The Promise of Outreach for Engaging and Retaining Out-of-Care Persons in HIV Medical Care

The Fenway Institute of Fenway Community Health, Boston, Massachusetts, USA.
AIDS PATIENT CARE and STDs (Impact Factor: 3.5). 02/2007; 21 Suppl 1(supplement 1):S85-91. DOI: 10.1089/apc.2007.9983
Source: PubMed


From the beginning of the HIV/AIDS epidemic, outreach workers have been on the frontlines of HIV prevention, working in community venues to increase knowledge and promote behaviors to reduce HIV transmission. As demographics of the HIV-infected population have changed, the need has grown to locate out-of-care individuals and learn how to engage and retain them in HIV care. Through the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Outreach Initiative, 10 sites across the United States implemented and evaluated enhanced outreach models designed to increase engagement and retention in HIV care for underserved, disadvantaged HIV-infected individuals. Although the models differed in response to local needs and organizational characteristics, all made use of a common conceptual framework, and all used the same data collection and reporting protocols. Study teams enrolled and provided behavioral interventions to HIV-infected individuals who have been noticeably absent from research and from practice. Their interventions incorporated coaching, skills-building, and education, and were successful in reducing or removing structural, financial, and personal/cultural barriers that interfered with equitable access to HIV care. Desired outcomes of increased engagement and retention in HIV health care were achieved. Results demonstrate that interventions to promote equitable access to HIV care for disadvantaged population groups can be built from outreach models. Qualitative and quantitative analysis of the multisite data indicates that further development and evaluation of outreach-based interventions will result in effective tools for reaching HIV-infected individuals who would otherwise remain without needed care.

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    • "A number of factors influence access to mental health and substance abuse treatment services for PLWHA, including physical proximity to a service provider's office, education, housing situation, income, and transportation availability ( Craw et al., 2008; Ohl, Landon, Cleary, & LeMaster, 2008). In addition, rapport with case managers has been found to be a powerful predictor of client adherence to treatment and interventions ( Bradford, 2007). Most of our understanding , however, comes from research on the clients' perspectives. "
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    ABSTRACT: There are deleterious consequences to untreated mental health and substance abuse concerns among people living with HIV/AIDS (PLWHA). Most research on this population accessing specialized services has been described from the clients' perspectives. However, case managers play an important role in PLWHA receiving services. This study examined HIV case managers' perspectives of the barriers and facilitators encountered by their HIV-positive clients when seeking mental health and substance use treatment. In addition, the study describes case managers' use of mental health and substance abuse assessment instruments. Cross-sectional survey data were collected from case managers (N = 113). Structural challenges, such as financial concerns and limited transportation, were found to be significant barriers to mental health and substance abuse treatment. Positive client–provider relationships, accessible services, and case manager availability were influential in PLWHA accessing specialized services. Service delivery systems recommendations include increased social support systems, colocated and integrated services, and training of case managers to motivate clients to seek mental health and substance abuse treatment.
    Health & social work 03/2015; 40(2). DOI:10.1093/hsw/hlv023 · 0.94 Impact Factor
    • "Results have been used in the Virginia Department of Health's HIV service provider education program to increase understanding of transgender persons and to improve provider readiness to address their specific health care needs (Bradford, Xavier, & Hendricks, 2005). The focus groups were designed as the first research component of the Virginia Transgender Health Initiative, and the results proved useful in the development of the statewide quantitative survey (Xavier, Honnold, & Bradford, 2007), the next step in this multiyear program. "
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    ABSTRACT: We explored health care access experiences of 32 male-to-female (MtF) and 15 female-to-male (FtM) transgender people of different ethnicities in Virginia using data from focus groups conducted in 2004. Victimization associated with social stigmatization played a dominant role in participants’ lives, manifested by discrimination; violence; and health care provider insensitivity, hostility, and ignorance of transgender health. Access to transgender-related medical services that would allow participants to pass in their chosen genders was their highest medical priority. Faced with barriers to access, hormonal self-medication was common, and silicone injections were reported by both MtF and FtM participants. Due to economic vulnerability, sex work was reported as a source of income by both MtFs and FtMs. MtFs expressed concern over confidentiality of HIV testing and additional discrimination if testing positive. FtMs expressed difficulty accessing gynecological care due to their masculine gender identities and expressions. Cultural and technical competency training for providers and implementation of local programs in transgender hormonal therapy are recommended to improve transgender health care access.
    International Journal of Transgenderism 01/2013; 14(1):3-17. DOI:10.1080/15532739.2013.689513
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    • "Peers can effectively reach HIV+ individuals not in care and help facilitate their engagement in HIV and related health care (Bradford, 2007; Cabral et al., 2007; Gwadz et al., 2011; Tobias, Cunninghan, Cunningham, & Pounds, 2007). Peers are effective, in part, through their understanding the targeted group's needs and concerns and offering valuable social support (Whittemore, Rankin, Callahan, Leder, & Carroll, 2000) and improving HIV services utilization (Broadhead et al., 2002; Knowlton, Hua, & Latkin, 2005). "
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    ABSTRACT: Abstract Substance use among HIV+ individuals can be a barrier to HIV care, resulting in poor health outcomes. Motivational interviewing (MI) is an effective intervention to reduce substance abuse and increase HIV-related health. Healthcare workers from various backgrounds can be effectively trained in delivering MI interventions; however, there has been limited evidence that peers can effectively deliver MI interventions with fidelity. Peers have traditionally worked in HIV care settings and represent a valid context for a peer-delivered intervention focused on motivational issues. We trained four peers in MI. In this paper, we describe the intervention, explain the MI training methods, and investigate whether peers can be trained in MI with fidelity. The MI training included didactic instruction, group workshops, and individual feedback sessions. Two of four peers achieved MI treatment fidelity as measured by the Motivational Interviewing Treatment Integrity Code Version 3.0. Overall, peers had difficulty using open-ended questions and querying pros and cons, skills thought necessary to elicit change talk. They also tended to give too much direct advice where reflections would have been appropriate. A challenge was training peers to change familiar ways of communicating. Nonetheless, they did well at assessing and highlighting motivation to change. The total training hours (40 h) was long compared with other published MI studies. However, the intervention included several components with two targeted change behaviors. It is likely that peers can be trained in MI with fidelity in less time given a more streamlined intervention. When working with peers who have life stressors similar to the target group, it is important to be flexible in the training.
    AIDS Care 12/2012; 25(7). DOI:10.1080/09540121.2012.748169 · 1.60 Impact Factor
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