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: 3.58). 02/2007; 21 Suppl 1(supplement 1):S85-91. DOI: 10.1089/apc.2007.9983
Source: PubMed

ABSTRACT 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.

1 Follower
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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; DOI:10.1080/09540121.2012.748169 · 1.60 Impact Factor
  • Source
    • "565). Cultural competence has been shown to increase engagement and retention rates in a variety of research, treatment, and training environments when information is presented in tailored formats and flexible interactive styles that are acceptable to and effective in reaching the targeted populations (Aktan 1999; Baer et al. 2009; Bradford 2007; Calsyn et al. 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The UMBC Psychology Department's Center for Community Collaboration (CCC) provides training and support for capacity building to promote substance abuse and mental health treatment as well as adherence improvement in community agencies funded through the Ryan White Act serving persons living with HIV/AIDS. This article describes an approach to dissemination of Evidence Based Practices (EBPs) for these services that uses the Interactive Systems Framework (ISF) and incorporates a collaborative process involving trainer cultural competence, along with a comprehensive assessment of organizational needs, culture, and climate that culminates in tailored training and ongoing collaboration. This article provides: (1) an overview of the CCC's expanded ISF for the effective dissemination of two EBPs-motivational interviewing and the stages of change perspective; (2) an examination of the role of trainer cultural competence within the ISF framework, particularly attending to organizational culture and climate; and (3) case examples to demonstrate this approach for both general and innovation-specific capacity building in two community based organizations.
    American Journal of Community Psychology 04/2012; 50(3-4). DOI:10.1007/s10464-012-9508-8 · 1.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The following references constitute the resources used in the preparation of the monograph, Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation by William L. White to be released mid-2009. Copies of the full monograph will be available for purchase or download through the Center for Substance Abuse Treatment's Great Lakes Addiction Technology Transfer Center ( A.A. guidelines for A.A. members employed in the alcoholism field. (ND). New York: General Service Office, Alcoholics Anonymous. AA volunteers provide support to inpatients. (1982). Alcohol Health and Research World, 6(3), 34-35.
Show more