Translation & Dissemination
Connect Disseminated to CDC-Funded Community-Based Organizations Nationwide
Connect is the first relationship-based HIV/STI prevention intervention with demonstrated effectiveness in reducing sexual risk behaviors when provided to individuals or to couples together. Click on the “Introducing Connect” video for an overview of the project.
Funded by the Center for Disease Control (CDC), from 2007-2012, a team of SIG investigators led by Dr. Susan Witte packaged the Connect intervention for dissemination through the DEBI program (Diffusion of Effective Behavioral Interventions), and further translated the program into a web-based version. The translation includes a multimedia interface to assist in facilitator training with all program materials in downloadable format. Click to view a complete list of resources included in the Connect package. The team then tested whether training and implementation on the web-based version would yield higher adoption rates among 40 community-based agencies in New York State, compared to 40 agencies receiving the training and implementation on the DEBI described above. Findings will be reported at the 2012 International AIDS Conference in Washington, D.C. in July.
The Connect package is now disseminated to CDC-funded community-based organizations nationwide. See www.effectiveinterventions.org.
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HIV/STD Safer Sex Skills Groups for Women in methadone maintenance or drug-free outpatient treatment programs (CTN-0019)
Project WORTH (El-Bassel & Schilling, 1992) was recently tested in a community-based research/practice collaborative study through NIDA’s Clinical Trial Network. Dr. Susan Tross, Associate Director of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, was the principal investigator of the study. Members of SIGs Team, Dr. Lisa Cohen and Ms. Aimee Campbell were project manager and national project director.
The study tested the effectiveness of El Bassel’s and Schilling’s safer sexual skills building group intervention to reduce unprotected sexual risk behavior in sexually active women in MMTP or in drug-free outpatient treatment. Primary outcome analyses of this study, implemented in 12 community-based treatment programs, is underway.
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CTN dissemination training
The CTN Women and Trauma intervention team presented a train-the-trainer model workshop in November of 2006 for community-based clinicians who were involved in the NIDA CTN multi-site clinical trial. Led by Drs. Gloria Miele, Lisa Cohen, and Lisa Litt, clinicians were trained to train counselors in their local areas across the country to deliver either the Women’s Health Education intervention or the 12-session version of Seeking Safety used in the study. Dr. Hien presented preliminary findings from the Women and Trauma study to the attendees.
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BEST (Body Education for Trauma Survivors)
Dr. Lisa Cohen is heading a new project to develop an enhanced multimedia intervention to help women who have experienced interpersonal trauma make connections between their trauma histories, physical symptoms and health issues, identify and decrease barriers to self care related to the body and physical health, promote improved health practices and prevention, and to increase utilization of appropriate medical services. BEST is based on the Women’s Health Education intervention tested in the NIDA CTN Women and Trauma study.
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Translating Proven Interventions for Underserved and Emergent High Risk Populations (2006-2008)
This two-year program, funded by the Centers of Disease Control and Prevention (CDC), and conducted in collaboration with the Columbia Center for New Media Teaching and Learning (CCNMTL), will translate and package the Connect intervention for use in real world settings, and achieve technology transfer of the packaged intervention with two HIV services agencies in New York City. Developed and tested by SIG investigators, Connect is the first relationship-based HIV/STI prevention intervention with demonstrated effectiveness in reducing sexual risk behaviors when provided to individuals or to couples together, among a sample of HIV-negative, positive and mixed serostatus couples. It is on the CDC's Compendium of HIV Prevention Interventions with Evidence of Effectiveness, and recommended as a “best evidence” intervention for dissemination. The goal of this two year project is to achieve technology transfer with two HIV services agencies, including AIDS-Related Community Services (ARCS), and AIDS Service Center-NYC (ASC-NYC), providing educational and client services for high risk and underserved individuals infected or affected by HIV in New York State.
In collaboration with the Center for New Media Teaching and Learning (CCNMTL), SIG investigators and our community advisory board are translating and replicating the science of couple HIV prevention in real world settings. To ensure standardized and highest fidelity delivery of core intervention elements among facilitators with a range of experience, as well as to improve the capacity for future dissemination, the translation includes a multimedia interface to assist in facilitator training, with all program materials in downloadable format. The final package will include: A Starter Kit, Technical Assistance Guide, Implementation Manual, Training of Facilitator’s Curriculum, a complete DVD with the 22 videos used during facilitator training or program implementation, a marketing video, and a CD-Rom with Facilitator Training Interface, which also includes all 22 video vignettes used in training or program implementation. The Connect package will become one of the CDC DEBI’s (Diffusion of Effective Behavioral Interventions) and be widely disseminated to CDC-funded community based organizations nationwide.
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Using Multimedia Technologies to Disseminate HIV/STI Prevention for Heterosexual Couples (2007-2012)
This is a 5-year, NIMH funded, randomized clinical trial (RCT) to compare the effectiveness of disseminating a traditional, manualized package of Connect, a 6-session, relationship-based HIV/STI prevention intervention for heterosexual couples at high risk for HIV/STI transmission, versus a state of the art, multimedia, internet-based version of Connect to clients at community-based organizations (CBOs) across New York State. Recommended by the Centers for Disease Control and Prevention (CDC) as a best evidence intervention for dissemination, the Connect intervention was designed and tested by SIG investigators. For the proposed study, we are collaborating with the Columbia Center for New Media Teaching and Learning (CCNMTL) to translate the Connect sessions into an entirely internet-based version of the program called Multimedia Connect. Multimedia Connect has the same content as the Traditional version, including the original core elements, but packages both the client implementation manual and the facilitator training curriculum in an entirely computer-assisted, interactive interface. This study takes place with the active collaboration and commitment of 80 HIV services organizations from across New York State.
This study grows out of a major strategic initiative at SIG to fulfill its mission by disseminating the evidence-based interventions developed and tested back to the community-based agencies, and clients and families who need it most. This study also promises to advance prevention science by leveraging the power of new media to test the effective translation and dissemination of an evidence-based prevention intervention in real world settings.
Led by Susan Witte, the study will randomly assign 40 of the agencies to receive the Multimedia intervention and training package (Multimedia) and the other 40 to receive the original, manualized Connect intervention and training package (Traditional). The technology transfer process involves all agencies receiving two days of onsite training and two planned technical assistance conference calls, by study investigative staff, in the first two months following training. Telephone assessments completed by up to 6 staff at each agency will measure primary outcomes, mediating, moderating and process measure variables at baseline, 6, 12 and 18 months post-technology transfer. The primary outcome of the study is adoptions of the Connect intervention. The unit of analysis is the CBO.
This study is the first effectiveness study examining dissemination of a couple-based HIV prevention intervention. If successful, the prototype of Multimedia Connect may be employed for use in the prevention or treatment of an array of other mental health, health and human services-related issues in the future. The study also integrates community-based participatory research (CBPR) to assure best practice in the research-to-practice translation and implementation process and will provides new data on levels of program fidelity for traditional versus multimedia dissemination approaches.
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NAF Women’s Project: Reducing sexual risk and alcohol abuse among women in Ulaanbaatar, Mongolia (2007-2009)
In a collaboration with the National AIDS Foundation (NAF) in Ulaanbaatar, Mongolia, SIG is conducting a study to adapt and test the effectiveness of a HIV/STI sexual risk reduction intervention (HIV-SRR) combined with motivational interviewing (MI) for women with alcohol abuse histories and who engage in high risk sexual behaviors in Mongolia. This study is an extension of the comprehensive HIV and substance abuse intervention research conducted by the investigative team at SIG and will be an initiative supported by the newly established Global Health Center. Pilot work by the study investigators, PI Susan Witte, Associate Director and SIG, and co-PI, Altantsetseg Batsukh, Executive Director of NAF and a CUSSW alumnus, indicate that a number of Mongolian women engage in unprotected sex exchange transactions and that 85% of these women report harmful alcohol use, which may contribute to HIV/STI risk. NAF is the largest resource for HIV prevention capacity-building to NGOs throughout Mongolia. Funded from August 2007 until July 2009, the study will recruit 165 women from the NAF program who have a recent history of alcohol abuse and engage in high risk sexual behaviors. These women will complete informed consent, baseline assessments, and be randomized to receive one of three study treatments: 1) the combination of 4 sessions of HIV sexual risk reduction plus 2-session MI (HIV-SRR+MI); 2) a 4-session HIV-SRR alone or 3) a 4-session wellness promotion (WP-C) control condition. All women will be asked to attend their intervention sessions, and then to complete an immediate post test at the end of the last session, and two additional follow up assessments at 3 and 6 months following the last intervention session.
A substantial body of research has found associations between moderate to heavy alcohol consumption and sexual risk behaviors, however, there are few HIV intervention models for women who abuse alcohol. Further, there are several compelling public health reasons to conduct this study in Mongolia. Mongolia is centrally located in Asia, bordered by Russia and China: two countries experiencing rapidly expanding HIV epidemics. Having been economically devastated following the dismantlement of the USSR, Mongolia is experiencing a rise in internal and external migration, primarily among men in search of employment, and increasingly along migration and trade routes, unemployable women, often unmarried and with child and adult dependents, engaging in survival sex. Concurrent with escalating opportunities for risky heterosexual behaviors are mounting rates of alcoholism and sexually transmitted infections (STIs). In the general adult population in Mongolia, 51% of men and 8% of women report alcohol abuse and up to 58% of women under the age of 25 have at least one diagnosed STI. Strong evidence that unprotected sexual contact in the presence of STIs enhances the probability of HIV transmission suggests that, without urgently needed interventions, Mongolia is poised to become a significant contributor to the regional HIV epidemic.
As part of the effort to stem HIV and STI infection worldwide, SIG recognizes that Innovative adaptation, introduction and testing of low cost, targeted, empirically-validated prevention interventions, such as HIV-SRR and MI may help prevent the proliferation of HIV in Mongolia, and provide support to vulnerable populations. Evidence that alcohol use may impede relative efficacy of HIV sexual risk reduction substantiates the need for combining empirically-validated strategies, such as HIV-SRR and MI, to more effectively reduce HIV risk among alcohol-abusing populations.
This project will advance the science of HIV prevention and alcohol treatment among alcohol-abusing women engaging in high risk sexual behaviors in Mongolia and build research capacity within Mongolia for HIV/STI and alcohol-related issues.
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