Evidence-based HIV prevention in community settings: provider perspectives on evidence and effectiveness

Abstract

As part of the efforts to expand evidence-based practice (EBP) in HIV prevention at the community level, the Centers for Disease Control and Prevention (CDC) created the Diffusion of Effective Behavioral Interventions (DEBI) program. Frontline service providers, who are charged with adopting and implementing these interventions, however, have resisted and criticized the dissemination of evidence-based HIV prevention interventions. Their failure to implement the interventions with fidelity and abandonment of plans to implement interventions in which they were trained have often been discussed from the framework of ‘capacity-building’. This framework points to ‘deficits’ within community-based organizations (CBOs) that impede the uptake of EBP. This article presents the perspective of 22 frontline service providers from CBOs (n = 8) in a Midwestern state on their experiences with the DEBI program, and illustrates the reasons providers may not implement EBP. Analysis of interview responses reveals that providers cite diverse reasons – beyond organizational capacity – for lack of implementation with fidelity. Specifically, they offer critiques of the DEBI program based on the models of evidence of effectiveness on which it is based.

Keywords:

• effectiveness
• HIV prevention

Notes

Note

1. I use the term ‘EBP’, rather than the more common ‘evidence-based medicine’ (EBM), and ‘EBI’, in order to address issues common to the proliferation of evidence-based models of service delivery in a wide array of health care delivery settings, including clinical practice, public health prevention settings, and community-based service provision.