Funding reductions in HIV behavioral intervention impact program fidelity

The recent economic downturn has affected HIV behavioral prevention funding in the U.S., but data on how reductions have impacted ongoing translation of evidence-based interventions are sparse. We examined how funding reductions impact the ability of health departments (HD) and community-based organizations (CBO) to deliver behavioral evidence-based programs.

Method: Using a national database of agencies trained in RESPECT, an HIV counseling and testing program, we enrolled 30 urban and rural HDs and CBOs . We report on interviews with executive directors (n=30) and program delivery staff (n=62) addressing fiscal changes and their impact. Data from client surveys (n=808) assessed program fidelity.

Results: Analyses revealed that 57% of agencies (n=17) had declines in RESPECT funding. Agencies compensated for losses with organizational changes (e.g., reduced staff), programmatic modifications, and fiscal adjustments (e.g., redistributed funds, cut contracts). Examination of agencies evidencing programmatic fiscal decline, found that low client fidelity scores were associated with significant staff reductions and corresponding workload increases. Furthermore, staff at these agencies were more likely to report lower competence fidelity with the program. Additional qualitative analyses examined variations in program adaptations to reduce program costs and potentially enhance fidelity.

Conclusions: Funding reductions have resulted in reduced capacity to deliver behavioral interventions. Staffing disruptions and heavy workloads, a result of the economic downturn, appear to impact program fidelity. A number of strategies may be successful in addressing this situation including enhanced training, better screening of at-risk clients, and reductions in less critical program adaptations (e.g., prevention education with low risk clients).