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HRSA
awarded grants under its Special Projects of National
Significance program to the applicants listed
below.
Men
of Color Health Awareness Project, Inc
25 Franklin Street
Rochester, NY 14604
The
purpose of this project is to modify and adapt
comprehensive, theory based, and culturally appropriate
prevention intervention programs for use with
HIV-infected YCMSM, establish an effective outreach
program which identifies infected YCMSM and links
them into care, and increase counseling and testing
of this population. This project will adapt the
Many Men, Many Voices (3MV) curriculum for the
younger target audience they will be enrolling
and validate associated instruments; they also
propose a randomized trial of the intervention.
Finally, they will intensify outreach and co-locate
services and expand other services to enhance
outreach. The local evaluation will be conducted
by a University of Rochester School of Nursing
research team.
Intervention
- Intensified
outreach via provider presentations, case finding
and high-risk education in community settings,
presence at community events, monthly newsletter,
website, speakers bureau, and peer-led support
group
- Co-location
of CTR and referral services with intensified
outreach and MOCHA office activities Enhanced
CTR and referrals for services via a care collaborative
- Primary
care and case management via the care collaborative
- Individualized
prevention counseling with HIV+ using revised
Rochester
- STD/HIV
Behavioral Counseling (RoSHBeC) model
- Small
group level prevention intervention with HIV+
and peers using adapted 3MV curriculum
Outputs
- A
revised RoSHBeC model and a revised 3MV curriculum
- A
clearly established network with identified
responsibilities and sufficient links and capacity
to provide culturally competent comprehensive
care to HIV+
- Two
focus groups and four pilot test groups involving
48 persons to adapt 3MV
Short
Term Outcomes
- Increase
awareness in the community of purpose and goals
of MOCHA and the care collaborative
- Increase
use of website
- Increase
availability of culturally competent care and
support services
- Increase
knowledge of individual serostatus and early
identification of HIV+ clients and enrollment
into care systems at earlier disease stages
- Increase
the number of providers who are competent with
the revised RoSHBeC model and 3MV curriculum
- Increase
the number clients involved in behavior change
via RoSHBeC counseling and 3MV groups
Long
Term Outcomes
- Increase
understanding among YMSM of factors that influence
risk behavior
- Decrease
risk taking behaviors among YMSM
Proposed
Local Evaluation Strategy
- Focus
groups to assess and adapt (if needed) individual-
and group-level curricula
- Evaluation
of process data/fidelity to the intervention
focusing on process, utilization, and programmatic
- Randomized
controlled trial “feasibility pilot test”
comparing ni=16 (N=32) YCMSM at their office,
recruited with fliers, HIV prevention intervention,
and the general healthy/career development group;
each has twohour weekly MMMV group sessions
for six weeks
- Evaluations
for this pilot at pretest, Week 6, and Month
3
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Dept
of Health Services, County of LA
HIV Epidemiology Program Evaluation Center, LA
Department of Health Services
600 South Commonwealth Ave., Suite 1920
Los Angeles, CA 90005-4001
The
Los Angeles County HIV Epidemiology Program (LACHEP)
will offer expanded, active, community-based outreach
to HIV counseling and testing, followed by referral
and linkage into care at one of two clinics: AltaMed
and Drew University Oasis Clinic. The program
will offer Latino and African American YMSM intensive
integrated case management (ICM) sessions at local
clinics. A randomized controlled study of the
intervention will be used, as well as qualitative
and quantitative methods to follow clients and
evaluate the program.
Intervention
- Active
and passive community outreach, with mobile
and clinic-based CTR, using incentives for post-testing
- One-hour
integrated case management (ICM) sessions at
two sites – one African American identified
and the other Latino identified, with biweekly
peer support groups for clients, partner counseling
and referral services, and transition to standard
case management after two years
- Weekly
intervention visits at first, then bi-weekly,
then monthly second year
Outputs
- 2,000
people reached during outreach use CTR; 100-200
HIV+ identified via active outreach; 100 HIV+
identified via passive outreach: 100 African
Americans and 100 Latinos linked to ICM—90
African Americans and Latinos linked to standard
case management (as control)
- 90
African Americans and 90 Latinos complete 42
ICM sessions, average ICM caseload of 25-35
clients
- All
clients receive medical care quarterly, 1,000
additional services visits
- Client
receives 30 prevention messages during ICM,
with 100 ICM clients transitioned to standard
case management
Short
Term Outcomes
- Increased
knowledge of HIV, HIV threat, and personal serostatus
- Increased
use of HIV services, with decreased unmet need
among HIV+ who are not getting care
- 75%
kept appointment rate; 50% decrease in viral
loads; 50% increase in CD4 counts; 50% increase
in condom use; 50% decrease in high risk behaviors;
50% increase in voluntary disclosure to of serostatus
to partners; 50% increase in asking about partner
serostatus
- Increased
rapport with ICM regarding prevention
Long
Term Outcomes
- Increased
use of HIV care services by previously undiagnosed
HIV+.
- HIV
care seen by clients as of higher quality and
more culturally competent
- Decreased
morbidity and mortality related to HIV among
HIV+
- Increased
use of ongoing local continuum of care by HIV+
Proposed
Local Evaluation Strategy
- Randomized,
controlled design with two groups: African American
and Hispanic (ni=90); control group of n=90
African American and Hispanic in traditional
case management programs
- Stratified
blocked randomization (two sites, race/ethnicity-specific)
- Data
collection: repeated measures, structured face-to-face
interviews, adopt validated tools where possible
- Qualitative
component with providers
- Baseline
and twice yearly follow-up face to face interviews
over 36 months
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University
of North Carolina at Chapel Hill
Department of Medicine/Division of Infectious
Diseases (ID)
130 Mason Farm Road, CB #7030
Chapel Hill, NC 27599-7030
A
collaborative between UNC and community-based
prevention and case management agencies will conduct
and evaluate a social marketing campaign on college
campuses, promote access to HIV treatment and
care among newly diagnosed African American HIV-infected
college students at a consortium of colleges.
They will assess the prevalence of acute HIV infections
through a serosurvey, and compare outcomes between
campuses exposed and not exposed to the intervention.
UNC will partner with North Carolina Central University,
a historic Black university, and the Alliance
of AIDS Services, a community-based AIDS service
organization.
Intervention
- Elicitation
research to develop a prevention intervention
- Outreach
by CBO and campus organization staff to inform
about HIV and promote CTR
- Media
campaign on campuses and in local community
- Social
marketing partnerships with campus groups and
local businesses, freshman orientation education;
CTR at student health centers and in the community
- Cultural
competency training of CTR staff and use of
RNA testing by CTR staff
- Health
department Disease Intervention Specialists
to locate HIV+ not in care and promote partner
testing
- Provision
of primary and specialty care via UNC ID clinic
- Prevention
for positives program at UNC ID via new protocol
follow-up by DIS and local case managers to
locate HIV+ lost to care
Outputs
- Six
focus groups will be held to develop prevention
intervention
- Greater
than 85/90% of HIV+ located and linked to care
Short
Term Outcomes
- Increase
penetration and receipt of prevention messages
- Increase
use of CTR and knowledge of individual serostatus
- Decrease
risk behaviors by HIV+ and within larger community
- Increase
identification of HIV+ earlier in course of
disease and increase access and retention in
care
- Improve
quality of primary care and prevention services
Long
Term Outcomes
- Improve
health outcomes and enhanced quality of life
for HIV+ patients
- Decrease
morbidity and mortality among HIV+ and decrease
HIV transmission within community
Proposed
Local Evaluation Strategy
- Compare
individual at the participating campuses and
those at similar non-participating campuses
- Focus
groups and key informant interviews with peers,
members of advisory board and staff
- Interviews
pre-test and also end of Years 2 and 5
- Convenience
sampling to assess n=100 general population
and n=50 members of target population
- Seroprevalence
study on intervention and control campuses in
pooled batches to identify RNA+ samples versus
antibody testing, to assess acute infection
- Linkages
into care at UNC ID clinic will be tracked over
time, but tools and method based on existing
project evaluation (demographic, clinical, behavioral,
utilization) at UNC ID clinic
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AIDS
Project East Bay
1755 Broadway, Second Floor
Oakland, CA 94612
AIDS
Project East Bay collaborates with the Sexual
Minority Alliance of Alameda County (SMAAC) and
Alameda County Medical Center (ACMC) in this project.
New and adapted programs, within an existing network
of programs, will comprise a youth-directed, community-based
outreach based through a variety of approaches.
The local evaluation design includes a prospective,
repeated measures design, which also compares
enrollees with a control group of those receiving
other East Bay AIDS Center (EBAC) services. Local
evaluation of outreach and testing activities
is through process evaluation and comparison of
previous periods in a historical cohort approach.
A faculty member of the University of California
San Francisco will participate in the local site
evaluation.
Intervention
- Outreach,
counseling, testing, and referral (CTR), and
linkages into community-based programs
- Screen
at ACMC (eventually developing rapid testing
mobile van)
- Cohort
design, with repeated measures
- Historical
comparison group
- Target
population: African American
Outputs
- Youth
centered outreach n=7,500 high-risk young African
American
- Rapid
testing to n=450
- Link
into care n=35
- Link
to community involvement, prevention with positives,
and self-empowerment for n=50
- Then
enroll in Mpowerment and/or TLC
- Repeated
measures design. ni=3,050 (total N=6100); control
group is those receiving other EBAC; crosssectional
for rest
Short
Term Outcomes
- Increased
awareness of HIV risks and benefits of HIV counseling/testing
among African American MSM
- Increased
knowledge of serostatus among high risk MSMs
- Increased
engagement and retention of HIV+ into care
- Decreased
risk behaviors by HIV+ in care
- Reduced
risk behaviors among African American MSM
Long
Term Outcomes
- Improve
health and wellbeing, and quality and length
of life of HIV+ MSM
Proposed
Local Evaluation Strategy
- Outreach
and testing to general population; process evaluation.
Compare with historical data
- Intervention
participants vs. stages of change
- Focus
groups in first six months with members of target
population
- Cohort
design
- Process
evaluation
- Outcome
evaluation: primary outcomes include: improved
clinical outcomes, adherence to treatment and
appointments, improved CD4 and viral load measurements,
improved safer sex behavior
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Harris
County Public Health and Environmental Services
Harris County Public Health and Environmental
Services Department
2223 West Loop South
Houston, TX 77027
The
purpose of this project to be conducted through
the Harris County Public Health and Environmental
Services Department, is to engage HIV seropositive
YCMSM into care, link them into appropriate services,
and facilitate retention in care using existing
locally defined categories of RWCA services. A
new approach to case management will be evaluated
which coordinates a variety of relevant services
into one Client Management Team (CMT)—a wide-ranging
and intensive service which provides outreach,
medical care coordination, service linkage, peer
counseling, health education, and other services
to engage and retain high risk youth in care.
Evaluation includes use of existing client data,
and comparison with previously enrolled clients.
Intervention
- Consolidated
case management based on combination of existing
services.
- A
multidisciplinary team will provide case management,
outreach, peer counseling, medical care coordination,
and health education risk reduction using a
Client Management Team (CMT) approach
- Outreach
is not for testing individuals at large, but
rather outreach to existing or newly diagnosed
HIV+ YCMSM
- During
outreach clients come for services every week
in 4-8 hours.
- Counseling
and testing as needed, and individual sessions
on education, services, etc.
Outputs
- Enroll
10 to 15 HIV+ by 8/05; enroll 85 by end of project
- A
minimum of 50 to 80% of newly-identified HIV+
clients will enter primary care and/or case
management
- A
minimum of 50/60/90% of HIV+ clients will use
primary care during 6 month period per year
Short
Term Outcomes
- Increase
proportion of HIV+ who know their serostatus
- Increase
knowledge of HIV risk reduction and practice
of safer sex
- Increase
proportion of HIV+ that are identified, linked
to care, and remain in care
- Increase
client use of primary care and support services
- Improved
or maintained CD4 counts
- Improved
or maintained viral loads
- Increase
knowledge of care system and how to use it
- Increase
adherence to treatment regimens
Long
Term Outcomes
- Reduce
new HIV cases among YCMSM
- Slow
and stabilize disease progression in HIV+
Proposed
Local Evaluation Strategy
- Comparison
group of those in system not enrolled in the
program. ni=85; nc=30
- Client
assessments from case management requirements
(e.g., assessment form within ten working days
of assessment and linked to service within 30
days). Centralized Patient Data Management System
(CPCDMS) to collect data, with one face to face
interview visit q30 days and at least one visit
to natural environment every 90 days
- Comparison
group is those clients enrolled into CPCDMS
within two years of project start and those
enrolled by other agencies meeting the inclusion
criteria
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Bronx
AIDS Services, Inc.
540 East Fordham Road
Bronx, NY 10458
The
Bronx Boogie Down Project is a collaboration of
Bronx AIDS Services, Inc. (BAS) and the Adolescent
AIDS Program of the Children’s Hospital at
Montefiore Medical Center (AAP). The project strives
to improve outreach, care and prevention services
to engage seropositive YCMSM in the region and
help them stay in care. The project strives to
use social and geographic mapping, performed by
community ethnographer-organizers (CEOs), to identify
high-risk areas for this target population, and
then develop new methods of outreach to improve
access to services and establish use of popular
opinion leaders. Once outreach has taken place,
the program expects to enroll 15 to 20 YCMSM of
color to medical care per year and achieve risk
reduction and retention in care among participants.
The local evaluation includes mapping and focus
groups with the target population followed by
content analysis using Ethnograph, and process
evaluation.
Intervention
- Ethnographic
investigation, followed by outreach in mobile
van with counseling and testing, then entry
and retention into care with assistance of case
management model
- Training
of CEOs who will examine and map social and
sexual networks
- Community
organizing and individualized interviewing by
CEOs that convey HIV information and identify
HIV+ not in care
- Outreach
to agencies that serve YMSM
- Standard
and CTR and linking of HIV+ to care and accompanying
HIV+ to appointments
- Case
management and support services management with
prevention counseling by case manager and/or
support services manager Rapid testing of partners
of HIV+
Outputs
- 10
CEOs trained and CEO interviews
- 100
MSM and maps four Bronx communities
- 80-100
HIV+ linked to care, 10 partners of HIV+ receive
rapid testing
- Connection
for seropositive into care via a case management
model for n=15 to 20 YCMSM annually
Short
Term Outcomes
- Increased
use of CTR services.
- Increased
knowledge of personal serostatus
- Increased
use of services by HIV+
- Increased
adherence of HIV+ to treatment plans and medications
- 60%
of HIV+ who receive behavioral counseling will
reduce one risky behavior
Long
Term Outcomes
- Improved
health status of HIV+.
- Reduced
HIV infection within the community
- Proposed
Local Evaluation Strategy
- Primarily
qualitative and ethnographic endeavor using
social network evaluation, with mapping of target
population and mapping YCMSM
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Wayne
State University
540 East Canfield, Room 1128, Scott Hall
Detroit, MI 48201
This
project strives to conduct innovative field and
Internet outreach to encourage YCMSM to find out
their HIV status and enroll, engage, and maintain
in care. The investigators will use and evaluate
a motivational interviewing (MI) strategy, with
extensive MI training to field workers, to encourage
at-risk YCMSM to be
counseled and tested for HIV. Traditional peer-outreach
will be compared with traditional peer outreach
in combination with MI. They will also conduct
an evaluation of internet-based outreach to this
population.
Intervention
- Traditional
peer outreach versus traditional peer outreach
plus motivational interviewing
- Comprehensive
continuum of care based on a continuous relationship
model and elements of social network theory,
with community and Internet outreach
- MI
during outreach to use CTR and during post-testing
to engage in care
- Inter-disciplinary
care using MI to promote retention in care and
risk reduction
- Healthy
Choices MI support group intervention, Brother-to-Brother
prevention group intervention
- Agency
outreach to capture HIV+ identified elsewhere,
outreach and home visits for those lost to care
- Peer
advocacy and recreation services
Outputs
- 150
YMSM reached per year via 1,500 community outreach
contacts, with one-half using MI
- 100
YMSM reached per year via Internet outreach,
with one-half using MI
- 52
YMSM use CTR in first year, with all clients
who receive CTR receiving MI with regard to
post-testing
- All
HIV+ receive MI regarding enrolling in care,
with 100%-80% HIV+ to receive MI regarding staying
in care
- 18
support groups held, 60 youth to receive case
management, 80 youth to receive advocacy services
- All
lost-to-care receive attempted contact
Short
Term Outcomes
- Increase
knowledge of HIV risks, readiness to know serostatus,
knowledge of individual serostatus
- Increase
in number of clients who use CTR, enroll in
care and arrive at first primary care appt
- Increased
attendance at quarterly primary care visits,
adherence to treatment regimens, self-efficacy
and social support, readiness to change negative
behaviors, and re-enrollment of lost-to-cares
Long
Term Outcomes
- Decrease
in unmet health care needs and HIV transmission
related to not knowing serostatus
- Improve
health and well-being of HIV+
- Reduction
in high risk sexual and substance using behaviors
Proposed
Local Evaluation Strategy
- Compare
peer outreach to peer outreach plus motivational
interviewing to assess the effect on readiness
to accept diagnosis, receipt of HIV CTR, and
return for test results; also linkage into care
- Randomized
controlled trial with pre-post test comparisons:
randomization to traditional versus traditional
plus motivational interviewing to assess if
intervention results in the pursuit of HIV CTR
- For
field recruitment, field outreach three days
per week
- Baseline,
three, and six month follow-up
- For
field: ni=50 (total N=100), for Internet: ni=75
(total N=150)
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Working
for Togetherness
Youth Empowerment Center
Chicago Area Priority Access Project
3333 W. Arthington St., #108
Chicago, IL 60624
The
Chicago Area Priority Access (CAPA) Project at
Working For Togetherness aims to decrease barriers
within the HIV/AIDS healthcare delivery system
for young African American MSM (YAAMSM) and increase
integration of services for these young men. The
three primary goals of the CAPA Project are to:
1) conduct outreach to deliver HIV prevention
messages and increase early detection of seropositive
YAAMSM; 2) develop an integrated, adolescent-specific
continuum of care network for seropositive YAAMSM;
and 3) create and operate a Youth Empowerment
Center to increase youth self-efficacy to enter
and remain in culturally- and developmentally-appropriate
HIV primary care.
Project
activities include maintaining and enhancing the
CAPA Project Continuum of Care, housing and implementing
preventive interventions for HIV-positive YAAMSM
in the Youth Empowerment Center, performing local
and multi-site evaluation activities, and disseminating
project information and evaluation findings at
local and national conferences.
The
CAPA Project evaluation is assessing the effectiveness
of “Mobile Tech” outreach in helping
YAAMSM receive HIV prevention services, learn
their HIV status, and access medical care. The
project will also adapt a CDC – Effective
Behavioral Intervention to determine effectiveness
in reducing HIV risk behaviors among these youth.
The completed evaluation is expected to deliver
a protocol to replicate Mobile Tech outreach,
provide research evidence on the effectiveness
of CDC-EBI for YAAMSM, and offer a Collaborative
Continuum for Care Model for community-based organizations
and healthcare providers to link HIV-positive
youth to care.
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