title: HIV Prevention in Resource Limited Settings: A Case Study of Challenges and Opportunities for Implementation.
abstract: BACKGROUND
  Sub-Saharan Africa has the highest global prevalence of HIV, and the prevention of transmission between HIV-seropositive and -serodiscordant sexual partners is a critical component of HIV prevention efforts. Behavioral interventions that have demonstrated efficacy in reducing risk behaviors associated with HIV transmission and infection and have been translated, or adapted, to a variety of settings.
  
  
  OBJECTIVE
  This manuscript examined implementation of behavioral interventions within resource limited health care delivery settings, and their adoption and integration within service programs to achieve sustainability.
  
  
  METHODS
  The CDC/Partner Program, an evidence-based risk reduction intervention, was implemented in Community Health Centers (CHCs) in Zambia using a staged technology transfer process, the Training the Trainers Model. Provincial workshops and training workshops on the provision of the intervention were used to establish a cadre of trainers to provide on-site intervention facilitators capable of ultimately providing coverage to over 300 CHCs.
  
  
  RESULTS
  CHC staff provided the intervention to clinic attendees in four provinces over 4 years while also training new facilitators. The implementation process addressed multi-level issues within the context of training, consultants, decision making, administration, and evaluation as well as practical considerations surrounding travel, training, staff compensation and ongoing quality assurance.
  
  
  CONCLUSIONS
  The majority of challenges to implementation and maintenance were addressed and resolved, with the exception of structural limitations related to restricted resources for personnel and funding. Strengths of the program included its collaborative structure, active program leadership, commitment and support at the provincial level, the use of task shifting by existing clinic staff, the train the trainer model and ongoing quality control. Enhanced infrastructure is needed in for future implementation, such as training centers within each province, certified expert coaches and annual workshops and system changes to ensure available staff.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Suite 404A, Miami, FL, 33136, USA, djones@med.miami.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Jones
authors.forename: Stephen
authors.initials: S
authors.lastname: Weiss
authors.forename: Ndashi
authors.initials: N
authors.lastname: Chitalu
mesh_terms: D017954:Africa South of the Sahara; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007857:Leadership; D008297:Male; D040242:Risk Reduction Behavior; D012747:Sexual Partners