV interventions into practice: community-based organizations' experiences with the diffusion of effective behavioral interventions (DEBIs).

Efficacious behavioral interventions developed to address the spread of HIV/STIs are currently being disseminated in the USA through a national diffusion program (DEBI) spearheaded by the Centers for Disease Control and Prevention (CDC). Understanding how interventions are translated to real world settings is necessary to further scientific knowledge of this process and to facilitate future translation efforts in public health. Prior studies have begun to elucidate how agencies translate behavioral interventions into practice, but further work is needed. Guided by the ADAPT framework, we examined agencies' assessment, preparation, and implementation of interventions. Our qualitative interview-based study focused on six community-based agencies in California (United States) funded to implement three group-level HIV interventions. Findings showed considerable variation in the extent to which agencies engaged in assessment and broad-based preparation and in the ease with which agencies implemented the interventions. The findings provide insight into the process that agencies undergo in the translation of effective behavioral interventions and illustrate how agencies can inform logic models that guide translation. We also identify relevant dimensions of existing models, including the ADAPT framework and Rogers's (1995, 2005) diffusion of innovations in organizations, that have value for agencies that are translating research to practice.

Assessing community needs and agency capacity--an integral part of implementing effective evidence-based interventions.

Community-based organizations and public health departments have historically applied for and received funding to implement a variety of HIV prevention interventions, but it is unclear how they make decisions regarding which interventions to implement or whether their agency has sufficient capacity and/or resources to effectively carry them out. Assessment activities can play a valuable role in helping agencies make these decisions by providing information to better target services. Recent funding efforts supporting the Diffusion of Effective Behavioral Interventions Project and other evidence-based approaches for HIV prevention require that agencies possess basic skills to effectively conduct individual-, group-, or community-level interventions, as well as the specific activities associated with an evidence-based intervention (EBI). We examine the link among community assessment, agency capacity, and intervention effectiveness, and provide resources to better guide programs in assessing their communities and organizations in order to implement the most effective EBI.

Assessing HIV prevention provider knowledge of behavior science theory: building on existing intuitive experience.

Behavioral science theory is recommended as a basis for prevention programs, yet many STD/HIV prevention providers have little academic background in this area and see no relevance of theory to their work. This study assessed STD/HIV prevention providers' intuitive insight about behaviors. Comparisons of behavioral determinants from providers "common sense" theories with determinants identified in formal theories are made through the use of Theoretical Domains, a teaching tool designed to enhance the understanding and use of behavioral science in planning and implementing interventions. Understanding how to effectively apply behavior change concepts, combined with prevention providers' basic, intuitive knowledge can enhance understanding, communication, and skills exchange between providers and researchers. Building capacity in local communities begins with a participatory process of community members, prevention providers, and researchers working together as equal partners. Better translation of research into practice using theory-based interventions will benefit the field of STD/HIV prevention.

Theoretical domains: a heuristic for teaching behavioral theory in HIV/STD prevention courses.

The HIV/STD epidemics have broadened the need for better behavioral intervention programs and highlighted the importance of providing training in behavioral theory to frontline program practitioners. However, there is a lack of effective methods for teaching theoretical concepts to people who may not have a background in behavioral science. This article presents a solution to this challenge by introducing a new heuristic for teaching theory and for placing individual theories/models in a broader context. Using a broad framework, we identify five domains that influence behavior: risk appraisal, self-perceptions, emotions and arousal, relationships and social influence, and environmental and structural factors. Each domain is described, and a brief overview of supporting literature is provided. Following the presentation of domains, we discuss course structure and activities.