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Department of Population and Quantitative Health Sciences

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Community Health and Preventive Medicine | Health Services Administration | Health Services Research | Public Health Education and Promotion | Virus Diseases


BACKGROUND: Sustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs.

OBJECTIVE: This proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time.

METHODS: This study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5.

RESULTS: It is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023.

CONCLUSIONS: The study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14816. Xiaoming Li, Sharon Marshall, Glenda Rolle, Nikkiah Forbes, Bonita Stanton. Originally published in JMIR Research Protocols (, 21.08.2020.


HIV prevention, adolescent, evidence-based intervention, implementation, sustainability

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© Bo Wang, Lynette Deveaux, Sonja Lunn, Veronica Dinaj-Koci, Samiran Ghosh, Xiaoming Li, Sharon Marshall, Glenda Rolle, Nikkiah Forbes, Bonita Stanton. Originally published in JMIR Research Protocols (, 21.08.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



Wang B, Deveaux L, Lunn S, Dinaj-Koci V, Ghosh S, Li X, Marshall S, Rolle G, Forbes N, Stanton B. Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting. JMIR Res Protoc. 2020 Aug 21;9(8):e14816. doi: 10.2196/14816. PMID: 32821065; PMCID: PMC7474416. Link to article on publisher's site

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JMIR research protocols

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.