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

AIDS and Behavior volume 25, pages 3472–3481 (2021)Cite this article

Abstract

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.

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Availability of Data and Material (Data Transparency)

Data (i.e. instruments and transcripts) are available from the PI (Melissa Davey-Rothwell).

Code Availability

We used MAXQDA to analyze the qualitative data. The codebook is available from the PI (Melissa Davey-Rothwell).

References

  1. Davey-Rothwell MA, Tobin K, Yang C, Sun CJ, Latkin CA. Results of a randomized controlled trial of a peer mentor HIV/STI prevention intervention for women over an 18 month follow-up. AIDS Behav. 2011;15(8):1654–63.

    PubMed  PubMed Central  Article  Google Scholar 

  2. Tobin K, Davey-Rothwell MA, Nonyane BA, Knowlton A, Wissow L, Latkin CA. RCT of an integrated CBT-HIV intervention on depressive symptoms and HIV risk. PLoS ONE. 2017;12(12):e0187180.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  3. Garfein RS, Golub ET, Greenberg AE, Hagan H, Hanson DL, Hudson SM, et al. A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users. AIDS. 2007;21(14):1923–32.

    PubMed  Article  PubMed Central  Google Scholar 

  4. Purcell DW, Latka MH, Metsch LR, Latkin CA, Gomez CA, Mizuno Y, et al. Results from a randomized controlled trial of a peer-mentoring intervention to reduce HIV transmission and increase access to care and adherence to HIV medications among HIV-seropositive injection drug users. J Acquir Immune Defic Syndr. 2007;46(Suppl 2):S35-47.

    PubMed  Article  PubMed Central  Google Scholar 

  5. Latkin CA, Davey-Rothwell MA, Knowlton AR, Alexander KA, Williams CT, Boodram B. Social network approaches to recruitment, HIV prevention, medical care, and medication adherence. J Acquir Immune Defic Syndr. 2013;63(Suppl 1):S54–8.

    PubMed  PubMed Central  Article  Google Scholar 

  6. Knowlton A, Hua W, Latkin C. Social support networks and medical service use among HIV-positive injection drug users: implications to intervention. AIDS Care. 2005;17(4):479–92.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  7. Simoni JM, Nelson KM, Franks JC, Yard SS, Lehavot K. Are peer interventions for HIV efficacious? A systematic review. AIDS Behav. 2011;15(8):1589–95.

    PubMed  PubMed Central  Article  Google Scholar 

  8. DiFranceisco W, Kelly JA, Otto-Salaj L, McAuliffe TL, Somlai AM, Hackl K, et al. Factors influencing attitudes within AIDS service organizations toward the use of research-based HIV prevention interventions. AIDS Educ Prev. 1999;11:72–86.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Lankenau SE, Sanders B, Hathazi D, Jackson BJ. Recruiting and retaining mobile young injection drug users in a longitudinal study. Subst Use Misuse. 2010;45(5):684–99.

    PubMed  PubMed Central  Article  Google Scholar 

  10. Seffrin B, Panzano PC, Roth D. What gets noticed: how barrier and facilitator perceptions relate to the adoption and implementation of innovative mental health practices. Community Ment Health J. 2009;45(4):260–9.

    PubMed  Article  PubMed Central  Google Scholar 

  11. Addison D, Baim-Lance A, Suchman L, Katz B, Swain C, Piersanti K, et al. Factors influencing the successful implementation of HIV linkage and retention interventions in healthcare agencies across New York State. AIDS Behav. 2019;23(1):105–14.

    PubMed  Article  PubMed Central  Google Scholar 

  12. Chen JC, Goetz MB, Feld JE, Taylor A, Anaya H, Burgess J, et al. A provider participatory implementation model for HIV testing in an ED. Am J Emerg Med. 2011;29(4):418–26.

  13. Orchard J, Li J, Gallagher R, Freedman B, Lowres N, Neubeck L. Uptake of a primary care atrial fibrillation screening program (AF-SMART): a realist evaluation of implementation in metropolitan and rural general practice. BMC Fam Pract. 2019;20(1):170.

    PubMed  PubMed Central  Article  Google Scholar 

  14. Pinto RM, Witte SS, Filippone PL, Choi CJ, Wall M. Policy interventions shaping HIV prevention: providers’ active role in the HIV continuum of care. Health Educ Behav. 2018;45(5):714–22.

    PubMed  Article  PubMed Central  Google Scholar 

  15. Pinto RM, Witte SS, Filippone PL, Baird KL, Whitman WR. Factors that influence linkages to HIV continuum of care services: implications for multi-level interventions. Int J Environ Res Public Health. 2017;14(11):1355.

    PubMed Central  Article  PubMed  Google Scholar 

  16. Castro FG, Barrera M, Martinez CR. The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit. Prev Sci. 2004;5(1):41–5.

    PubMed  Article  Google Scholar 

  17. Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health. 2011;33(3):412–21.

    CAS  Article  Google Scholar 

  18. Veniegas RC, Kao UH, Rosales R, Arellanes M. HIV prevention technology transfer: challenges and strategies in the real world. Am J Public Health. 2009;99(S1):S124–30.

    PubMed  PubMed Central  Article  Google Scholar 

  19. Latkin CA, Sherman S, Knowlton A. HIV prevention among drug users: outcome of a network-oriented peer outreach intervention. Health Psychol. 2003;22(4):332.

    PubMed  Article  Google Scholar 

  20. CDC. Replicating effective programs. 2019; Available at: https://www.cdc.gov/hiv/research/interventionresearch/rep/index.html. Accessed 12 June 2020.

  21. CDC. CDC's approach to public health—high-impact prevention (HIP). 2019; Available at: https://www.cdc.gov/nchhstp/highimpactprevention/index.html#:~:text=High%2Dimpact%20prevention%20(HIP)%20is%20a%20public%20health%20approach,reducing%20disparities%2C%20given%20available%20resources. Accessed 12 June 2020.

  22. Green-Hennessy S. Suspension of the National Registry of Evidence-Based Programs and Practices: the importance of adhering to the evidence. Subst Abuse Treat Prev Policy. 2018;13:26.

    PubMed  PubMed Central  Article  Google Scholar 

  23. Damschroder LJ, Hagedorn HJ. A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav. 2011;25(2):194.

    PubMed  Article  PubMed Central  Google Scholar 

  24. Cannon JS, Gilbert M, Ebener P, Malone PS, Reardon CM, Acosta J, et al. Influence of an implementation support intervention on barriers and facilitators to delivery of a substance use prevention program. Prev Sci. 2019;20(8):1200–10.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Cooke A, Saleem H, Hassan S, Mushi D, Mbwambo J, Lambdin B. Patient and provider perspectives on implementation barriers and facilitators of an integrated opioid treatment and HIV care intervention. Addict Sci Clin Pract. 2019;14(1):1–8.

    Article  Google Scholar 

  26. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.

    PubMed  PubMed Central  Article  Google Scholar 

  27. Dir AL, Watson DP, Zhiss M, Taylor L, Bray BC, McGuire A. Barriers impacting the POINT pragmatic trial: the unavoidable overlap between research and intervention procedures in “real-world” research. Trials. 2021;22(1):1–11.

    Article  Google Scholar 

  28. Warner G, Kervin E, Pesut B, Urquhart R, Duggleby W, Hill T. How do inner and outer settings affect implementation of a community-based innovation for older adults with a serious illness: a qualitative study. BMC Health Serv Res. 2021;21(1):1–13.

    Article  Google Scholar 

  29. Teychenne M, Apostolopoulos M, Ball K, Olander EK, Opie RS, Rosenbaum S, et al. Key stakeholder perspectives on the development and real-world implementation of a home-based physical activity program for mothers at risk of postnatal depression: a qualitative study. BMC Public Health. 2021;21(1):1–11.

    Article  Google Scholar 

  30. Sogolow E, Peersman G, Semaan S, Strouse D, Lyles CM, HIV/AIDS Prevention Research Synthesis Project Team. The HIV/AIDS Prevention Research Synthesis Project: scope, methods, and study classification results. J Acquir Immune Defic Syndr. 2002;30(Suppl 1):S15-29.

    Google Scholar 

  31. Collins C, Harshbarger C, Sawyer R, Hamdallah M. The diffusion of effective behavioral interventions project: development, implementation, and lessons learned. AIDS Educ Prev. 2006;18(supp):5–20.

    PubMed  Article  PubMed Central  Google Scholar 

  32. Dolcini MM, Gandelman AA, Vogan SA, Kong C, Leak T, King A, et al. Translating HIV interventions into practice: community-based organizations’ experiences with the diffusion of effective behavioral interventions (DEBIs). Soc Sci Med. 2010;71(10):1839–46.

    PubMed Central  Article  Google Scholar 

  33. Owczarzak J, Broaddus M, Pinkerton S. A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention. Health Educ Res. 2016;31(2):283–94.

    PubMed  PubMed Central  Article  Google Scholar 

  34. Owczarzak J, Broaddus M, Pinkerton S. Audit culture: unintended consequences of accountability practices in evidence-based programs. Am J Eval. 2016;37(3):326–43.

    PubMed  Article  PubMed Central  Google Scholar 

  35. Veniegas RC, Kao UH, Rosales R. Adapting HIV prevention evidence-based interventions in practice settings: an interview study. Implement Sci. 2009;4(1):1–9.

    Article  Google Scholar 

  36. Jeffries WL, Garrett S, Phields M, Olubajo B, Lemon E, Valdés-Salgado R, et al. Implementation of evidence-based HIV interventions for gay, bisexual, and other men who have sex with men. AIDS Behav. 2017;21(10):3000–12.

    PubMed  Article  PubMed Central  Google Scholar 

  37. Collins CB, Sapiano TN. Lessons learned from dissemination of evidence-based interventions for HIV prevention. Am J Prev Med. 2016;51(4 Suppl 2):S140–7.

  38. Dolcini MM, Davey-Rothwell MA, Singh RR, Catania JA, Gandelman A, Narayanan V, Harris J, Mckay VR. Use of effective training and quality assurance strategies is associated with high-fidelity EBI implementation in practice settings: a case analysis. Transl Behav Med. 2021;11(1):34–45.

  39. McKay VR, Combs TB, Dolcini MM, Brownson RC. The de-implementation and persistence of low-value HIV prevention interventions in the United States: a cross-sectional study. Implement Sci Commun. 2020;1(1):1–10.

    Article  Google Scholar 

  40. Cornelius T, Jones M, Merly C, Welles B, Kalichman MO, Kalichman SC. Impact of food, housing, and transportation insecurity on ART adherence: a hierarchical resources approach. AIDS Care. 2017;29(4):449–57.

    PubMed  Article  PubMed Central  Google Scholar 

  41. Pagoto SL, Spring B, Coups EJ, Mulvaney S, Coutu M, Ozakinci G. Barriers and facilitators of evidence-based practice perceived by behavioral science health professionals. J Clin Psychol. 2007;63(7):695–705.

    PubMed  Article  PubMed Central  Google Scholar 

  42. Cullen L, Hanrahan K, Farrington M, Anderson R, Dimmer E, Miner R, et al. Evidence-based practice change champion program improves quality care. J Nurs Adm. 2020;50(3):128–34.

    PubMed  Article  PubMed Central  Google Scholar 

  43. Draus PJ, Siegal HA, Carlson RG, Falck RS, Wang J. Cracking the cornfields: recruiting illicit stimulant drug users in rural Ohio. Sociol Q. 2005;46(1):165–89.

    Article  Google Scholar 

  44. Havens JR, Latkin CA, Pu M, Cornelius LJ, Bishai D, Huettner S, et al. Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program. J Subst Abuse Treat. 2009;36(3):306.

    PubMed  Article  PubMed Central  Google Scholar 

  45. Batchelder A, Cockerham-Colas L, Peyser D, Reynoso S, Soloway I, Litwin A. Perceived benefits of the hepatitis C peer educators: a qualitative investigation. Harm Reduct J. 2017;14(1):67.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  46. Dolcini MM, Harper GW, Boyer CB, Pollack LM. Project ORE: a friendship-based intervention to prevent HIV/STI in urban African American adolescent females. Health Educ Behav. 2010;37(1):115–32.

    PubMed  Article  PubMed Central  Google Scholar 

  47. Rotheram-Borus MJ, Rhodes F, Desmond K, Weiss RE. Reducing HIV risks among active injection drug and crack users: the safety counts program. AIDS Behav. 2010;14(3):658–68.

    PubMed  Article  PubMed Central  Google Scholar 

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Funding

This project was supported by National Institute of Mental Health (Grant# 1K01MH096611).

Author information

Affiliations

  1. Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, MD, USA

    Melissa Davey-Rothwellh, Jill Owczarzak, Karina Collins, Karin Tobin, Frances Mitchell & Carl Latkin

  2. Oregon State University, College of Public Health and Health Sciences, School of Social and Behavioral Health Sciences, Corvallis, OR, USA

    M. Margaret Dolcini

  3. Pennsylvania State University, College of Health and Human Development, Health and Family Studies, University Park, PA, USA

    Abenea Jones

  4. Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, 2213 McElderry Street, 2nd Floor, Baltimore, MD, 21212, USA

    Melissa Davey-Rothwellh

Authors
  1. Melissa Davey-Rothwellh
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  2. Jill Owczarzak
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  3. Karina Collins
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  4. M. Margaret Dolcini
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  5. Karin Tobin
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  6. Frances Mitchell
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  7. Abenea Jones
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  8. Carl Latkin
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Contributions

MDR was the PI of the study and led the study design, analysis, and manuscript writing; JO assisted with the analysis and manuscript writing; KC assisted with the literature review and manuscript writing, MD reviewed the manuscript and provided guidance to MDR throughout the study, DM assisted with data collection, AJ reviewed the manuscript, KT reviewed the manuscript, CL reviewed the manuscript and was the PI of the SHIELD intervention.

Corresponding author

Correspondence to Melissa Davey-Rothwellh.

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Consent to Participate

All participants in the study provided verbal consent.

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All authors have reviewed this manuscript and consent to publication.

Ethical Approval

This study was reviewed and deemed exempt by the Johns Hopkins Institutional Review Board.

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Davey-Rothwellh, M., Owczarzak, J., Collins, K. et al. Lessons Learned from Implementing the SHIELD Intervention: A Peer Education Intervention for People Who Use Drugs. AIDS Behav 25, 3472–3481 (2021). https://doi.org/10.1007/s10461-021-03275-z

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  • DOI: https://doi.org/10.1007/s10461-021-03275-z

Keywords

  • Social network
  • Facilitators and barriers
  • Implementation science
  • People who use drugs