title: Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention.
abstract: BACKGROUND
  Since the scale-up of HIV/AIDS prevention evidence-based interventions (EBIs) has not been simple, it is important to examine processes that occur in the translation of the EBIs into practice that affect successful implementation. The goal of this paper is to examine facilitators and barriers to effective implementation that arose among 72 community-based organizations as they moved into practice a multilevel HIV prevention intervention EBI, the Mpowerment Project, for young gay and bisexual men.
  
  
  METHODS
  CBOs that were implementing the Mpowerment Project participated in this study and were assessed at baseline, and 6-months, 1 year, and 2 years post-baseline. Semi-structured telephone interviews were conducted separately with individuals at each CBO. Study data came from 647 semi-structured interviews and extensive notes and commentaries from technical assistance providers. Framework Analysis guided the analytic process. Barriers and facilitators to implementation was the overarching thematic framework used across all the cases in our analysis.
  
  
  RESULTS
  Thirteen themes emerged regarding factors that influence the successful implementation of the MP. These were organized into three overarching themes: HIV Prevention System Factors, Community Factors, and Intervention Factors. The entire HIV Prevention System, including coordinators, supervisors, executive directors, funders, and national HIV prevention policies, all influenced implementation success. Other Prevention System Factors that affected the effective translation of the EBI into practice include Knowledge About Intervention, Belief in the Efficacy of the Intervention, Desire to Change Existing Prevention Approach, Planning for Intervention Before Implementation, Accountability, Appropriateness of Individuals for Coordinator Positions, Evaluation of Intervention, and Organizational Stability. Community Factors included Geography and Sociopolitical Climate. Intervention Factors included Intervention Characteristics and Adaptation Issues.
  
  
  CONCLUSIONS
  The entire ecological system in which an EBI occurs affects implementation. It is imperative to focus capacity-building efforts on getting individuals at different levels of the HIV Prevention System into alignment regarding understanding and believing in the program's goals and methods. For a Prevention Support System to be maximally useful, it must address facilitators or barriers to implementation, address the right people, and use modalities to convey information that are acceptable for users of the system.
authors.affiliation: Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, , CA, USA. susan.kegeles@ucsf.edu.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kegeles
authors.affiliation: Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, , CA, USA. Greg.rebchook@ucsf.edu.
authors.forename: Gregory
authors.initials: G
authors.lastname: Rebchook
authors.affiliation: Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, , CA, USA. scott.tebbetts@ucsf.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Tebbetts
authors.affiliation: Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, San Francisco, 94158-2549, , CA, USA. emily.arnold@ucsf.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Arnold
mesh_terms: D001727:Bisexuality; D057191:Capacity Building / Q000379:methods*; D003153:Community Health Services / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods*; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016730:Program Development; D015397:Program Evaluation; D014481:United States