Implementation of HIV prevention interventions with people living with HIV/AIDS in clinical settings: challenges and lessons learned.

Center for AIDS Prevention Studies, AIDS Policy Research Center, University of California, 50 Beale Street Suite 1300, San Francisco, CA 94105, USA.
AIDS and Behavior (Impact Factor: 3.49). 10/2007; 11(5 Suppl):S17-29. DOI: 10.1007/s10461-007-9233-8
Source: PubMed

ABSTRACT Integrating HIV prevention into the clinical care of people living with HIV has emerged as a priority in the US As part of a cross-site evaluation this study examined the processes by which 15 clinic-based projects implemented interventions funded under the Health Resources and Services Administration's (HRSA) HIV Prevention with Positives (PwP) in Clinical Settings Initiative. We conducted 61 in-depth interviews with researchers and interventionists across the 15 projects. Intervention implementation was feasible assuming several key components were in place: (1) internal leadership to overcome resistance and foster interest and motivation among clinical providers and staff; (2) adequate attention to creating seamless flow between clinic practice and intervention; and (3) ongoing training that met clinician and staff needs as prevention interventions become a regular part of care. Interventions well matched to the clinical environment and the patient populations were feasible and acceptable to health care providers, prevention interventionists, and clinic staff.

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Available from: Carol Dawson Rose, Aug 27, 2015
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    • "Specific demonstration studies on the implementation of prevention interventions for HIVinfected individuals within clinic settings suggests that peer-led interventions and prevention case management (PCM) models may be effective strategies in reducing high-risk behaviors (Koester et al., 2007; O'Cleirigh et al., 2008). Secondary prevention programs targeting HIV-infected individuals have resulted in significant changes in risky sexual and injection drug use behaviors (Kalichman et al., 2001; Margolin et al., 2003; Rotheram-Borus et al., 2001). "
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    ABSTRACT: There is growing interest in integrating HIV prevention counseling for HIV-infected gay and bisexual men into HIV primary care. HIV-infected peers and professionally trained prevention case managers (PCMs) have been used to provide prevention counseling services. The current qualitative study seeks to examine participant perceptions of the acceptability of HIV-infected peer counselors and of trained prevention case managers from the perspective of 41 HIV-infected gay and bisexual men. Semi-structured interviews were conducted with HIV-infected men who were currently receiving primary HIV health care. Positive peer counselor themes included shared experiences and para-professional. Positive themes specific to the PCM relationships included were provision of resources and professional skills and knowledge. Common themes identified across both peer and PCM counselor relationships were creating a comfortable environment, non-judgmental stance, and rapport building/communication skills. Recommendations for HIV secondary prevention interventions are presented.
    Journal of Gay & Lesbian Social Services 07/2010; 22(3):269-286. DOI:10.1080/10538720903426388
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    • "The sites using a combination of medical care providers and prevention specialists (“multi-provider” sites) did not demonstrate effectiveness in terms of reduced risk among patients receiving intervention services. There is evidence from the qualitative results from this study that these interventions may be difficult to implement because of the attention required to train and sustain provider attention [11]. When a project had to ensure fidelity to an intervention protocol for both medical care providers and prevention specialists within one clinical setting, the effort for project staff was significant and at times, the procedures were too daunting and/or confusing. "
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    ABSTRACT: To support expanded prevention services for people living with HIV, the US Health Resources and Services Administration (HRSA) sponsored a 5-year initiative to test whether interventions delivered in clinical settings were effective in reducing HIV transmission risk among HIV-infected patients. Across 13 demonstration sites, patients were randomized to one of four conditions. All interventions were associated with reduced unprotected vaginal and/or anal intercourse with persons of HIV-uninfected or unknown status among the 3,556 participating patients. Compared to the standard of care, patients assigned to receive interventions from medical care providers reported a significant decrease in risk after 12 months of participation. Patients receiving prevention services from health educators, social workers or paraprofessional HIV-infected peers reported significant reduction in risk at 6 months, but not at 12 months. While clinics have a choice of effective models for implementing prevention programs for their HIV-infected patients, medical provider-delivered methods are comparatively robust.
    AIDS and Behavior 03/2010; 14(3):483-92. DOI:10.1007/s10461-010-9679-y · 3.49 Impact Factor
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    ABSTRACT: Interventions for people with HIV/AIDS became a national priority in 2003. While the importance of involving HIV-positive people in the design, delivery, and evaluation of prevention programs is widely recognized, information about how to implement peer-based services in clinic settings is sparse. The four projects described in this article implemented peer-based interventions as part of larger, multi-site Special Projects of National Significance (SPNS) initiative. Common themes reported by Project Directors/Evaluators describe the challenges and benefits of peer-based interventions across these programs, including infrastructural, clinical and research-related issues. We also discuss the benefits to Peers, researchers, and the clinics sites.
    Journal of HIV/AIDS & Social Services 04/2008; 7(1):7-26. DOI:10.1080/15381500802093092
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