Maintaining Program Fidelity in a Changing World: National Implementation of a School-Based HIV Prevention Program

Area of Science:

• Public Health
• Educational Interventions
• Implementation Science

Background:

• Large-scale evidence-based interventions often struggle with consistent implementation fidelity.
• The COVID-19 pandemic presented unique challenges to delivering school-based health programs.

Purpose of the Study:

• To assess the impact of implementation strategies on teacher fidelity to the Focus on Youth in The Caribbean (FOYC) and Caribbean Informed Parents and Children Together (CImPACT) HIV prevention programs.
• To examine factors influencing program fidelity and its association with student outcomes in The Bahamas.

Main Methods:

• A quasi-experimental design involving 79 Grade 6 teachers across 24 schools.
• Teachers received training, and support was provided through school coordinators and peer mentors.
• Data collected via questionnaires and implementation records over two years.

Main Results:

• Teachers maintained high fidelity, delivering an average of 79.3% of sessions and 80.8% of core activities in Year 1, and 84.2% of sessions and 72.9% of core activities in Year 2.
• Positive perceptions of school coordinators and the presence of mentors were significantly associated with higher implementation dose.
• Teacher fidelity in Year 1, self-efficacy, and coordinator performance predicted Year 2 implementation.

Conclusions:

• Implementation strategies can support sustained high fidelity to school-based HIV prevention programs, even amid disruptions like the COVID-19 pandemic.
• School coordinators and mentors play a crucial role in successful program implementation.
• Further support is recommended to optimize the delivery of school-based programs and improve student outcomes.