This document summarizes a presentation on implementing evidence-based interventions for HIV prevention. It describes how the CDC/DEBI project disseminates over 23 evidence-based interventions to community organizations through training, technical assistance, and quality assurance efforts. It outlines the DEBI model of disseminating interventions which includes developing intervention packages, training providers, and building organizational capacity. It also discusses how fidelity tools are used to evaluate proper implementation and the various technical assistance resources available to organizations.

1. Working on Program Implementation and
Fidelity: The DEBI Experience
Jonny F. Andia, Ph.D
Behavioral Scientist
2011 National HIV Prevention Conference – Atlanta, GA
August 14th – 17th 2011
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention

2. Background
• Evidence-based interventions (EBIs) are part of the National
HIV/AIDS Strategy to reduce the incidence of HIV in the U.S.
and territories.
• The CDC/DEBI project disseminates over 23 EBIs with
multiple national partners.
• Correct adoption of EBI programs, fidelity and quality
assurance (QA) are of paramount importance.

3. Purpose of the Presentation
• Describe implementation tools and quality assurance
procedures related to EBIs and other Public Health
Strategies (PHS)
• Describe the EBI dissemination process and methods
used by CBA (capacity building assistance) partners to
help implement and assess fidelity among CBOs
(community-based organizations)

4. The DEBI Project
• This project disseminates evidence-based HIV
prevention interventions into prevention practice.
• DEBI’s goal is achieved by development and
coordination of a national-level strategy providing quality
assurance related to:
– Training
– Technical assistance
– Providing national infrastructure and support for CBA
activities to state health departments and CBOs

5. DEBI Model of Dissemination, Implementation and
Fidelity*
INTERVETNION
PROGRAM
HEALTH PACKAGE DESIGN
MARKTING
STRATEGY
TRAINING
STRATEGIC
PLANING CAPACITY
BUILDING
ASSISTANCE, TA &
POLICY AND FIDELITY
INCENTIVES
EVALUATION &
QUALITY
CONTROL
* Charles Collins, et al., The diffusion of Effective Behavioral Interventions Project: Development, Implementation and
Lessons Learned. Moving Science Into Practice, AIDS Education and Prevention (SS) Vol. 18, Spl A. August 2006

6. The Intervention Package Design
• CDC develops and evaluates prototype training
materials with members of the target population and in
collaboration with original researchers to ensure transfer
of science-based technology into practice.
– Promotional videos
– Instructional videos
– Detailed protocols
– Evaluation guides, including sample evaluation tools
– Technical assistance guides
– Sample health education materials
Note: These should be living documents which may be periodically updated so
as to improve implementation.

7. Training Delivery Strategy
• A range of pedagogical methods and learning strategies
based on adult learning practices are used to transfer
science-based information to CBOs and health
departments, among them:
– Face-to-face training
– Virtual classrooms
– Web-conference technology
– Individual on-line instruction

8. Training Delivery
Institutions, organizations and individuals that partner with
CDC to disseminate EBIs:
• STD/HIV Prevention Training Centers (PTCs)
• Capacity Building Assistance (CBA) providers
• AIDS Education Training Centers (AETCs)
• The original researchers
• Danya International, Inc. and or other contractual
services

9. DEBI Training Logistics and Planning
• Activities provided by DEBI contractors (i.e., Danya
International) to plan, coordinate, support and
monitor training services and outcomes of diffusion
of EBIs

10. DEBI Training Results (26 Interventions)
Trainings From 1/1/2002 to 5/31/2011 (approximately 8 years)
# of trainings # Participants # Employees # Employees
CBOs HDs
1142 18,531 4,410 1,027
Trainings From 9/1/2010 to 6/30/2011 (8 months)
# of trainings # Participants # Employees # Employees
CBOs HDs
169 2,540 664 114

11. Capacity Building and Technical Assistance
Capacity building assistance includes training, TA, and
information and technology transfer
Types:
• CDC project officers
• CDC science application team
• CBA Request Information System (CRIS) **
• Behavioral and Social Science Volunteer Program
• Capacity building assistance organizations (CBAs)
• PTC trainers may offer phone technical assistance

12. CRIS – Technical Assistance
The CRIS system is a web-based system that can be
accessed 24 hours, 7 days a week.
Key features include:
• Monitoring and tracking TA requests
• Provides ongoing status reports and a model of
communication among the CBA provider, program
consultants, project officers and behavioral experts.
• Allows requests for additional services from other
CBA providers
• Assesses the impact and effectiveness of the TA
provision

13. Technical Assistance (CRIS) and Other Related
Trainings Events (TEC)
Technical Assistance (CRIS) for CBOs (Nov 2009 to Jun 2011)
Total TA TA for CBOs TA for EBIs EBI/PHS General
requests and PHS implementation evaluation
515 337 (65%) 166 40 44
Other related trainings/TEC (Nov 2009 to Jun 2011)
Total TEC EBI/PHS Courses on EBI/PHS General
trainings support implementation M&E evaluation
courses of EBI/PHS
302 74 (15%) 13 1 15

14. Fidelity Tools
• Fidelity tools are usually created by TA experts to
assess proper implementation of an intervention in
multiple/different conditions
• Fidelity tools are an integral part of any needs
assessment process (what is needed to maximize
efficiency during implementation)
• Issues of adaptation are identified early in the
implementation process

15. Example 1: Safety Counts Fidelity Tool - NCHP

16. Example 2: SHIELD Fidelity Tool - JSI

17. Example 3: Community PROMISE

18. Fidelity Tools Assessment Areas
• Organization (is the agency ready for the
intervention?)
• Governance (proper organizational support for the
intervention)
• Programmatic infrastructure (who is doing what in
the intervention?)
• Workforce and professional development
• Resources and support
These inputs are ‘required’ to implement an EBI!

19. Evaluation Field Guides for CBOs & HDs
STAGE 1 (MACRO) STAGE 2 (JSI) STAGE 3 (PEB)
1. SISTA 13. WILLOW 21. SHIELD
2. RAPP 14. START 22. CLEAR
3. VOICES 15. CONNECT
4. HEALTHY RELATIONSHPS 16. SIHLE
5. PROMISE 17. CRCS
6. POL 18. MIP (English & Spanish)
7. MPOWERMENT 19. PfH
8. 3MV 20. PARTNER SERVICES
9. FOCUS ON YOUTH
10. STREET SMART
11. SAFETY COUNTS
12. SISTA TO SISTA

20. Evaluation: Specialized Capacity Building Tools

21. Results/Conclusions
• Capacity building and technical assistance experts
(CDC and CBA/PTC providers) develop capacity
building tools and other fidelity tools to assess the
proper implementation of interventions
• Provision of CBA during dissemination and
implementation of EBIs is fundamental to ensure
optimal levels of fidelity and outcomes

22. Co-authors
• Juli Powers, MPH. JSI Research and Training
Institute, Inc.
• Ricky Tavares, MPH. National Community Health
Partners
• Naima Cozier, MSPH. JSI Research and Training
Institute, Inc.
• Charles Collins, Ph.D. NCHHSTP/CBB

23. Acknowledgements
• Rashad Burgess, MPH. CDC/CBB
• Aisha Gilliam, Ed.D. CDC/CBB
• Ashley Gamayo, MPH. CDC/CBB (ASPH Fellow)
• JSI Research & Training Institute, Inc.
• National Community Health Partners (NCHP)

24. Thank you!
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention