The de-implementation and persistence of low-value HIV prevention interventions in the United States: a cross-sectional study

High Impact for Whom? A Qualitative Analysis of Organization Concerns About the Transition to High-Impact Prevention Policy

HIV represents a significant health burden in the United States. In 2012, the Centers for Disease Control and Prevention (CDC) stopped recommending many once-promoted interventions as part of a shift from one HIV intervention policy, Diffusion of Effective Behavioral Interventions (DEBI), to another, High Impact Prevention (HIP). Twenty-nine staff members from 10 organizations were interviewed to explore how organizations reacted to this shift. Three major themes emerged: (1) Personal experience, community assessment, and epidemiological evidence influenced organizations' perceptions of efficacy and preference for earlier interventions. (2) Organizations were concerned that HIP interventions were not a good fit for their priority populations. (3) Organizations were frustrated with the top-down approach by the CDC prioritizing HIP interventions over earlier interventions. These results indicate that organizations continue to see value in and provide DEBI interventions. In addition, a more participatory process incorporating qualitative evidence and organizations' experiences may be necessary to achieve widespread de-implementation of DEBI interventions.

Lessons Learned from Implementing the SHIELD Intervention: A Peer Education Intervention for People Who Use Drugs

HIV prevention and care peer education interventions have demonstrated effectiveness at changing HIV risk and care behaviors among a variety of at-risk populations in different settings. However, little is known about the implementation of this type of intervention in community-based settings. Further, there is limited information available regarding the facilitators and barriers to implementing peer education interventions in community-based settings. In this study, we explore implementation facilitators, barriers, and strategies to overcome these barriers among 12 organizations that implemented the SHIELD intervention, an evidenced-based peer education intervention for people who use drugs. Guided by the Consolidated Framework for Implementation Research, we identified several facilitators and barriers at the outer, inner individuals, and intervention level of the implementation process. Future evidence-based public health programs should, in addition to addressing effectiveness, be relevant to the needs and lives of clients.

Persistence of inefficient HIV prevention interventions: a mixed-method analysis of the reasons why

Growing evidence suggests that public health organizations continue to provide inefficient interventions even when better intervention options may be available. Factors informing an organization's decision to continue providing inefficient interventions are unclear. We present an analysis of HIV service organizations to understand factors influencing organizations to continue or end interventions. Between 2017 and 2019, HIV service organizations were recruited from the Center for Disease Control and Prevention's (CDC) website gettested.org, in the 20 metropolitan areas with the highest HIV incidence. Organizations were eligible to participate if they had provided at least one of 37 HIV prevention interventions identified as inefficient by the CDC. 877 organizations were recruited, with a response rate of 66%, (n = 578). Thirty-eight percent (n = 213) of organizations met the eligibility criteria, and 188 organizations completed the survey asking about reasons for continuing or ending interventions. Funding status (41%, n = 79) and client demand for interventions (60%, n = 116) were reported as the primary driving factors why organizations continued ineffective interventions. Scientific evidence was a rarely reported reason for ending an inefficient intervention (12%, n = 23). Qualitative responses indicated interventions were continued if clients demanded interventions they found useful or if staff perceived interventions as improving client behavior and health outcomes. Conversely, interventions were ended if client demand or retention was low, not relevant to the target population or funding ended. The decision to continue or end inefficient interventions is influenced by a number of factors-most often by funding and client interest but not scientific evidence.

Better Service by Doing Less: Introducing De-implementation Research in HIV

The course of HIV research has led to a multitude of interventions to prevent and treat HIV. With the arrival of more effective interventions comes the need to end, or de-implement, less effective interventions. PURPOSE OF REVIEW: To describe the state of de-implementation research in HIV and provide a rationale for expanded research in this area. RECENT FINDINGS: Existing studies have identified a set of HIV-specific interventions appropriate for de-implementing and described the persistence of interventions that should be ended. However, to our knowledge, strategies to successfully promote appropriate de-implementation of HIV-specific interventions have not been examined. De-implementing interventions that are no longer needed is an opportunity to improve the quality and effectiveness of HIV services. Opportunities to expand this field of research abound.