Funder: National Institute on Drug Abuse
Project period: 09/15/2010 - 08/31/2013
Grant Type: Research
This is a three-year study entitled, Translation of the Risk Avoidance Partnership (RAP) for Drug Treatment Clinic Implementation, which uses the R34 mechanism for Pilot and Feasibility Studies in Preparation for Drug Abuse Prevention Trials. The purpose of this study is to translate the Risk Avoidance Partnership (RAP), an efficacious community intervention designed to diffuse HIV/hepatitis/STI risk reduction through drug-user networks, for use in drug treatment clinics. Strong evidence of the project's efficacy when tested in a community research setting suggests the importance and timeliness of moving it to real-world applications. The Institute for Community Research, which developed and tested the original RAP intervention, and the Hartford Dispensary, a drug-abuse treatment clinic, are partnering to translate RAP for implementation in community drug treatment clinics, while adhering to the theoretically and empirically identified core components of the RAP model, and to pilot it in one of the Dispensary clinics. In doing so, we seek to understand how the RAP intervention needs to be modified to fit the clinic context, while retaining sufficient integrity and fidelity in relation to the original design such that it potentially will achieve the same or similar outcomes among PHA trainees and their contacts, and to learn what happens when it is piloted in the clinic setting. We also seek to develop needed pre-implementation measures of clinic and community readiness and context to prepare for implementing the intervention, as well as process and fidelity measures specific to the adapted RAP-Clinic design for use when implementing the intervention. Thus, the aims of the study are to: 1. Develop and pilot pre-implementation measures to assess: a) "organizational readiness/context" of the clinics theorized to influence RAP-Clinic implementation process, outcomes, and sustainability; and b) "community context" expected to affect RAP-Clinic peer intervention implementation and diffusion. 2. Using a participatory process with HD staff and patients, a) create RAP-Clinic by modifying RAP to "fit" the clinic context while maintaining initially tested and identified RAP core components; b) develop a capacity building Training of Trainers to implement the revised design; and c) develop implementation tracking measures, including process and "fidelity" tracking forms for use during RAP-Clinic implementation. 3. Pilot the adapted RAP-Clinic intervention for feasibility and test all instruments and forms during the pilot. 4. Manualize the modified "RAP-Clinic" intervention and finalize instruments and fidelity documentation forms. Aims 1 and 2 will be conducted in years 1-2, Aim 3 in years 2-3, and Aim 4 in year 3. The development and testing of pre- and post-implementation measures (Aim 1) will be conducted in 5 of the HD branch clinics: Hartford, New Britain, Bristol, Manchester, and Windham, to allow adequate variation in clinic and community conditions and a sufficient number of staff to be interviewed for instrument development and testing. We will conduct the pilot (Aim 3) only in the Hartford branch clinic in order to avoid contamination of any of the other settings, should we choose to use them for a full RAP-Clinic test in a subsequent study. This study uses mixed qualitative (in-depth interviews, focus groups, field observations, community mapping, pilot intervention observations) and quantitative (clinic and community survey assessments, pre/post-intervention risk behavioral and social network surveys of pilot participants and their network contact referrals) to assess clinic and community characteristics relevant to intervention implementation and for process and fidelity documentation and pilot intervention outcome measures to estimate effect sizes of key outcomes. If RAP-Clinic is indicated as feasible and potentially efficacious, we will use findings and materials from this study as the foundation to conduct a full test of RAP-Clinic in a subsequent efficacy and/or services research implementation study. PUBLIC HEALTH RELEVANCE: The proposed study will translate an efficacious peer-delivered HIV prevention intervention (RAP) originally tested with active drug users in a community research setting, and to pilot it for use in drug treatment clinic settings in order to train clinic patients as Peer Health Advocates. If the pilot is successful, the translated RAP- Clinic intervention will be ready for a larger implementation test in multiple clinical settings. This proposal responds to the need for more available evidence-based interventions in real-world settings to reduce HIV risks and harms among high risk drug-using groups.