Replicating effective programs: HIV/AIDS prevention technology transfer.

The Centers for Disease Control and Prevention (CDC) works to prevent HIV infection in collaboration with community and state partners. CDC is identifying effective interventions from the research literature and disseminating these interventions to its prevention partners. This article presents the methods used by CDC scientists and original intervention researchers in CDC's Replicating Effective Programs (REP) project to (a) translate some HIV prevention behavioral intervention research into materials with enough detail and clarity that state and community partners can select and implement effective interventions and (b) transfer and support these technologies so that they can be implemented successfully. The experience of the REP project indicates that technology transfer is complex. Interventions need to be adapted to local circumstances. Prevention partners need written materials, training, and technical assistance. Researchers need to collaborate with prevention program providers to develop interventions that are feasible for prevention partners to conduct.

Future directions and emerging issues in technology transfer between HIV prevention researchers and community-based service providers.

The public health objective of preventing new HIV infections can be achieved only through effective information exchange among service providers, researchers, and policymakers. The potential for successful transfer of research-based HIV prevention technology to service providers will be enhanced if investigators take into account in the research planning stage how interventions will be used in the field, seek early input from community members and service providers, test variations of interventions that may increase their practicality in applied settings, and determine the cost and effectiveness of intervention delivery. Strategies are needed to ensure that the experiences of service providers help to inform the HIV prevention research agenda, improve service organization infrastructure and capacity development, and facilitate organizational networking so that providers can use new-generation HIV prevention interventions. Policies are needed to facilitate the development of intervention packages, training, and ongoing technical assistance for service providers in implementing effective HIV prevention interventions.

A technology transfer model for effective HIV/AIDS interventions: science and practice.

The widespread use of effective, science-based interventions to motivate and sustain behavior change provides an important approach to reducing the spread of HIV. The process of disseminating information about effective interventions and building capacity for implementing them in field settings must be improved, however. Starting with a review of diffusion of innovations and technology transfer literature, we offer a technology transfer model for HIV interventions. We identify participants and activities directed toward the use of effective interventions by prevention services providers (e.g., health departments and community-based organizations) in each phase of technology transfer: preimplementation, implementation, and maintenance and evolution. Preimplementation activities focus on selecting an intervention and preparing for implementation. Implementation activities include initial implementation and process evaluation. Maintenance and evolution are ongoing with continued support for and evaluation of the intervention. This article takes the perspective of providers. Other perspectives are presented elsewhere in this issue.

Strengthening HIV prevention: application of a research-to-practice framework.

As the HIV epidemic continues to affect at-risk and vulnerable populations, providers strive to improve prevention programs, in part by seeking new interventions with greater effects. Although interventions with scientific evidence of effectiveness are vital to this effort, many challenges limit access to research products. We examine key challenges and offer a framework for moving research to practice, one in which research steps are linked to practice steps and all these activities take place in a complex and dynamic environment. The Replicating Effective Programs (REP) project of the Centers for Disease Control and Prevention and other technology transfer activities illustrate the operation of this framework for HIV prevention. Further actions to improve technology transfer are called for. These include reducing time from study design to practice; learning from field-based implementations; providing guidance about fidelity to, and tailoring of, science-based interventions; improving linkages among consumers, providers, and researchers; and seeking additional resources.

Transfer of research-based HIV prevention interventions to community service providers: fidelity and adaptation.

HIV prevention research interventions usually follow protocols with specific procedures. If a community-delivered intervention uses the same procedures with the same populations as those in the original research, the behavior change effects should be similar. However, community-based providers may not replicate an intervention exactly as it was conducted in the effectiveness study. Adaptation may be needed to better meet the needs of the clients, community, or organization. We propose that interventions can be defined in terms of core elements likely to be responsible for effectiveness. These core elements cannot be changed without fundamentally changing the intervention, whereas other characteristics may be modified without altering effectiveness. HIV prevention researchers and service providers can collaborate to develop interventions that not only are effective but can also be successfully implemented by service organizations. If researchers actively involve service providers and community members in intervention planning, technology transfer goals can be better achieved.

Gender differences for non-fatal unintentional fall related injuries among older adults.

OBJECTIVES: To quantify gender differences for non-fatal unintentional fall related injuries among US adults age 65 years and older treated in hospital emergency departments (EDs). METHODS: The authors analyzed data from a nationally representative sample of ED visits for January 2001 through December 2001, available through the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). For each initial ED visit, coders record one principal diagnosis (usually the most severe) and one primary part of the body affected. RESULTS: Based on 22,560 cases, an estimated 1.64 million older adults were treated in EDs for unintentional fall injuries. Of these, approximately 1.16 million, or 70.5%, were women. Fractures, contusions/abrasions, and lacerations accounted for more than three quarters of all injuries. Rates for injury diagnoses were generally higher among women, most notably for fractures which were 2.2 times higher than for men. For all parts of the body, women's injury rates exceeded those of men. Rate ratios were greatest for injuries of the leg/foot (2.3), arm/hand (2.0), and lower trunk (2.0). The hospitalization rate for women was 1.8 times that for men. CONCLUSIONS: Among older adults, non-fatal fall related injuries disproportionately affected women. Much is known about effective fall prevention strategies. We need to refine, promote, and implement these interventions. Additional research is needed to tailor interventions for different populations and to determine gender differences in the underlying causes and/or circumstances of falls. This information is vital for developing and implementing targeted fall prevention strategies.