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THE SPNS MANDATE
The purpose of the Special Projects of National Significance
(SPNS) program is to advance knowledge and skills through the
support, development and evaluation of innovative models of HIV
care for financially disadvantaged and medically underserved populations.
The SPNS program, administered by the Health Resources and Services
Administration (HRSA) HIV/AIDS Bureau (HAB), is part of the Ryan
White Comprehensive AIDS Resources Emergency Act, also known as
the CARE Act.
SPNS models of innovative care for HIV-positive patients have
been designed to respond to the needs of the HIV epidemic. Currently,
it is estimated that about 650,000 to 950,000 persons are infected
with HIV and approximately 40,000 new infections occur every year
in the United States. Only about one-third of HIV-infected adults
are currently receiving regular or ongoing medical care for HIV
infection. The most affected populations are traditionally underserved
and hard-to-reach groups, particularly women, injection drug users
and their heterosexual partners, gay and bisexual men of color
and youth. HIV/AIDS is now most heavily impacting minority communities
and individuals living in poverty.
SPNS response to the epidemic began in 1991 with some of the
first Federal grants to target adolescents and women living with
HIV. Today, a portfolio of 72 grants funded either solely by the
HIV/AIDS Bureau or in partnership with other Federal agencies
addresses the cutting-edge issues in HIV care.
The SPNS program is an integral link to all CARE Act programs.
While it provides an opportunity to develop and evaluate new services,
the program places great emphasis on the dissemination of these
services. SPNS promotes the dissemination and replication of effective
models of care relevant to the present challenges of the epidemic.
These models include the integration of HIV primary care services
to the needs of individuals who present with multiple diagnoses
such as substance abuse, mental health, and other psycho-social
burdens that complicate the effective delivery of health care.
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As CARE Act grantees develop innovative services, the SPNS program
will provide the funding and technical assistance for grantees
to evaluate innovations and disseminate findings to the HIV community.
Within each multi-site SPNS initiative, grantees focus their
interventions on a specific population or treatment issue, either
by implementing components of existing interventions or designing
new models. These models are evaluated for effectiveness, efficiency,
and replicability. An important corollary is an examination of
the contextual issues that contribute to the success or failure
of an intervention in a particular setting or with a particular
population.
Evaluation of Models
The structure of most of the multi-site initiatives is designed
to collect data and evaluate interventions across sites. The projects
are grouped by type of intervention or topic (e.g., outreach,
prevention) with the guidance of an evaluation center, whose tasks
include:
· facilitating cross-site evaluation, with technical assistance
provided
· developing standardized data collection instruments
· assuring data quality
· disseminating findings
· and assessing policy implications of study findings.
Each grantee is required to participate in development of the
evaluation plan for the overall initiative and most collect uniform
data that can be analyzed and compared across programs. The SPNS
initiatives have demonstrated that collaboration for multi-site
evaluation of care programs is possible and rewarding, and that
it requires time and effort on the part of all stakeholders: the
evaluation centers, HRSA/SPNS, and the projects.
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