title: Sustainability of Evidence-Based Practices for HIV Prevention among Female Sex Workers in Mexico.
abstract: OBJECTIVE
  This study examined service provider perceptions of requirements for successful sustainment of an efficacious intervention for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico.
  
  
  METHODS
  Semi-structured interviews were conducted with 77 leaders and counselors from 12 community-based reproductive health clinics located throughout Mexico participating in a large hybrid effectiveness-implementation randomized controlled trial to scale-up the use of Mujer Segura, a psychoeducational intervention designed to promote condom use and enhance safer sex negotiation skills among FSWs.
  
  
  RESULTS
  Five sets of requirements for sustainment were identified: 1) characteristics of the provider, including competence in delivering the intervention, need for continued technical support and assistance from outside experts, and satisfaction with addressing the needs of this population; 2) characteristics of the clients (i.e., FSWs), including client need and demand for services and incentives for participation; 3) characteristics of the organization, including its mission, benefits, and operations; 4) characteristics of the outer setting, including financial support and relationship with the community-based organization's central offices, and transportation and security in areas where FSWs live and work; and 5) outcomes associated with the intervention itself, including a reduction of risk through education and increased outreach through referrals from FSWs who received the intervention.
  
  
  CONCLUSIONS
  Although the requirements for successful sustainment of interventions like Mujer Segura are consistent with the factors identified in many models of implementation, the results illustrate the importance of local context in assigning priority to these model elements and suggest that the five categories are not discrete entities but interconnected.
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA, United States of America.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Palinkas
authors.affiliation: Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States of America.
authors.forename: Claudia V
authors.initials: CV
authors.lastname: Chavarin
authors.affiliation: Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, United States of America; School of Public Health, San Diego State University, San Diego, CA, United States of America.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Rafful
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA, United States of America.
authors.forename: Mee Young
authors.initials: MY
authors.lastname: Um
authors.affiliation: Research and Evaluation Unit, Mexican Foundation for Family Planning (Mexfam), Mexico City, Mexico.
authors.forename: Doroteo V
authors.initials: DV
authors.lastname: Mendoza
authors.affiliation: Faculty of Biomedical Sciences, Autonomous University of Ciudad Juarez, Ciudad Juárez, Chihuahua, Mexico.
authors.forename: Hugo
authors.initials: H
authors.lastname: Staines
authors.affiliation: Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States of America.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
authors.affiliation: Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States of America.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000458:organization & administration; D017280:Condoms / Q000706:statistics & numerical data; D003376:Counseling; D061345:Early Medical Intervention / Q000458:organization & administration; D055317:Evidence-Based Practice; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006282:Health Personnel / Q000523:psychology*; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D008962:Models, Theoretical; D015337:Multicenter Studies as Topic; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control*; D009938:Organizations / Q000458:organization & administration*; D015397:Program Evaluation; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D034121:Reproductive Health Services / Q000458:organization & administration*; D021841:Safe Sex; D060386:Sex Workers / Q000193:education* / Q000523:psychology; D014932:Women's Health Services / Q000458:organization & administration*