Abstract

Maintaining program fidelity in a changing world: National sustainability of a school-based HIV intervention

Elizabeth Schieber, PhD¹, Lynette Deveaux², Lesley Cotrell, PhD ³, Xiaoming Li, PhD⁴, Stephenie Lemon, PhD¹, Maxwell Pointier², Karen MacDonell, PhD⁵, Sylvie Naar, PhD⁶, Bo Wang, PhD¹ (1)University of Massachusetts Chan Medical School, (2)The Bahamas Ministry of Health, Nassau Bahamas, (3)West Virginia University , (4)University of South Carolina Arnold School of Public Health, (5)Wayne State University School of Medicine, (6)Florida State University

APHA 2022 Annual Meeting and Expo

Background: Large-scale, evidence-based interventions face challenges to fidelity of sustained implementation. We developed implementation strategies to support teachers implementing an evidence-based, HIV prevention program in schools The Bahamas across two school years during the COVID-19 pandemic.
Methods: Data were collected from 79 Grade 6 teachers in 24 government elementary schools during the 2019-2020 and 2020-2021 school years. Teachers recorded their characteristics and perceptions as well as their adherence to the nine-session program (with 35 core activities). School coordinators and peer mentors provided teachers with implementation monitoring, feedback, and additional support.
Results: In Year 1, teachers on average taught 79.3% of the sessions and 80.8% of core activities; teachers in Year 2 covered 84.2% of sessions and 72.9% of the core activities. Teachers with high-performing school coordinators in the second year taught significantly more sessions on average (7.8 vs. 7.0, t = 2.04, P < 0.05) and more core activities (26.3 vs. 23.0, t = 2.41, P < 0.05) than teachers with “satisfactory coordinators. Teachers with “very good or “satisfactory mentors, taught more sessions than teachers without a mentor (7.9 vs 7.3; t = 2.22; P = 0.03). Linear mixed models indicated that teachers’ implementation fidelity in Year 1, confidence in execution of core activities, and school coordinators’ performance were significantly associated with Year 2 implementation fidelity.
Conclusions: Teachers maintained high fidelity of a comprehensive HIV prevention program over two years during the COVID-19 pandemic. Future program implementers should consider implementation supports to improve the sustainability of school-based programs.