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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 Fransisco: 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:
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To facilitate and conduct rigorous evaluation
research across multiple demonstration sites
that will have maximum impact on practice and
policy of HIV prevention.
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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.
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To synthesize and disseminate findings from
demonstration projects so that they have optimum
impact on further prevention research, practices
and policies.
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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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