Table 3.

Challenges and Solutions in Developing the Asian American Hepatitis B Program (AAHBP)

Challenges	Strategies to Overcome Challenges	Specific Examples and Steps Taken to Address Challenges
Creating shared vision and framework	Co-learning process Appreciating partner differences, expertise, and perspectives Consensus-building activities Mobilizing partners	Five active community-based partners representing a considerable range of expertise/ interests from various academic disciplines, each had a unique vision of how the project should unfold. Partners all participated in creating a shared vision and outlining the framework and core services of the program. The program director’s extensive experience in negotiating across cultures and agendas was key to facilitating group discussions and overcoming this challenge.
Transitioning from coalition to program	Involving all partners in AAHBP’s Steering Committee Creating a working Executive Committee Creating Subgroup Committees Centralizing the AAHBP	At the outset, decisions were made in a large group resulting in slow and cumbersome decision making. To streamline the process, smaller, more manageable task forces that included community, researchers, and clinicians with specific responsibilities were created within the coalition.
		NYU served as the lead coordinating agency, centralizing all resources that were disbursed to partners according to jointly-developed Memorandum of Understanding (MOUs). Centralizing all activities ensured consistency in program development, implementation, and reporting, as well as continuity of services. The program director was placed at NYU to coordinate all aspects of the program and serve as the liaison with the City Council and the New York City Department of Health and Mental Hygiene (New York City DOHMH).
Negotiating roles and responsibilities	Ensuring equitable budget allocations Developing MOUs that explicitly defined roles and responsibilities	Roles and responsibilities were defined through joint participation in the development and implementation of the protocols. Jointly developed MOUs outlining the nature of their responsibilities and their compensation were signed by program partners. This process ensured shared understanding of expectations and program objectives.
Recognizing the “devil in the details”	Establishing quality assurance protocols and ensuring compliance to these protocols Establishing centralized and consistent messaging of AAHBP education and communication	AAHBP activities were conducted at multi-site community-based sites all across New York City. It was critical that the program created rigorous quality assurance and program protocols before implementation. Six months of concerted planning with all partners was invested at the start of the program to identify potential challenges and barriers in all aspects of program development, from outreach, education, recruitment, screening, vaccination, referral, and treatment. A standardized implementation and quality assurance protocol was systemically created for each area. Core AAHBP staff and an external evaluator (assigned by the funder), visited each site to observe and monitor program activities and data collection.
		Although each site provided data, the core repository was centralized at NYU. AAHBP staff extensively conducted chart-reviews and data cleaning on an ongoing basis to immediately identify discrepancies and potential challenges. AAHBP program staff centrally developed all core outreach and educational messages in collaboration with input from community partners and a advertising consultants to ensure cultural and language relevance.
Balancing the tension between service and research components	Facilitating co-learning process to integrate the needs and priorities of community and service partners with academic partners Ensuring that all partners have shared access to data and equal opportunity for publication and dissemination	Two thirds of the city council funds were primarily dedicated to the service components of the AAHBP grant for vaccination, screening, and treatment costs. Academic partners felt the opportunity to amass a significant data set that captured several clinical points in time on underrepresented communities in clinical research was important, while community partners stressed the service component of the program.
		The use of CBPR principles played a critical role in balancing the tension between service and research components and goals. Strategies that addressed the challenge required a co-learning process of partners’ needs, agendas, and priorities and the recognition that all partners would participate in all areas of service and research components.
Competing tensions with the city health department and the AAHBP	Providing transparency of the program and its components to the New York City DOHMH and City Council Working with the New York City DOHMH Evaluator Ensuring that the program accomplished all of its stated deliverables and objectives	New York City DOHMH was assigned as the fiscal conduit for AAHBP. New York City DOHMH and AAHBP had differing priorities in regards to HBV prevention and treatment.
		To increase New York City DOHMH support for the program, there were ongoing meetings and discussions, in addition, AAHBP worked closely with New York City DOHMH’s external program evaluator to ensure transparency of program activities, development of core deliverables, and appropriate expenditures.