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Using the Exploration-Preparation-Implementation-Sustainment (EPIS) Framework to prepare for the implementation of evidence-based practices into adolescent HIV settings

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Abstract

Despite advances in evidence-based practices (EBP) to support HIV prevention and treatment, youth ages 13–24 experience significant disparities in HIV risk and outcomes. An important factor in this disparity is poor EBP implementation, yet implementation research is limited, particularly in youth-serving settings. This study used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide the implementation of four Motivational Interviewing (MI) and MI-framed interventions into youth-serving HIV prevention and treatment settings. Key stakeholders (n = 153) across 13 sites completed pre-implementation interviews. Stakeholders’ comments identified two critical factors for effective implementation: fit with the patient population and provider receptivity, including concerns about scope of practice, buy-in, and time. Stakeholders recommended strategies for structuring training, fidelity monitoring, and facilitating implementation including engaging informal leaders, collaboratively developing the implementation strategy, and site-wide implementation. Results highlight the importance of pre-implementation contextual assessment and strategic planning for identifying provider concerns and developing responsive implementation strategies.

RESUMEN

A pesar de los avances en las prácticas basadas en evidencia (EBP, por sus siglas en inglés) para apoyar la prevención y el tratamiento del VIH, los jóvenes de 13 a 24 años atraviesan disparidades significativas en el riesgo y los desenlaces del VIH. Un factor importante en esta disparidad es la implementación deficiente de las EBP, aunque la investigación sobre la implementación es limitada, particularmente en entornos que atienden a jóvenes. Este estudio utilizó el marco de Exploración, Preparación, Implementación, Mantenimiento (EPIS) para guiar la implementación de cuatro entrevistas motivacionales (MI) e intervenciones enmarcadas en MI en entornos de prevención y tratamiento del VIH que atienden a jóvenes. Las partes interesadas clave (n = 153) en 13 sitios completaron las entrevistas previas a la implementación. Los comentarios de las partes interesadas identificaron dos factores críticos para una implementación efectiva: idoneidad para la población de pacientes y receptividad de los proveedores, incluidas las preocupaciones sobre el alcance de la práctica, la aceptación y el tiempo. Las partes interesadas recomendaron estrategias para estructurar la capacitación, monitorear la fidelidad, y facilitar la implementación, incluyendo la participación de líderes informales, el desarrollo colaborativo de la estrategia de implementación y la implementación en todo el sitio. Los resultados destacan la importancia de la evaluación contextual previa a la implementación y la planificación estratégica para identificar las preocupaciones de los proveedores y desarrollar estrategias de implementación que respondan a ellas.

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Data Availability

N/A.

Code Availability

Not applicable.

Notes

  1. Stakeholders with the same role identification are numbered in order of appearance in the manuscript

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Acknowledgements

The EPIS project (ATN 153; MPI: Carcone and Coyle) was supported by the NIH Adolescent Medicine Trials Network for HIV/AIDS Interventions as part of the Scale It Up Program (U19HD089875, Naar PI). Dr. Aarons was supported by NIMH grant R03MH117493 and NIDA grants R01DA049891 and R01DA038466. The content presented here is solely the responsibility of the authors and does not represent the official views of the funding agencies. The authors would like to thank Sonia Lee, Jessica De Leon, Monique Green-Jones, Lindsey McCracken, Amy Pennar, Bonita Stanton, Regina Firpo-Triplett, Sitaji Gurung, Rafael Dilones, Daniel Szymczyk, Doug Keeler, Jesse Bradford-Rogers, Patrick George, Christopher Boutelle, Jonathan Marmo, Steven Samrock, Emily Capote, Tina Koo, S. Scott Jones, and Demetria Cain for their contributions and support of the EPIS project.

Funding

The EPIS project (ATN 153; MPI: Carcone and Coyle) was supported by the NIH Adolescent Medicine Trials Network for HIV/AIDS Interventions as part of the Scale It Up Program (U19HD089875, Naar PI). Dr. Aarons was supported by NIMH grant R03MH117493 and NIDA grants R01DA049891 and R01DA038466. The content presented here is solely the responsibility of the authors and does not represent the official views of the funding agencies.

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Authors and Affiliations

  1. Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, United States

    April Idalski Carcone

  2. Education, Training, and Research (ETR), Scotts Valley, California, United States

    Karin Coyle

  3. Center for Translational Behavioral Science, Florida State University, Tallahassee, Florida, United States

    Seyram Butame & Sylvie Naar

  4. Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, United States

    Gary W. Harper

  5. ACTRI Dissemination and Implementation Science Center, University of California, San Diego, La Jolla, California, United States

    Gregory A. Aarons

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  1. April Idalski Carcone
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  2. Karin Coyle
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  3. Seyram Butame
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  5. Gregory A. Aarons
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Contributions

April Idalski Carcone, EPIS Project study co-lead, conceived of the research question for this paper, oversaw data coding, conducted all data analyses and interpretation, and wrote the initial draft of the manuscript. Karin Coyle, EPIS Project study co-lead, assisted with data interpretation, read manuscript drafts, and provided feedback. Seyram Butame coded data, read manuscript drafts, and provided feedback. Gary W. Harper read manuscript drafts and provided feedback. Gregory A, Aarons is co-developer of the EPIS framework and consulted on the EPIS Project study conceptualization, read and edited manuscript drafts, and provided feedback. Sylvie Naar, Scale It Up Study Principal Investigator, read manuscript drafts and provided feedback.

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Carcone, A.I., Coyle, K., Butame, S. et al. Using the Exploration-Preparation-Implementation-Sustainment (EPIS) Framework to prepare for the implementation of evidence-based practices into adolescent HIV settings. AIDS Behav 26, 4093–4106 (2022). https://doi.org/10.1007/s10461-022-03735-0

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