“Beach Blitz”: A High Impact Prevention Strategy to Reduce New HIV Infections

State: FL Type: Model Practice Year: 2016

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Broward County is located in the southeastern portion of the State of Florida with Miami-Dade County to the south and Palm Beach County to the north.  Broward County’s 2014 population estimate of 1,869,235, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.5% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2014 population by race (Black 28.8%, Asian 3.6%, Hispanic 27.4%, other races .5%, for a total of 60.3% and White 39.7%).

The Florida Department of Health in Broward County (DOH-Broward) is the official Public Health Agency in Broward County and has been operational since 1936. It is part of the Integrated Florida Department of Health (DOH) and operates in cooperation with the Broward County Commission under Florida Statute 154. DOH-Broward’s mission is “to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts”.  DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system that includes hospitals, clinics, planning agencies, community-based organizations and others.  DOH-Broward provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining and improving health and safety within the county.


According to the United States Centers for Disease Control and Prevention (CDC) in 2013, the Fort Lauderdale Division of the Miami Metropolitan Statistical Area (MSA) has the second highest rate of new HIV infections, the fourth highest AIDS case rates in the United States. In 2014, Broward County had 19,391 people living with HIV/AIDS and ranked second in both Syphilis cases and rates in the State of Florida according to the Florida Department of Health STD surveillance data. According to the Greater Fort Lauderdale Convention and Visitors Bureau, Broward County had a record 14 million visitors in 2014 and is expected to increase to 15 million visitors in 2015. Broward County also hosts many events and parties targeted to MSM (Men who have sex with men), young adults, and other members of the lesbian, gay, bisexual and transgender (LGBT) community. The most reported mode of transmission for HIV is MSM followed by heterosexual contact. Social networks and dynamics occurring may increase the susceptibility of HIV/STD transmission. There is a need to develop effective prevention activities targeting these individuals who may be at significant risk of acquiring HIV. In 2014, DOH-Broward STD program received 204 referrals (reports) of Broward County residents named as contacts to laboratory confirmed cases of STD diagnosed in other counties or states.

The Broward Beach Blitz (BBB) Initiative aligns with goal number one of the National HIV/AIDS Strategy (NHAS), to reduce new HIV infections and had four main objectives:

1.)       To increase condom distribution for 2015 by 50% compared to the same time period during 2014.

2.)       To increase community engagement, support for and participation in the Broward>AIDS campaign.

3.)       To increase inter-agency collaboration through coordination of efforts.

4.)       To provide a model practice for the evaluation of prevention initiatives utilizing CDCs High Impact Prevention (HIP) core components.

The BBB Initiative was a collaborated effort involving eight community organizations, in addition to DOH- Broward staff, that provided comprehensive and targeted HIV prevention services through four (4) core activities: community engagement, condom distribution, HIV/STI testing, and outreach. A Monitoring and Evaluation (M&E) plan was created and implemented to determine the success and impact of this project.

All objectives were met except for one; to increase condom distribution for 2015 by 50% compared to the same time period during 2014. Condoms distributed in 2014 during February and March totaled 614,643 and for the same months in 2015, 503,840 condoms were distributed.

The BBB initiative included four (4) core activities: community engagement, condom distribution, HIV/STI testing, and outreach. The outcomes for these activities were measured by tracking following the Monitoring and Evaluation (M&E) plan created. The involvement of a variety of stakeholders and their collaboration resulted in the provision of activities for the entire target area, an increased participation in thorough data collection, which were reasons for this initiative’s success.

By increasing the condom distribution, community engagement, and inter-agency collaboration, comprehensive and targeted HIV prevention services are able to be delivered to residents and visitors of Broward County’s coastline during this late winter/early spring season will help to reduce new HIV transmission in Broward County.

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Broward County Health Department
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“Beach Blitz”: A High Impact Prevention Strategy to Reduce New HIV Infections
Broward County is located in the southeastern portion of the State of Florida with Miami-Dade County to the south and Palm Beach County to the north.  Broward County’s 2014 population estimate of 1,869,235, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.5% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2014 population by race (Black 28.8%, Asian 3.6%, Hispanic 27.4%, other races .5%, for a total of 60.3% and White 39.7%). The Florida Department of Health in Broward County (DOH-Broward) is the official Public Health Agency in Broward County and has been operational since 1936. It is part of the Integrated Florida Department of Health (DOH) and operates in cooperation with the Broward County Commission under Florida Statute 154. DOH-Broward’s mission is “to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts”.  DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system that includes hospitals, clinics, planning agencies, community-based organizations and others.  DOH-Broward provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining and improving health and safety within the county. Public health issue:  According to the United States Centers for Disease Control and Prevention (CDC) in 2013, the Fort Lauderdale Division of the Miami Metropolitan Statistical Area (MSA) has the second highest rate of new HIV infections, the fourth highest AIDS case rates in the United States. In 2014, Broward County had 19,391 people living with HIV/AIDS and ranked second in both Syphilis cases and rates in the State of Florida according to the Florida Department of Health STD surveillance data. According to the Greater Fort Lauderdale Convention and Visitors Bureau, Broward County had a record 14 million visitors in 2014 and is expected to increase to 15 million visitors in 2015. Broward County also hosts many events and parties targeted to MSM (Men who have sex with men), young adults, and other members of the lesbian, gay, bisexual and transgender (LGBT) community. The most reported mode of transmission for HIV is MSM followed by heterosexual contact. Social networks and dynamics occurring may increase the susceptibility of HIV/STD transmission. There is a need to develop effective prevention activities targeting these individuals who may be at significant risk of acquiring HIV. In 2014, DOH-Broward STD program received 204 referrals (reports) of Broward County residents named as contacts to laboratory confirmed cases of STD diagnosed in other counties or states. Goals and objectives:  The Broward Beach Blitz (BBB) Initiative aligns with goal number one of the National HIV/AIDS Strategy (NHAS), to reduce new HIV infections and had four main objectives: 1.)       To increase condom distribution for 2015 by 50% compared to the same time period during 2014. 2.)       To increase community engagement, support for and participation in the Broward>AIDS campaign. 3.)       To increase inter-agency collaboration through coordination of efforts. 4.)       To provide a model practice for the evaluation of prevention initiatives utilizing CDCs High Impact Prevention (HIP) core components. How implemented:  The BBB Initiative was a collaborated effort involving eight community organizations, in addition to DOH- Broward staff, that provided comprehensive and targeted HIV prevention services through four (4) core activities: community engagement, condom distribution, HIV/STI testing, and outreach. A Monitoring and Evaluation (M&E) plan was created and implemented to determine the success and impact of this project. Results:  All objectives were met except for one; to increase condom distribution for 2015 by 50% compared to the same time period during 2014. Condoms distributed in 2014 during February and March totaled 614,643 and for the same months in 2015, 503,840 condoms were distributed. Success of this practice?:  The BBB initiative included four (4) core activities: community engagement, condom distribution, HIV/STI testing, and outreach. The outcomes for these activities were measured by tracking following the Monitoring and Evaluation (M&E) plan created. The involvement of a variety of stakeholders and their collaboration resulted in the provision of activities for the entire target area, an increased participation in thorough data collection, which were reasons for this initiative’s success. Public Health impact:  By increasing the condom distribution, community engagement, and inter-agency collaboration, comprehensive and targeted HIV prevention services are able to be delivered to residents and visitors of Broward County’s coastline during this late winter/early spring season will help to reduce new HIV transmission in Broward County.  
According to the United States Centers for Disease Control and Prevention (CDC) in 2013, the Fort Lauderdale Division of the Miami Metropolitan Statistical Area (MSA) has the second highest rate of new HIV infections at 46.9 per 100,000 and the fourth highest AIDS case rates in the United States at 25.6 per 100,000. According to the Florida Department of Health surveillance data for 2014, in Broward County males comprised 82% of new HIV cases and 69% of new AIDS cases. Among males, Men Who Have Sex with Men (MSM) is the predominate mode of transmission. Blacks comprise 25% of the population, but 42% of the new HIV cases and 61% of the new AIDS cases in 2014. Additionally, Broward County was home to 19,391 people living with HIV/AIDS in 2014. According to the Greater Fort Lauderdale Convention and Visitors Bureau, Broward County had a record 14 million visitors in 2014 and is expected to increase to 15 million visitors in 2015. During the late winter/early spring season there is a visible increase in the residents and visitors along Broward County’s coastline in addition to copious events and parties, such as the Winter Party Festival, targeting MSM (Men who have sex with men), young adults, and other members of the LGBT community. Due to the increase in social events during this time coupled with sexually charged marketing, the potential for HIV/STI transmission will also increase. The most reported mode of transmission for HIV is MSM followed by heterosexual contact. There is a need to develop effective prevention activities targeting these individuals who may be at significant risk of acquiring HIV during this vulnerable time of the year. To reduce new HIV cases and address National HIV/AIDS Strategy (NHAS) goals, CDC recommends a High-Impact Prevention (HIP) approach. There are five components of HIP: effectiveness and cost, feasibility of full-scale implementation, coverage in the target population, interaction and targeting, and prioritization. CDC defines these components, however does not provide a clear methodology for the evaluation of prevention initiative to determine HIP criteria. There is a need to develop clear monitoring and evaluation components when designing prevention initiatives that can provide evidence of effectiveness and guide future prevention program planning.  In 2014, DOH-Broward STD program received 204 referrals (reports) of Broward County residents named as contacts to laboratory confirmed cases of STD diagnosed in other counties or states.  What is target population size?: Broward County’s 2014 population estimate of 1,869,235, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census). Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  Almost one-third, 31.5% of the residents are foreign-born. Broward County is a minority/majority county demonstrated by its 2014 population by race (Black 28.8%, Asian 3.6%, Hispanic 27.4%, other races 0.5%, for a total of 60.3% and White 39.7%). The target population of the BBB Initiative is the residents and visitors of Broward County’s coastline during the late winter/early spring season that may be at significant risk of acquiring HIV. The Greater Fort Lauderdale Convention and Visitors Bureau estimated 14 million visitors in 2014. They also estimated that number will increase by a million visitors in 2015. The BBB Initiative activities reached an estimated minimum of 2,127 in less than one week (5) business days of implementation. What percentage did you reach?: During the two (2) week implementation, a total of 21,272 condoms were distributed, 607 risk reduction education sessions conducted, 307 condom polls collected, 50 combined HIV and STI screenings, 20 new Business Response to AIDS (BRTA) partners, 8 agency collaborations, and 36 staff who volunteered a total of 119 hours. What has been done in the past to address the problem?:  In the past, prevention activities were planned based utilizing mostly anecdotal data versus data driven planning. Individual organizations also planned their HIV prevention activities separately without coordination with similar organizations in the community or DOH Prevention staff.  Monitoring and Evaluation data was generally gathered in the form of contract deliverables that may not be appropriate measures of program effectiveness. Why is current/proposed practice better?:  The BBB Initiative was a collaborated effort involving eight community organizations, in addition to DOH- Broward staff, that provided comprehensive and targeted HIV prevention services to the residents and visitors throughout Broward County’s entire Coastline during a season where there is an inherent increase in individuals concentrating along this geographic location. The increased concentration of individuals increases the quantity of social interactions, which can increase the vulnerability of HIV risk during this late winter/early spring season. This initiative was implemented through four (4) core activities: community engagement, condom distribution, HIV/STI testing, and outreach. A Monitoring and Evaluation (M&E) plan was created prior to the BBB implementation to determine the success and impact of this project by requiring data collection tools, staff training on proper data collection and close tracking of the appropriate outcomes. The M&E plan required data collection tools, staff training on proper data collection and close tracking of the appropriate outcomes. The BBI initiative also aligned with the NHAS goals and the specific activities outlined in the local jurisdictional prevention plan, including identifying condom distribution partners in the public and private sectors increase the accessibility, acceptability, and education in the use of barrier methods, i.e. male and female condoms for members of the priority populations in healthcare and non-healthcare settings, integrating condom distribution with activities such as community-level interventions to promote condom use and other risk reduction behaviors and support and participate in National HIV observance events, i.e. National Condom Week. The objectives of the BBB Initiative included increasing condom distribution, encouraging community engagement and support for the Broward> AIDS campaign, providing HIV and STI screening, and promoting interagency collaboration through coordinated efforts for prevention. The BBB Initiative evaluation is based on the five components of HIP: effectiveness and cost, feasibility of full-scale implementation, coverage in the target population, interaction and targeting, and prioritization. It uses these components to inform suggestions for scalability planning. Specifically, it offers strategies for increasing impact among target populations without increasing costs. The Broward Beach depended upon the collaboration between community, providers, and DOH-Broward in order to be successful. The involvement of a variety of stakeholders such as Healthy Mothers, Healthy Babies of Broward County Inc., The Pride Center, Latinos Salud, AIDS Health Care Foundation, Broward Community and Family Health Centers, Broward House, Care Resources, The Faith Network, community volunteers and DOH-Broward’s HIV, Hepatitis, and STD Programs was the main reason for this Initiatives success. The four core activities were able to be conducted and documented properly and completely throughout the entire target area because of the continued involvement of these stakeholders and staff. Is current practice innovative?:  The current practice is new to the field of public health. The CDC introduced the HIP initiative to address the goals of the NHAS in 2012 and HIP implementation began in January 2013. Since this time there has been limited guidance on how to conduct M&E for HIP and literature reviews show few examples of HIP evaluation for local health departments and limited published academic journals. The BBB Initiative set out to develop a methodology for the evaluation of “High Impact” prevention practices. Is current practice evidence-based? Current practice is not evidenced based.  
HIV in the U.S.
Goal(s) and objectives of practice:  The Broward Beach Blitz (BBB) Initiative aligns with goal number one of the National HIV/AIDS Strategy, to reduce new HIV infections and had three main objectives: 1.)    To increase condom distribution for 2015 by 50% compared to the same time period during 2014. 2.)    To increase community engagement, support for and participation in the Broward>AIDS campaign. 3.)    To increase inter-agency collaboration through coordination of efforts 4.)    To provide a model practice for the evaluation of prevention initiatives utilizing the HIP core components These objectives were achieved through the focus on four (4) core activities: Community engagement, condom distribution, HIV/STI testing, and outreach. The M&E plan was created and implemented to determine the success and impact of this project by first capturing the following information: 1.       Number of condoms distributed 2.       Number of outreach contacts (defined as conversations covering HIV education, HIV testing awareness, and/or Condom education) 3.       Number of businesses recruited for Business Responds to AIDS (BRTA) 4.       Number of people tested   What did you do to achieve the goals and objectives?:  The Florida Department of Health in Broward County initiated The Broward Beach Blitz, a two-phase high impact event running from February 14, 2015 through March 6, 2015. The Broward Beach Blitz is a part of the larger Broward>AIDS campaign that set out to achieve several objectives under the scope of the Broward County Jurisdictional Prevention Plan (BCJPP) and the National HIV/AIDS Strategy (NHAS). These objectives included increasing condom distribution, encouraging community engagement and support for the Broward> AIDS campaign, providing HIV and STI screening, and promoting interagency collaboration through coordinated efforts for prevention. The Broward Beach Blitz will be broken up into two phases, each with their own focus. Phase 1 is intended to accomplish its specific focus, as well as help lay the groundwork for Phase 2.   Phase 1: Time period: February 14th through February 21st (National Condom Week) 2014 Activities include: Community Engagement and Condom Distribution Activities Aim: To increase community engagement, awareness and participation in the Broward Beach Blitz   Phase 2: Time Period: February 28th – March 6th 2014 Activities include: HIV testing, STI screenings, condom polls and active outreach Aim: To commence Broward Beach Blitz activities for visitors and Broward residents   Prior to commencing the BBB Initiative, DOH-Staff met several times to discuss the project goals and objectives and develop a recruitment and delivery plan for the initiative. A brief proposal was created including the project overview, objectives, time frame, core activities, geographic assignments, evaluation plan and overall expectations from those organizations choosing to collaborate on this initiative. This proposal and a formal invitation to participate were disseminated to contracted providers and community organizations via DOH contract managers and the DOH Outreach Planning Group. Organizations who were interested in participating were invited to attend an informational meeting to discuss the details of the proposal and required meeting dates for training. Participation in the BBB Initiative required a written consent by a representative of the organization committing to the project’s goals, objectives and activities. Participation also required attendance to three (3) additional meetings that would provide guidance and training to the staff and would encourage team building and collaboration between the agencies involved.   Organizations that chose to participate were provided beach assignments where specific street intersections are encouraged. As part of the collaborative nature of this project, organizations were asked to limit their activities to the beach boundaries, which they were assigned.  However, it was encouraged that organizations communicate with each other on the findings of their community observations and on the social networks occurring throughout the time period. During Phase 1, organizations conducted community observations to identify community needs, best times and specific locations to conduct activities, and take note of social networks and interactions that could facilitate the prevention work. During Phase 1, local businesses were also informed of the initiative and asked to participate by either displaying posters about the initiative and/or serving as a condom distribution sites. Written agreements were signed by the businesses that committed to supporting the BBB initiative.    Before initiating the second phase, another meeting was held to discuss the findings, successes and challenges from phase 1 activities. Utilizing this information, recommended plans of action for phase 2 were outlined. During Phase 2, the community at large was approached by the BBB initiative participants through the provisions of HIV/STI testing, condom distribution, risk reduction education sessions, and condom polling to solicit information concerning condom knowledge attitudes and behaviors. A final meeting was held with all BBB initiative participants to collect data and information gathered and to transcribe feedback concerning the overall event and its details. This information was then analyzed and its results summarized and recommendations for the improvement of future initiatives were formulated.   After collecting and organizing qualitative and quantitative data from the Broward Beach Blitz, these data were analyzed using the framework of High Impact Prevention listed below:   1.       Effectiveness and Cost: Utilizes funds to most efficiently reduce overall rates of HIV Infection  2.       Feasibility of full-scale implementation: Interventions are practical to implement on a large scale, at reasonable cost 3.       Coverage in the target populations: Considers how many people will be reached once the activity is implemented. 4.       Interaction and targeting: Considers how interventions interact, and how they can most effectively be combined to reach the most affected populations in a given area. 5.                   Prioritization: Assesses impact of activities on HIV infection rates. Assessment allows planners to prioritize the interventions that will have the greatest overall potential to reduce infections.   Qualitative data were then organized in the following four categories, “Location and Target Population”, “Time”, “Attitudes”, and “Community Engagement & Collaboration”.   Any criteria for who was selected to receive the practice (if applicable)? Not applicable What was the timeframe for the practice The timeframe for the practice was from 2014 to 2016. Were other stakeholders involved? What was their role in the planning and implementation process? What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) One of the four goals of the BBB Initiative was to increase inter-agency collaboration through coordination of efforts which included the engagement of stakeholders. This was done by disseminating a proposal and a formal invitation to participate to contracted providers and community organizations via DOH contract managers and the DOH Outreach Planning Group. Organizations who were interested in participating were invited to attend an informational meeting to discuss the details of the proposal and required meeting dates for training. Participation in the BBB Initiative required a written consent by a representative of the organization committing to the project’s goals, objectives and activities. Participation also required attendance to three (3) additional meetings that would provide guidance and training to the staff and would encourage team building and collaboration between the agencies involved. It was encouraged that organizations communicate with each other and to DOH staff on the findings of their community observations and on the social networks occurring throughout the time period. A total of four (4) meeting were held involving all BBB initiative stakeholders to train and inform staff, discuss the findings, successes and challenges, collect data and information gathered from implementation, solicit feedback and most importantly encourage open communication between the organizations involved and DOH. The overall success of this initiative was a result of stakeholder engagement which resulted in participation of all stakeholders, well attended meetings, and a large amount of data and feedback for evaluation. The planning of the next BBB Initiative event will incorporate all the information provided by the stakeholders involved. Any start up or in-kind costs and funding services associated with this practice?  Please provide actual data, if possible.  Else, provide an estimate of start-up costs/ budget breakdown.   In kind costs were provided by the Department of Health in Broward County Prevention Program and the organizations that participated for staff time and resources. The estimated staff costs for BBB implementation was $60,747.12  
What did you find out?  To what extent were your objectives achieved?  Please re-state your objectives from the methodology section. The Broward Beach Blitz (BBB) Initiative had four main objectives: 1.)    To increase condom distribution for 2015 by 50% compared to the same time period during 2014. 2.)    To increase community engagement, support for and participation in the Broward>AIDS campaign. 3.)    To increase inter-agency collaboration through coordination of efforts 4.)    To provide a model practice for the evaluation of prevention initiatives utilizing the HIP core components A total of 21,272 condoms were distributed and 607 risk reduction education sessions conducted. A risk reduction session was comprised of one 30 second to 1 minute interaction with an individual in which educational and prevention information regarding HIV and STI's was discussed. A total of 50 combined HIV and STI screenings were conducted on site during the week. The week long effort compiled 20 new Business Response to AIDS (BRTA) partners, 8 agency collaborations, and 36 staff who volunteered a total of 119 hours. A total of 307 condom polls were completed between March 2, 2015 and March 6, 2015. The mean age of respondents was 27.7 years, most respondents were residents of the county (54.6%; visitors 43.5%). There was no significant difference between the mean age of visitors and residents (p=0.068; a=0.068). The majority of respondents felt that condoms were an effective tool at preventing the transmission of HIV and STIs (93.1%). The majority of respondents also said they enjoyed using condoms (56%), and felt that latex condoms were the best choice at preventing transmission (86%). Staff comments were collected from forms and meetings used as part of Beach Blitz program evaluation. Specifically, comments were collected from 7 Staff Calendars, 17 Outreach Activity Reports, 6 HIV Evaluation Forms, and recorded notes from the Beach Blitz debriefing meeting. There were a total of 83 staff comments. These comments were divided and coded based on four categories outlined below: Location and Target Population:  There were 28 total comments about location and target population. 54% of those comments linked location to a specific target population. Nine comments were about Hollywood Beach and a majority described the beach as having “elderly people” It was also described as “family oriented”, having “snowbirds” (tourists from Canada), and being “majority white”. There were two comments about Sebastian Beach. One person said it was “mainly MSM”. The other person stated that it had several “young adults”. There were also two comments about Las Olas Beach, and both explained that the beach had “Spring Breakers”. Other comments about location mainly discussed parking. Specifically, 21% of the comments (6 comments total) were related to beach parking. 5 out of 6 (83%) of comments about parking were negative, with a majority describing difficult parking on Hollywood Beach in particular. There was one positive comment about convenient parking on Sebastian Beach. Time :  There were 10 comments total about the time of day. 8 out of 10 (80%) of those comments indicated that times “after lunch” or between 1pm and 6pm were optimal for reaching the target population: large groups of residents and visitors, particularly students on Spring Break. 6 out of 10 responses (60%) indicated that 1-6pm was ideal on Sebastian to Las Olas Beach (the Fort Lauderdale Beaches). Responses about time of day suggest that timing is important, but it is also linked with location (Table 2). Attitudes:  There were 21 Comments total were related to attitudes. 13 of 21 comments (62%) indicated that people were receptive to receiving condoms. 2 out of 21 comments (9.5%) noted that organizations on Hollywood Beach in particular were reluctant to accept condoms. There were no other comments about negative attitudes. The following staff notes also indicate what was suggested in condom polls: “The community expressed some lack of knowledge,” and “education is very much needed.” Community Engagement & Collaboration:  There were a variety of responses related to community engagement, but the mention of police presence on the beach was a common theme. Eighteen (18) total comments were related to community engagement and collaboration. Police presence was mentioned in 35% of outreach reports (6 out of 17) indicating police and city law enforcement as a potential community partner. Three out of the four goals of this initiative were achieved. Even with a large amount of condoms distributed, there was not an increase in condom distribution during the season. Evaluation results do indicate that with strategic scale up of this initiative, more condoms could be distributed to the community. Did you evaluate your practice? o   List any primary data sources, who collected the data, and how (if applicable) o   List any secondary data sources used (if applicable) o   List performance measures used. Include process and outcome measures as appropriate. o   Describe how results were analyzed o   Were any modifications made to the practice as a result of the data findings? Quantitative and Qualitative data received from all the BBB Initiative stakeholders involved informed Beach Blitz evaluation. Quantitative data collected include statistics on the number of condoms distributed, businesses engaged, and tests conducted. In addition, condom polls (surveys distributed to beach goers) were used to collect data on demographics, condom use, and correct knowledge about condoms. Condom polls doubled as risk reduction tools, opening conversations about safe sex and gauging the HIV/STD prevention knowledge of beach goers. Qualitative data took the form of calendars, outreach activity reports, evaluation forms, and notes from a staff debriefing following the. Staff comments (both written comments on calendars and reports and recorded comments during debriefings) were compiled and transcribed onto one document.  These comments were then divided based on patterns and coded into four categories: location, time, attitudes, and community engagement. After collecting and organizing qualitative and quantitative data from the Broward Beach Blitz, these data were analyzed using the framework of High Impact Prevention listed below: 1.       Effectiveness and Cost: Utilizes funds to most efficiently reduce overall rates of HIV Infection  2.       Feasibility of full-scale implementation: Interventions are practical to implement on a large scale, at reasonable cost 3.       Coverage in the target populations: Considers how many people will be reached once the activity is implemented. 4.       Interaction and targeting: Considers how interventions interact, and how they can most effectively be combined to reach the most affected populations in a given area. 5.       Prioritization: Assesses impact of activities on HIV infection rates. Assessment allows planners to prioritize the interventions that will have the greatest overall potential to reduce infections. Prioritization: Prioritization is defined as assessing the impact of activities on HIV infection rates, and using interventions with the greatest potential to reduce new infections. The Broward Beach Blitz was planned with the goal of prioritization in mind. Specifically, Beach Blitz locations were selected based on county data, divided by zip code that indicated the number of persons living with HIV (PLWH) in particular areas. Beach locations were selected near areas with the highest numbers of PLWHA. The Beach Blitz focused on an area where there was a lack of business partners. As condom polls suggest, the Beach Blitz successfully accomplished prioritization by reaching a population in need of education. For future efforts, it is important to chart new HIV infection rates over time, especially by zip code. This will help to analyze whether our event and outreach to businesses had any impact on the overall rate of infection. Coverage in the target population: The target population of the BBB Initiative is the residents and visitors of Broward County’s coastline during the late winter/early spring season that may be at significant risk of acquiring HIV. In order to meet the goals of High Impact Prevention, the target population must be included in all aspects of intervention. Geo mapping of priority areas by zip codes indicate that the coastline areas of relatively moderate to high HIV incidence and prevalence but low HIV service provision. Therefore, making these geographic regions identified a good target for the implementation of HIV prevention initiatives. Broward County’s specific target populations concerning HIV are Black heterosexuals and MSM of all races and ethnicities.  Interaction and targeting: The interaction and targeting component of high impact prevention considers how HIV prevention interventions interact. The goal is to combine interventions effectively in a way that reaches the most at-risk populations and meets all of their needs at once. The Broward Beach Blitz focused on interaction and targeting by offering HIV/STI screenings in combination with condom distribution and risk reduction sessions. Staff at mobile testing units successfully provided 50 combined HIV/STI trainings. However, qualitative data on location and staff feedback revealed opportunities for improvement. The feedback is listed below: 1.       Use location/time/demographic data to determine target populations for testing 2.       Put testing in area with high-risk populations 3.       Hollywood beach may not be the ideal location due to parking restriction and no bathrooms 4.       Closer partnership with police and the city of Fort Lauderdale next time. 5.       Advertise testing during risk-reduction sessions; would be helpful to have a script for staff. Effectiveness and cost (described in the following section): Feasibility of full-scale implementation (Scalability) For the purpose of this evaluation, scalability was considered the most important component.  Success in each of the previously listed components of High Impact Prevention determines whether a program is strong enough to be expanded in a way that, reaches larger numbers of a priority population, using interaction and targeting to address all of their needs, and doing so in a way that is cost effective.  The lessons learned section illuminates successes and areas for improvement, and shows how the Beach Blitz can be scaled up by taking these successful components and strategies for improvement into consideration. Three out of the four BBB Initiative goals were achieved. Although large quantities of condoms were distributed, the overall distribution numbers for the county did not increase as expected as such a robust condom distribution program exists. The evaluation data does show that with strategic scale-up and planning, an even larger number of condoms can be provided to the community.  
Lessons learned in relation to practice:  Stakeholder engagement and participation were essential in the implementation at data gathering for evaluation. There should be a stronger focus on training to record data correctly and efficiently, as to include relevant information such as age, race, gender identification, sexual orientation, and geographic area the interview took place. Estimates on time spent conducting risk reduction may also be useful in recommendations for efficient risk reduction techniques. As shown with prioritization, using existing data to determine the needs of prevention activities is key. Future programs should be sure to include targeting the populations at greatest risk and informing decisions based on the needs of the community. Future implementations should continue to include information collected from volunteers regarding best time of day, locations, and responses from participants should be used in planning and decision making in future programs. Evaluation based on HIP goals provided guidance for scalability planning, with increased cost effectiveness and improved results. Evaluation suggests that certain geographic areas were optimal for risk reduction activities. Future implementation should enhance monitoring and evaluation methods for the risk reduction activities in order to collect data on both time and location of delivery in addition to more specific demographics to ensure effective prioritization and targeting. This data would also assist in identifying “peak times” at particular locations in order to mobilize staff and resources at those times and sites, and make the following BBB Initiative more efficient and effective. Condom polls and cost-effectiveness data can be used for comparison in future HIP program initiatives. Completing a cost-effectiveness analysis is helpful in determining the public health impact of prevention activities. Lessons learned in relation to partner collaboration: The overall success of this initiative was a result of stakeholder engagement which resulted in participation of all stakeholders, well attended meetings, and a large amount of data and feedback for evaluation. Having a good communication strategy to solicit participation is key to recruiting the right organizations and to engage stakeholder buy-in. A written proposal of activities was drafted and provided to stakeholders who increased their understanding of the benefit and goals of participation. Regular meetings where stakeholders were allowed to provide feedback was essential to the buy in of their commitment and to increased sense of shared responsibility which was evident by the outcomes and amount of data collected. The planning of the next BBB Initiative event will incorporate all the information provided by the stakeholders involved. Did you do a cost/benefit analysis?:As a core component of HIP cost effectiveness is a significant portion of this analysis. We used information provided from staff on their activities combined with publically available statistics on average salary of communicable disease employees and HIV/STD information. This is further explored in the cases averted section below. The BBB was found to be cost effective. The cost of implementation of a large scale program was shown to be significantly less than the cost of infection in the population. Information collected from the first implementation will be used to inform future programs. Location and times of staff could be better managed to increase efficiency in the delivery of the intervention while continuing to reduce cost. Staff may be reassigned to different geographical areas that were found to have the most need. A total of 36 staff was used to execute the event over the course of five days. Staff logged a total of 119 hours which included recruiting BRTA partners, condom distribution, testing, and risk reduction sessions. The average salary for a communicable disease, STD and HIV program representative was determined to be $29,500 (https://jobs.myflorida.com/joblist.html). The hourly wage was then multiplied by the number of hours logged by staff to indicate a total of $60,747.12 for this week long event. Materials were donated or used from existing resources and for this analysis will not be included as a cost. Cases averted Rationale: During the event a total of 21,270 condoms were distributed at an average of 10 condoms per person. (We divided 21,270 by 10 to get 2,127). We used conservative estimates (1 sexual encounter per person; i.e. multiply 2,127 by 2) to determine how many people we reached (4,254).  Next, we used the Incidence of HIV per 100,000 people in 2014 to determine cases averted.  We found that this intervention, in theory, will avert 2.4 cases of HIV. Using this model we continued the calculations for syphilis (2.4 cases averted), chlamydia (18.5 cases averted), and gonorrhea (5.3 cases averted). Data were obtained from the CDC website for the most current (2013) national case rates, and Broward County, FL case rates (2012) were obtained for the Division of Disease Control and Health Protection. All data used the cost-effectiveness analysis is publically available (http://www.cdc.gov/std/stats13/chlamydia.htm; http://www.cdc.gov/hiv/pdf/g-l/hiv_surveillance_report_vol_25.pdf ). Estimated cost of treatment:  Cost of diagnosis and treatment of HIV, syphilis, chlamydia, and gonorrhea were estimated by Chesson et al. (2004). The authors estimated the lifetime cost of HIV to be $199,800, syphilis to be $444 considering time and stage of diagnosis, chlamydia as $20 for men and $244 for women, and gonorrhea ranging from $69 to $125. Estimations were based on averages of currently available data.  Updated data from national reporting were used to estimate direct cost in 2010 dollars for each infection accordingly by Owusu-Edusei et al. (2013). Estimated lifetime costs for chlamydia were $30 in men and $364 in women (assumptions of symptoms and progression of complication due to untreated infection were included). For gonorrhea, $79 for men and $354 for women; for syphilis $709 in men and women, and HIV $297,600 for men and women. These authors estimated the total direct cost of all reportable STIs in the US was $15.6 billion in 2010. Using estimates from the literature we determined cost savings from averted cases through the BBB. Cost savings from averting chlamydial cases was $30x18.45= $553.49 in men and $364x18.45= $6,715.8 in women. The cost savings for the BBB intervention is estimated at between $500 to over $700,000 based on disease. The estimated staff cost for BBB implementation was $60,747.12, however, the estimates cost savings were between $716,897.24 - $724,508.80. This event is considered cost effective in that the cost of implementation is significantly less that the cost of the burden of disease for the Broward County area. Is there sufficient stakeholder commitment to sustain the practice? Describe sustainability plans: The overall success of this initiative was a result of stakeholder engagement which resulted in participation of all stakeholders, well attended meetings, and a large amount of data and feedback for evaluation. Having a good communication strategy to solicit participation is key to recruiting the right organizations and to engage stakeholder buy-in. A written proposal of activities was drafted and provided to stakeholders who increased their understanding of the benefit and goals of participation. Regular meetings where stakeholders were allowed to provide feedback was essential to the buy in of their commitment and increased sense of shared responsibility which was evident by the outcomes and amount of data collected. The planning of the next BBB Initiative event will incorporate all the information provided by the stakeholders involved.  The overall feedback from the stakeholders was positive and they expressed a desire to continue collaborating on future BBB Initiatives. Stakeholders will continue to be engaged utilizing the methods previously described. The estimated staff cost for BBB implementation was $60,747.12, however, the estimates cost savings were between $716,897.24 - $724,508.80.  
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