Grants
for this initiative were awarded
to the applicants listed below.
The
abstract provides both contact
information and a brief description
of the project.
The
University of San Francisco: The
Ryan White Prevention Project
Center for AIDS Prevention Studies
AIDS Research Institute
University of California, San
Francisco
74 New Montgomery Street, #600
San Francisco, CA 94105
The
Ryan White Prevention Project
(RWPP) is a proposal to establish
an Evaluation and Support Center
for an Initiative on Prevention
with HIV Infected persons Seen
in Primary Care Settings (Center).
The mission of the Center is to
provide leadership in the design
and evaluation of interventions
that will have maximum impact
on the theory, practice and policy
of HIV prevention in primary health
care settings. The project is
being conducted by a multidisciplinary
team lead by the Center for AIDS
Prevention Studies (CAPS) within
the AIDS Research Institute (ARI)
at the University of California,
San Francisco (UCSF). The specific
aims of the Center are:
-
To facilitate and conduct rigorous
evaluation research across multiple
demonstration sites that will
have maximum impact on practice
and policy of HIV prevention.
-
To provide methodological (both
quantitative and qualitative)
research design and evaluation
consultation and support to
proposed demonstration projects,
technical assistance on the
development of behaviorally
based interventions, assist
sites in design of state-of-the-art
data collection and management
systems, and provide a central
database for measurement outcomes.
-
To synthesize and disseminate
findings from demonstration
projects so that they have optimum
impact on further prevention
research, practices and policies.
-
To provide the leadership to
stimulate innovative projects
and ensure scientific excellence,
as well as the organizational
capacity to ensure integrity
of research and sound fiscal
operations.
The
Center is working with HAB's SPNS
program for the next five years
as part of the agency's initiative
on prevention with person seen
in primary care settings. The
Center is also working with specific
projects to be funded during years
2-5 of the initiative. During
the first year, the Center has
worked with the SPNS program to
refine a proposed multisite evaluation
design for behavioral interventions
with HIV infected individuals
in health care settings. In the
following years, the Center will
work with the SPNS to evaluate
the demonstration projects and
disseminate findings to other
health care settings.
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DeKalb
County (GA) Board of Health
445 Winn Way, PO Box 987
Decatur, GA 30031
Project
Title: Prevention with HIV
Positives in the Clinical Setting
Project
Period: 2003-06
Target
Population: Urban African-American
patients living with HIV infection
Collaborating
Partners: The Southeast AIDS
Training and Education Center,
and the AIDS Research Consortium
of Atlanta
Description:
This project is testing the feasibility
and impact of three different
models of intervention with the
target population being seen at
an existing early care clinic.
The first model is prevention
counseling and education conducted
solely by existing clinical providers.
All providers are trained before
the project is initiated. The
second model will have such counseling
conducted by an HIV prevention
specialist. The third model is
a small group intervention. The
evaluation of the project will
examine and compare the impact
of each model with regard to development
of individualized plans for behavior
change, and self-reports of behavior
change sustained over time. Outcomes
with regard to decreases in secondary
transmission of HIV to others
are also being examined.
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Drexel
University
School of Public Health
1505 Race Street, 11th Floor,
MS 660
Philadelphia, PA 19102
Project
Title: The Protect and Respect
Program for Women Living with
HIV or AIDS
Project
Period: 2003-06
Target
Population: HIV-infected women
Collaborating
Organizations: the Partnership
Comprehensive Care Practice (PCCP)
of the Drexel University College
of Medicine; the Business College
at Drexel University; and the
Pennsylvania Mid-Atlantic AIDS
Education and Training Center
(AETC)
Description:
This project is seeking to reduce
high risk sexual behavior among
women being seen at PCCP by adding
prevention-oriented small group
skill-building sessions and peer
support activities to existing
prevention counseling provided
by clinical providers. Evaluation
focuses on clinical outcomes,
self report regarding behavior,
reports from providers and economic
analyses. Cost effectiveness analysis
is being performed by faculty
in the Business School. Training
is being provided by the Pennsylvania
Mid-Atlantic AETC.
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El
Rio Santa Cruz Neighborhood Health
Center
Special Immunology Associates
839 West Congress
Tuscon, AZ 85745
Project
Title: Supporting Healthy
Alternatives through Patient Education
(SHAPE)
Project
Period: 2003-06
Target
Population: HIV-infected persons
currently being seen in clinical
primary care services, many of
whom are persons of Latino descent
Collaborating
Partners: Impact Consulting,
and the Center for AIDS Prevention
Studies at the University of California,
San Francisco
Description:
This project is implementing a
prevention specialist educational
intervention to complement prevention
counseling currently provided
by clinical providers in the context
of ongoing HIV-oriented primary
care. A specialist intervention
developed by Kalichman, et.al.
(2001) is being modified to be
culturally and linguistically
matched to the target audience.
The intervention are focusing
on high-risk anal and vaginal
intercourse and disclosure of
HIV status to sexual partners.
Patients receiving the prevention
specialist intervention are being
compared to those receiving only
the clinical provider counseling.
The project evaluation is examining
outcome data related to reduction
HIV transmission and re-infection
risks, and increasing efficacy
for self-disclosure of serostatus.
Process data regarding project
reach and fidelity, and client
satisfaction are also be examined.
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Fenway
Community Health Center
7 Haviland Street
Boston, MA 02115
Project
Title: HIV Prevention in Primary
Care Settings
Project
Period: 2003-06
Target
Population: HIV infected men
who are sexually active with other
men
Description:
This project is conducting a randomized
trial of a four-session behavioral
intervention to reduce high-risk
sexual practices among HIV-infected
men who have sex with other men.
Particular attention is being
given to engaging men who are
receiving HIV-oriented primary
care at the Fenway Center. An
individualized intervention is
being given by a medical social
worker, to include education,
motivational and behavioral skills
enhancement in addition to standard
prevention case management (PCM).
Control group participants will
only receive PCM. Once screened,
patients who have engaged in unprotected
anal intercourse with anyone except
a monogamous seroconcordant partner
during the previous 3 months will
be enrolled into the study.
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Johns
Hopkins University
School of Medicine
1830 E. Monument Street, Room
445
Baltimore, MD 21287
Project
Title: Improving Provider
Counseling Interventions in HIV
Practice
Project
Period: 2003-04
Target
Population: HIV-infected patients
being seen in existing HIV clinics
Collaborating
Partners: The Rochester (NY)
Center for Health and Behavioral
Training
Description:
This project is evaluating the
impact of a prevention counseling
protocol that will be used by
existing clinical providers. Participating
patients are being asked to complete
an audio-computer assisted self
interview (ACASI) upon arrival
at clinical appointments. Of these,
a randomly-selected portion of
those presenting high-risk profiles
are given prevention counseling
as part of their scheduled visit.
The ACASI risk assessment with
counseling by providers (according
to assignment to an intervention
or control group) will continue
at every standard 3 month visit
for the following year. All providers
are being trained by a staff person
from the Rochester Center for
Health and Behavioral Training
before the project is initiated.
The project is being evaluated
by comparing changes in self-reported
transmission behavior at 12-month
follow-up in the intervention
group compared to the control
group. The project is also measuring
patients' intent to change behavior
as captured by the ACASI. Finally,
the evaluation is measuring improvements
in health service counseling during
clinical encounters, and patients'
perception of the intervention's
impact on interactions with clinical
providers.
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Los
Angeles County Department of Health
Services
600 S. Commonwealth Avenue, 6th
Floor
Los Angeles, CA 90005
Project
Title: HIV Prevention in Primary
Care Settings
Project
Period: 2003-05
Target
Population: Sexually active
HIV-infected patients being seen
at HIV-oriented primary care sites
Collaborating
Partners: The Keck School
of Medicine at the University
of Southern California, Children's
Hospital of Los Angeles, AltaMed
Health Services, and Northeast
Valley Health Corporation
Description:
From 2001-02, the awardee
and its partners studied the impact
of current prevention counseling
offered by clinical providers
in the context of ongoing clinical
care, and established impact baselines.
During 2003-05, the awardee and
its partners will study the effect
enhanced provider-based prevention
services using motivational interviewing
and loss-framed messages. Project
goals include improving the patient-provider
relationship, improving the ability
of providers to iimplement prevention
counseling, and reduce high-risk
sexual behaviors. Project evaluation
will assess the extent to which
the enhanced intervention meets
project goals, identify patient
characteristics that are covariates
of outcomes and/or that act as
moderators in the intervention,
and assess the extent to which
high-risk sexual behaviors are
related to demographic characteristics
and co-occuring behaviors such
as substance abuse.
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Mount
Sinai Hospital, Chicago
Infectious Disease Clinic
California Avenue at 15th Street
Chicago, IL 60608
Project
Title: HIV Prevention in Treatment
Settings
Project
Period: 2003-06
Target
Population: HIV-infected low-income
persons of African-American or
Mexican-American ethnicity
Description:
This project is evaluating
the impact of a 12 month-behavioral
intervention consisting of multiple
individualized educational sessions
with a peer advocate using computer-assisted
technology. Persons who receive
the intervention are being stratified
by length of time from diagnosis
(newly diagnosed vs. diagnosed
for more than 18 months), and
compared to persons who only receive
prevention counseling from primary
care providers according to current
protocols. Evaluation of the project
will examine impact of each intervention
on coping ability, adherence to
treatment regimens, elimination
of high-risk sexual behaviors,
and adoption of lower risk practices
with regard to drug use (particularly
injection drug use). Evaluation
issues to be investigated in the
peer advocate intervention include:
the extent to which the intervention
is effective with newly diagnosed
persons vs. persons who have been
infected for some time, and the
extent to which participant impacts
vary by HIV risk factor and demographic
characteristics.
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St.
Luke's Roosevelt Hospital Center
Center for Comprehensive Care
1111 Amsterdam Avenue
New York, NY 10025-0000
Project
Title: Positive Prevention
Project
Period: 2003-06
Target
Population: HIV infected persons
being seen at the Center for clinical
services
Description:
This project is implementing
an individualized, non-judgmental,
and culturally competent prevention
specialist intervention with current
patients. Staff nurses at the
Center are being trained in behavioral
risk assessment and theories and
techniques of behavior change.
Patients are periodically assessed
for risk and recruited into the
intervention based upon risk profile.
Motivational interviewing techniques
and peer support groups are being
employed. Specific behavioral
outcomes that the intervention
is seeking are: increased condom
use during sexual activity, decreased
high-risk needle use when injecting
substances, decreased substance
use, and improved treatment adherence.
The project's evaluation will
examine patient demographic variables,
activity process data, the impact
of the intervention on self-reported
risk behaviors and service utilization,
and clinical outcomes.
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University
of Alabama at Birmingham
Division of Infectious Diseases,
STD Program
ZRB 242, 1530 3rd Avenue, South
Birmingham, AL 35294
Project
Title: HIV Prevention in the
Primary Care Setting
Project
Period: 2003-06
Target
Population: HIV-infected men
who have sex with men
Description:
This project is conducting
a randomized trial evaluating
the effectiveness of an enhanced
provider-delivered, client-centered
intervention that seeks to increase
motivation, facilitate positive
decision-making, and increase
self-efficacy for changing sexual
risk behaviors. Provider-delivered
messages and strategies are based
on the conceptual framework of
the transtheoretical model of
change and matched to each patient's
level of motivation to change.
Computer-assisted self-interviewing
technology is being used. The
project will be evaluated with
regard to achievement of three
behavioral outcomes: increases
in condom use with primary and
any secondary casual partners,
decreases in number of sexual
partners among those reporting
multiple partners, and increases
in the frequency of HIV serostatus
disclosure to all sexual partners.
Patients receiving the intervention
will be compared to those receiving
only standard prevention counseling
according to current clinic protocols.
Incidence of sexually transmitted
diseases will also be examined.
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University
of California, Davis
AIDS Education and Training Center
4150 V Street, PSSB 500
Sacramento, CA 95817
Project
Title: Prevention Intervention
Strategies with HIV-infected Persons
Seen in Four Different Primary
Care Settings
Project
Period: 2003-06
Target
Population: HIV-infected persons
seen in clinics that primarily
serve low-income populations,
most of who are persons of color
Collaborating
Partners (if any): The Center
for Health Services Research in
Primary Care, and the NorCal HIV
Primary Care Providers Consortium
Description:
This project is training primary
care providers in existing clinics,
and adding the services of an
HIV specialist health educator
to promote behavior change among
HIV-infected patients. Two intervention
models are being tested. The first
model is a brief intervention
from a primary care provider during
a regularly scheduled clinic appointment.
The second model is a brief intervention
by the primary care provider,
immediately followed by an educational
session with an HIV specialist
health educator. All clinical
providers are being trained in
HIV prevention counseling before
the project begins. Evaluation
of the project will examine the
extent to which the sole clinical
provider counseling and the combined
provider-health education specialist
models are effective in reducing
the prevalence of high risk behavior
among patients being seen, compare
the impacts of each model, assess
the relative costs of each, and
postulate the cost-effectiveness
of each intervention.
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University
of California, San Diego
The Owen Clinic of the UCSD Medical
Center
200 W. Arbor Drive, MC 8681
San Diego, CA 92103-8681
Project
Title: Primary Prevention
for Positives
Project
Period: 2003-06
Target
Population: HIV-infected persons
currently being seen in primary
care services
Description:
This project is introducing an
enhanced intervention using individualized
prevention specialist counseling
sessions with a portion of the
target population identified as
at high risk for transmitting
infection to others. Those identified
as at high risk are being referred
into the enhance intervention
consisting of a minimum of six
hour-long sessions. Audio-computer
assisted self-interviewing (ACASI)
is being used to assess risk and
progress toward change. The patient,
primary care provider, and prevention
specialist are periodically reviewing
data provided by the ACASI system
with regard to patient knowledge,
skills, motivation , resources,
and support, and identify opportunities
for further change. The overall
goal is to reduce the risk of
HIV transmission from patients
to sexual and/or needle sharing
partners. The project evaluation
will examine the following data:
percent change in reported high
risk sexual and/or drug using
behaviors; intervention effects
on estimates of potentially transmitting
HIV to others; percent change
in STD rates as measured by laboratory
screening tests and client self-report;
costs of implementing the intervention;
and potential for reproducing
the intervention.
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University
of Miami
School of Medicine, Department
of Psychiatry and Behavioral Sciences
1695 NW 9th Avenue
Miami, FL 33136
Project
Title: Project Road Map
Project
Period: 2003-06
Target
Population: HIV-infected individuals
50 years of age and older
Collaborating
Partner: The Adult Special
Immunology Clinic at the Univsersity
of Miami's Jackson Memorial Hospital
Description:
This project is adapting an intervention
model developed in the NIMH Multi-site
Prevention Trial, Project LIGHT,
to include issues related to secondary
prevention of HIV infection, disclosure
of HIV status to others, and addressing
unique life needs of older adults.
Participants are being recruited
via referrals from primary care
providers, and randomly assigned
to an intervention group or a
control group. The intervention
group is receiving four 90 - 120
minute small group intervention
addressing prevention and risk
reduction issues. Specific groups
are being formed based upon language
(Spanish vs. English) and gender.
The impact of each intervention
will be evaluated with regard
to HIV knowledge, risk reduction
problem solving, and self-reported
lower risk sexual behaviors.
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University
of North Carolina, Chapel Hill
Infectious Disease Clinic
130 Mason Farm Road CB# 7030
Chapel Hill 27599
Project
Title: UNC HIV Prevention
Demonstration Project
Project
Period: 2003-06
Target
Population: HIV-infected persons
living in non-urban areas
Description:
This project is introducing
enhanced prevention services into
an existing Title III Early Intervention
program for HIV care. Enhanced
services consists of the following:
patient risk assessment using
a web-based risk screening tool,
counseling by primary care providers
based upon screening results,
patient education via an educational
tool linked to the web-based screening
tool, and motivational interviewing
by a health behavior specialist.
Primary care providers are being
trained before the enhanced intervention
is initiated. Project evaluation
will examine behavioral and health
outcomes to include self-reported
risk behaviors, disclosure of
HIV status to others, and incidence
of sexually transmitted infections.
Intervention (frequency and duration)
dose and cost data will also be
examined.
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University
of Washington
HIV/AIDS Research Program
901 Boren Avenue, Suite 900
Seattle, WA 98104
Project
Title: Prevention for Positives
Project
Period: 2003-06
Target
Population: HIV-infected patients
currently being seen at the Madison
Clinic
Collaborating
Partners: The Madison Clinic
of the Harborview Medical Center,
Seattle, WA
Description:
This project is implementing
an enhanced prevention specialist
intervention into an existing
HIV primary care clinic. Working
closely with primary care providers
and case managers, a trained nurse
specialist is conducting risk-assessments
with patients using a audio-enhanced,
computer-assisted self interview.
Persons with high risk profiles
are being recruited into a 12-month
individualized intervention by
the nurse specialist. Motivational
interviewing and small group peer
interventions are being employed.
Evaluation of the project will
examine changes in patient behaviors
at 12 and 24 month intervals.
Intervention patients will be
compared to patients referred
to the intervention but who choose
not to enroll or who delay enrollment.
Provider behavior change will
also be assessed through reviews
of medical records.
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Whitman-Walker
Clinic
1407 S Street, NW
Washington, DC 20009
Project
Title: Prevention with HIV-infected
Persons Seen in Primary Care
Project
Period: 2003-06
Target
Population: HIV-infected men
who are seen in HIV-oriented primary
care facilities
Collaborating
Partners: Georgetown University
School of Nursing and Health Studies,
and Boston University School of
Public Health
Description:
This project is evaluating the
impact of an intervention that
combines primary care provider
counseling with focused behavioral
interventions by health educators.
Outcome measures are being examined
include awareness of sexual risk,
openness and trust with primary
care providers regarding high
risk behaviors, and self-reports
of engagement in high-risk behaviors.
A quasi-experimental design with
a longitudinal time dimension
is being used. Duration and intensity
of the intervention, patient demographics,
and risk assessment scores are
also being compared.
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