The dynamics of de-adoption: a case study of policy change de-adoption and replacement of an evidence-based HIV intervention

摘要

Evidence-based intervention (EBI) de–adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de–adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010–2014), but then de­adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi­structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues’ implementation framework, we developed a narrative of RESPECT implementation, delivery, and de­adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de­adoption had wide­reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de­adoption as a phase of the implementation cycle. Furthermore, EBI de­adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.