Translation of the Risk Avoidance Partnership (RAP) for Drug Treatment Clinic Implementation

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Translation of the Risk Avoidance Partnership (RAP) for Drug Treatment Clinic Implementation
Research Method: Intervention Research (Translational)
Principal Investigator: Margaret R. Weeks, Ph.D.
Grant: National Institute on Drug Abuse (NIDA)1R34DA030248
Dates of Study: 2010-2013

Background
Increasing scientific literature and the NIH call for studies to test the translation of evidence-based risk reduction interventions into real-world contexts (Type II translation) in order to bridge the gap between research and practice to improve public health, and especially to reduce health disparities and inequities among disadvantaged groups. HIV, hepatitis, and other sexually-transmitted infections (STIs) remain significant threats to the health and well being of people with heroin and cocaine addictions, and have direct implications for their social networks, sex partners, and other community members.

We recently completed a community trial of the Risk Avoidance Partnership (RAP) (HIV Prevention in High-Risk Drug Use Sites: Project RAP; Longitudinal Study of the RAP Peer Intervention for HIV Prevention), a successful peer-delivered intervention designed to prevent HIV/hepatitis/STI risk among not-in-treatment drug injectors and crack users. These studies demonstrated the efficacy of RAP to diffuse prevention intervention through networks of active drug using Peer Health Advocates (PHAs), resulting in significant reduction in illicit drug use and drug-related risk behaviors among PHAs and their drug-using network members. Further, RAP intervention exposure was associated with entry into drug abuse treatment, improved attitudes toward risk reduction and health promotion, and increased drug-user empowerment and engagement in risk/harm reduction efforts in their neighborhoods/communities and with their peers. 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 goal of this 3-year translation study, is to modify RAP for use in drug treatment clinics by training clinic patients as PHAs, and to pilot test the modified intervention design. This study will lay the foundation for a subsequent study to test implementation of RAP in drug treatment clinics. ICR is partnering with Hartford Dispensary (HD) to conduct this translational intervention study.

This study is a follow-up to previous projects,HIV Prevention in High-Risk Drug Use Sites: Project RAP, and Longitudinal Study of the RAP Peer Intervention for HIV Prevention.

Project Goals and Objectives

	To 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.
	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.
	Pilot the adapted RAP-Clinic intervention in the Hartford clinics to test it for feasibility, and test all instruments and forms during the pilot.
	Manualize the modified “RAP-Clinic” intervention and finalize instruments and fidelity documentation forms.

Project Details

We will use an interactive, participatory process to adapt the original RAP model for use in drug treatment clinics (create RAP-Clinic). The full translation process will be documented to capture dynamics that affected decisions on balancing fidelity to the original design and fit to the new implementation context.

In year 1 we measured organizational readiness of the HD clinics, working with HD to develop measures to assess clinic needs (staffing, administrative, resources) before implementation of RAP in the clinic. We also assessed community context sequentially in 5 HD clinics/communities (Hartford, New Britain, Bristol, Manchester, Windham), to assess resources and conditions in the community and places patients can safely reach community drug users with peer-delivered intervention. Year 1 also included a pilot of the organizational and community readiness/context measures. We worked with HD staff to adapt the RAP PHA training curriculum and peer delivered intervention to fit implementation with clinic patients in a drug treatment clinic setting and developed measures that match the components and design of RAP-Clinic. In year 2, we pilot tested RAP-Clinic with 4 cycles of clinic patients (n=20 PHAs)in the Hartford branch clinics of the HD, including the 9-session PHA training and peer intervention delivery to their networks. Clinic patient PHAs and 2-3 of their not-in-treatment Contact Referral network members received baseline (pre-intervention) and 6-month (post-intervention) surveys on risk behaviors, RAP intervention exposure/implementation and their (ego/personal) social networks. In year 3, we will finalize all measures/forms and RAP-Clinic intervention materials, design, and implementation protocols in preparation for animplementation study.

Staff Contact:
Kristin M. Kostick, Ph.D.
Project Coordinator/Ethnographer
(860)278/2044 ext. 253

Project Staff:
ICR
Margaret R. Weeks, Ph.D.
Principle Investigator

Jianghong Li, M.D., M.S.
Co-Investigator

Chinekwu Obidoa, Ph.D.
Statistician

Hartford Dispensary
Phil Richmond
Associate Director

Maria Martinez
Project Site Coordinator

Carmen Nunez
Clinical Supervisor

Hector Cordero
PHA Training Facilitator

Maria Aguilera
PHA Training Facilitator