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Abstract：
High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.
摘要：
高质量实施基于证据的干预措施对于计划的有效性很重要，并且受到培训和质量保证（QA）的影响。然而,文献中的空白导致缺乏对实践环境中培训和监督的指导，特别是当程序发生重大适应时。我们检查了培训和QA与组织之间计划保真度的关系，这些组织提供了广泛传播的HIV咨询和测试EBI，其中由于新的测试技术而发生了重大调整。使用最大变化案例研究方法，我们检查了提供高保真度和低保真度计划的组织的培训和QA(机构:3=高;3=低)。我们确定了区分高保真度和低保真度机构的主题。例如,高保真机构更经常采用团队方法进行培训；证明使用有效的QA策略；利用培训和QA来识别和调整适合的问题，包括与适应相关的挑战；并了解REPECT和其他测试项目之间的区别。QA和保真度之间的关联是强烈而直接的，而训练和保真度之间的关系更为复杂。公共卫生需要高质量的培训和质量保证方法，以解决计划适合和计划适应问题。研究结果加强了使用有效QA策略的价值。未来的工作应该解决通过培训和质量保证来提高计划适应性的方法，确定一组QA策略，这些策略可以最大化程序保真度，并且可以实施，并确定低成本的补充培训方案。
