Exploring sustained implementation and fidelity of an evidence-based HIV prevention program - The importance of – and difficulty in – sustaining implementation, with fidelity, of effective HIV interventions is well recognized. Our research partnership of >20 years in The Bahamas, a country disproportionately impacted by the HIV epidemic, positions us well to explore sustainability of evidence-based interventions (EBIs) (Is the effective intervention still being delivered in schools after research-support implementation is ended? To what degree do the sustaining schools implement EBI with fidelity?) and evaluate multilevel determinants of sustainability for school-based HIV prevention program. Sustainability of EBIs has been identified as a major research priority for many years. Research on the sustainability of EBIs has been growing rapidly, but the sustainability of school-based health interventions after external funds end has been relatively unexplored. Our research will advance the field of implementation science and HIV prevention through qualitative and quantitative investigation of the processes of sustained implementation and adaptation. This effort builds on experience gained from completed research (R01HD064350) exploring factors related to fidelity of implementation of an evidence-based intervention—Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT) (“standard implementation”). The research also capitalizes on the opportunity afforded by a national implementation study (R01HD095765, 2018-2023) to evaluate theory-driven implementation strategies to increase fidelity of teacher implementation of FOYC+CImPACT in school settings (“enhanced implementation”). Our long-term goal is to develop a generalizable model for sustaining evidence-based prevention programs in school settings. This study aims to investigate the trajectories and determinants of program sustainability following the four-year implementation phase. We define sustainability as the extent to which programs maintain core elements/activities, implementation strategies, and program outcomes over time. As part of the national implementation trial in 2019-2023, 79 teachers in New Providence taught FOYC+CImPACT to four cohorts of grade-6 students (each cohort >2,000 students) in 24 public elementary schools. Teachers taught > 80% of the intervention curriculum in 2019–2023. To address the wider global questions as to what occurs (and why) after research- support delivery of an effective program in a community setting ends, we propose to conduct a two-year follow- up study among the 79 teachers, 24 school coordinators, and 12 high-performing teachers (mentors) involved in the national implementation study. The proposed time-critical study will leverage the NIH-funded decade- long implementation research to pursue the following specific aims: 1) Evaluate the sustainment of an effective HIV prevention program over two years; 2) Identify the multilevel determinants of sustainability of the school- based HIV prevention program; 3) Examine the impact of adaptation and implementation strategies on sustainability and student outcomes.
