Focus on the Future: Implementation of a Brief, Evidence-Based Behavioral Intervention for African American Men Who Have Sex with Women in STD Clinic Settings

Background: Cicatelli Associates (CAI) is replicating Focus on the Future (FOF) as a CDC Prevention Research Branch-Replicating Effective Programs grantee. FOF is a brief, individual-level, single session evidence-based behavioral intervention for African American men who have sex with women (MSW) ages 18-29. A Peer Health Advisor (PHA) delivers FOF to clients reporting condom use, STD symptoms/diagnosis during an STD clinic visit. PHA provides information, motivation and skills to address condom use barriers.  FOF has been shown to increase reported condom use, decrease subsequent STD acquisition and reported number of sexual partners.

Objectives: Articulate lessons learned implementing FOF in a “real world” STD clinic setting.

Methods: (CAI) facilitated the development, delivery and piloting of FOF training curriculum and implementation materials, based on formative research, from August to October 2011 in 4 STD clinics. On-site and remote technical assistance (TA) was provided. Process measures were collected through on-site observation, key informant interviews and weekly reports from TA providers, PHAs and STD clinic staff to assess # of clients served, use of and need for adaptation of implementation materials and challenges.  

Results: PHAs were able to implement FOF with fidelity. On average, PHAs served 4 clients/day.  Reliable systems to identify eligible population can increase the number of clients served.  Securing STD staff buy-in, hiring the appropriate PHA and clearly articulated roles/responsibilities and processes for integrating the intervention into clinic flow are essential to implementation. FOF costs averaged $45,000/year.

Conclusions:  Integration of a peer-led, individual, behavioral intervention in an STD clinic setting is feasible. Training and implementation materials support implementation of FOF with fidelity.

Implications for Programs, Policy, and Research: FOF addresses the need for evidence-based behavioral interventions for African American MSW in STD clinics.  PHAs can play a role in reducing STD/HIV health disparities.  Utilizing FOF in other site types should be explored.