Implementation of a confidential helpline for men having sex with men in India.

BACKGROUND: In India, men who have sex with men (MSM) often face physical violence and harassment from police and the general society. Many MSM may not openly disclose their sexual identity, especially if they are married to women and have families. Due to pervasive stigma and discrimination, human immunodeficiency virus (HIV) prevention programs are unable to reach many MSM effectively. OBJECTIVE: The objective of this paper was to describe the design, operations, and monitoring of the Sahaay helpline, a mHealth intervention for the MSM population of India. METHODS: We established the "Sahaay" mHealth intervention in 2013; a MSM-dedicated helpline whose main goal was to increase access to comprehensive, community-based HIV prevention services and improve knowledge, attitudes, and behaviors of MSM towards HIV and sexually transmitted infections (STI) in three states of India (Chhattisgarh, Delhi, and Maharashtra). The helpline provided a 24x7 confidential and easy to use interactive voice response system (IVRS) to callers. IVRS function was monitored through an online dashboard of indicators. The system also provided real-time reporting on callers and services provided. RESULTS: The helpline received more than 100,000 calls from 39,800 callers during the first nine months of operation. The helpline maintained an operational uptime of 99.81% (6450/6462 hours); and answered more than 81.33% (83,050/102,115) of all calls. More than three-fourths of the calls came between 9:00 am-12:00 pm. The most successful promotional activity was "interpersonal communication" (reported by 70.05%, 27,880/39,800, of the callers). Nearly three-fourths of the callers self-identified as MSM, including 17.05% (6786/39,800) as rural MSM and 5.03% (2001/39,800) as a married MSM. Most callers (93.10%, 37,055/39,800) requested information, while some (27.01%, 10,750/39,800) requested counseling on HIV/acquired immune deficiency syndrome (AIDS), STIs, and other health and nonhealth issues. There were 38.97% (15,509/39,800) of the callers that were provided contacts of different HIV/AIDS referral services. Many MSM clients reported increased self-esteem in dealing with their sexual identity and disclosing the same with their family and spouse; and an increase in HIV/AIDS risk-reduction behaviors like consistent condom use and HIV testing. CONCLUSIONS: National HIV/AIDS prevention interventions for MSM in India should consider scaling-up this helpline service across the country. The helpline may serve as an important mechanism for accessing hard-to-reach MSM, and thus improving HIV prevention programing.

High school coaches' assessments, intentions to use, and use of a concussion prevention toolkit: Centers for Disease Control and Prevention's heads up: concussion in high school sports.

This study evaluated school coaches' perceptions, assessments, and use of a toolkit to prevent and manage concussions among school athletes. A computer-assisted telephone survey was conducted with a stratified, random sample of high school coaches (n = 497; response rate = 39.3%; cooperation rate = 81.5%) from five states. Most reported that they had used or planned to use kit materials. Most (81%) in schools with a written plan for preventing and managing concussions indicated that the toolkit could be used to improve it and 96% of coaches in schools without a plan indicated that the kit could be used to develop one. Most assessed the kit as visually appealing, easy to use, and containing appropriate content. There were no significant differences among coaches with differing professional experience or for sports with different injury rates. Among those with other concussion-prevention materials, most indicated greater satisfaction with the toolkit.

The diffusion of effective behavioral interventions project: development, implementation, and lessons learned.

Implementation of evidence-based HIV/STD prevention interventions can play an important role in reducing HIV and sexually transmitted diseases. This article describes the development, implementation, and lessons learned of the Diffusion of Effective Behavioral Interventions (DEBI) project, a strategy funded by the Centers for Disease Control and Prevention to diffuse evidence-based, group- and community-level HIV/STD prevention interventions to health departments and community-based organizations nationwide. The article specifically provides an overview of the rationale, description, and theoretical foundation of the project; a review of marketing efforts, including assessment of interests, needs, and capacities relative to the project; a description of project products, their purpose, approach employed to develop them, and their use by implementers; a description of the project's training coordination functions and activities; technical assistance issues; an overview of process and outcome evaluation components; new developments in response to feedback; and a discussion of future directions for DEBI. Project successes and challenges are addressed to inform future efforts to diffuse prevention interventions.

The VOICES/VOCES success story: effective strategies for training, technical assistance and community-based organization implementation.

The Centers for Disease Control and Prevention's Diffusion of Effective Behavioral Interventions (DEBI) project successfully disseminated VOICES/VOCES, a brief video-based HIV risk reduction intervention targeting African American and Latino heterosexual men and women at risk for HIV infection. Elements of the dissemination strategy included a comprehensive and user-friendly intervention kit, comprising (a) an implementationmanual and othermaterials necessary for conducting the intervention (b) a Training of Facilitators (TOF) curriculum used to teach agency staff how to implement the EBI in their setting, (c) a network of expert trainers who attend a training institute to become adept at using the TOF curriculum to train facilitators, (d) a comprehensive training coordination center to plan and deliver TOF trainings, (e) proactive technical assistance to trainers, and (f) post-TOF technical assistance for local implementers. This article reports on those strategies and a local CBO's successful participation in DEBI, resulting implementation of VOICES/VOCES, with unique approaches to adaptation and tailoring.