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Alves OMA, Moreira JP, Santos PC. Developing community partnerships for primary healthcare: An integrative review on management challenges. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1723882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Odete Maria Azevedo Alves
- Institute of Biometic Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Alto Minho Local Health Unit, Public Business Entity, Viana do Castelo, Portugal
| | - Joaquim Paulo Moreira
- Center for Administration and Public Policy (CAPP), University of Lisbon, Lisbon, Portugal
- Atlantic, Lisboa, Portugal
- Fernando Pessoa University, Porto, Portugal
| | - Paula Clara Santos
- School of Health, Polytechnic of Porto, Porto, Portugal
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Center for Rehabilitation Research (CIR), Polytechnic of Porto, Porto, Portugal
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Tanner AE, Philbin MM, Chambers BD, Ma A, Hussen S, Ware S, Lee S, Fortenberry JD. Healthcare Transition for Youth Living With HIV: Outcomes from a Prospective Multi-site Study. J Adolesc Health 2018; 63:157-165. [PMID: 29887488 PMCID: PMC6113059 DOI: 10.1016/j.jadohealth.2018.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Youth living with HIV (YLHIV) in the United States (U.S.) account for nearly one-third of new HIV infections and face significant barriers to care engagement; only 25% are virally suppressed. Healthcare transition (HCT) from pediatric/adolescent to adult-oriented care can be particularly disruptive. Accordingly, we prospectively examined HCT processes at 14 distinct geographical sites across the U.S. METHODS We collected Audio Computer-Assisted Self-Interviews data and abstracted electronic medical records from 135 HCT-eligible YLHIV at baseline and 9-month follow-up. Descriptive analyses and multilevel modeling were conducted. Data also included qualitative interviews with 28 adolescent and 30 adult providers across 14 adolescent and 20 adult clinics, respectively. Interviews were analyzed using the constant comparative method; this analysis focused on specific HCT recommendations. RESULTS At baseline, youth were primarily age 24 (78.8%), male (76.8%), black (78.0%), identified as a sexual minority (62.9%), had attended an HIV appointment in the past 3 months (90.2%), had Medicaid for insurance (65.2%), and were always or mostly always adherent to their antiretroviral therapy (65.9%). At the 9-month follow-up only 37% of YLHIV successfully transitioned to adult care. Both individual-level (insurance status and disclosure-related stigma) and clinic-level (adolescent clinic best practices) factors were significant. Adolescent and adult clinic staff offered recommendations to support HCT; these focused primarily on clinical changes. CONCLUSIONS This study highlights the complex set of individual- and clinic-level factors associated with HCT. Addressing these key factors is essential for developing streamlined, comprehensive, and context-specific HCT protocols to support continuous care engagement for YLHIV.
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Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina.
| | - Morgan M Philbin
- Mailman School of Public Health, Columbia University, New York City, New York
| | | | - Alice Ma
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Sophia Hussen
- Department of Global Health, Emory University School of Public Health, Atlanta, Georgia; Division of Infectious Diseases, Emory University of School of Medicine, Atlanta Georgia
| | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Sonia Lee
- Maternal and Pediatric Disease Branch, National Institute of Child Health and Human Development, Rockville, Maryland
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Tanner AE, Philbin MM, Ma A, Chambers BD, Nichols S, Lee S, Fortenberry JD. Adolescent to Adult HIV Health Care Transition From the Perspective of Adult Providers in the United States. J Adolesc Health 2017; 61:434-439. [PMID: 28754584 PMCID: PMC5898429 DOI: 10.1016/j.jadohealth.2017.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/03/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during health care transition from adolescent- to adult-centered HIV care. HIV-related health care transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers' perspectives. METHODS We examined health care transition processes through semi-structured interviews with 28 adult clinic staff across Adolescent Trials Network sites. We also collected quantitative data related to clinical characteristics and transition-specific strategies. RESULTS Overall, participants described health care transition as a "warm handoff" and a collaborative effort across adolescent and adult clinics. Emergent transition themes included adult clinical care culture (e.g., patient responsibility), strategies for connecting youth to adult care (e.g., adolescent clinic staff attending youth's first appointment at adult clinic), and approaches to evaluating transition outcomes (e.g., data sharing). Participants provided transition improvement recommendations (e.g., formalized protocols). CONCLUSIONS Using evidence-based research and a quality improvement framework to inform comprehensive and streamlined transition protocols can help enhance the capacity of adult clinics to collaborate with adolescent clinics to provide coordinated and uninterrupted HIV-related care and to improve continuum of care outcomes.
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Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina.
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York
| | - Alice Ma
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Brittany D Chambers
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, California
| | - Sonia Lee
- Maternal and Pediatric Infectious Disease Branch, National Institute of Child Health and Human Development, Bethesda, Maryland
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Miller RL, Lee KS, Chiaramonte D, Santiago-Rivera OJ, Acevedo-Polakovich I, Boyer CB, Ellen JM. Youth health outcomes from the Connect-to-Protect Coalitions to prevent adolescent HIV infections. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 13:142-157. [PMID: 29623100 PMCID: PMC5880542 DOI: 10.1080/17450128.2017.1371818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect to Protect (C2P) coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2,248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking, and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.
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Miller RL, Reed SJ, Chiaramonte D, Strzyzykowski T, Spring H, Acevedo-Polakovich ID, Chutuape K, Cooper-Walker B, Boyer CB, Ellen JM. Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:199-214. [PMID: 28851064 PMCID: PMC5678968 DOI: 10.1002/ajcp.12162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.
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Affiliation(s)
| | - Sarah J. Reed
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine
| | | | | | | | | | - Kate Chutuape
- Johns Hopkins University School of Medicine, Department of Pediatrics
| | | | - Cherrie B. Boyer
- University of California, San Francisco, Department of Pediatrics
| | - Jonathan M. Ellen
- Johns Hopkins University School of Medicine, Department of Pediatrics
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Philbin MM, Tanner AE, Chambers BD, Ma A, Ware S, Lee S, Fortenberry JD, The Adolescent Trials Network. Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers' insights to create multi-level solutions to address transition barriers. AIDS Care 2017; 29:1227-1234. [PMID: 28599596 DOI: 10.1080/09540121.2017.1338655] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n = 28) and 20 adult clinics that receive transitioning adolescents (n = 30) from August 2015-June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents' transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers' ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.
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Affiliation(s)
- Morgan M Philbin
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Amanda E Tanner
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Brittany D Chambers
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Alice Ma
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Samuella Ware
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Sonia Lee
- c Maternal and Pediatric Infectious Disease Branch , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD , USA
| | - J Dennis Fortenberry
- d Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
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A Tailored Approach to Launch Community Coalitions Focused on Achieving Structural Changes: Lessons Learned From a HIV Prevention Mobilization Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21:546-55. [PMID: 26785397 DOI: 10.1097/phh.0000000000000182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment, and access to health care. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This article describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures such as building distributed coalition leadership to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions, and recommendations for public health practitioners who are seeking to start a similar coalition.
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Boyer CB, Walker BC, Chutuape KS, Roy J, Fortenberry JD. Creating Systems Change to Support Goals for HIV Continuum of Care: The Role of Community Coalitions to Reduce Structural Barriers for Adolescents and Young Adults. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2016; 15:158-179. [PMID: 27239165 PMCID: PMC4880364 DOI: 10.1080/15381501.2015.1074977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Routine population-wide HIV screening, early linkage and long-term retention in healthcare for HIV-infected individuals are key nodes of the HIV continuum of care and are essential elements of the National HIV/AIDS Strategy. Despite this, up to 80% of youth are unaware of their HIV infection status and only 29% are linked to HIV healthcare; less than half are engaged in long-term HIV healthcare, and far fewer maintain viral suppression. To fill this gap and to address the national call to action to establish a seamless system for immediate linkage to continuous and coordinated quality healthcare after diagnosis, this paper describes the processes and mechanisms by which the SMILE Program worked within the infrastructure of the ATN-affiliated Connect to Protect® (C2P) community coalitions to address structural barriers that hindered youth in their communities from being tested for HIV infection or linked and engaged in healthcare after an HIV positive diagnosis.
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Affiliation(s)
- Cherrie B. Boyer
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, CA
| | - Bendu C. Walker
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Kate S. Chutuape
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Jessica Roy
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - J. Dennis Fortenberry
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
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Chutuape KS, Muyeed AZ, Willard N, Greenberg L, Ellen JM. Adding to the HIV Prevention Portfolio - the Achievement of Structural Changes by 13 Connect to Protect ® Coalitions. GLOBAL JOURNAL OF COMMUNITY PSYCHOLOGY PRACTICE 2015; 5:1-8. [PMID: 25632407 PMCID: PMC4306189 DOI: 10.7728/0502201404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Opportunities to control risk factors that contribute to HIV transmission and acquisition extend far beyond individuals and include addressing social and structural determinants of HIV risk, such as inadequate housing, poor access to healthcare and economic insecurity. The infrastructure within communities, including the policies and practices that guide institutions and organizations, should be considered crucial targets for change. This paper examines the extent to which 13 community coalitions across the U.S. and Puerto Rico were able to achieve "structural change" objectives (i.e., new or modified practices or policies) as an intermediate step toward the long-term goal of reducing HIV risk among adolescents and young adults (12-24 years old). The study resulted in the completion of 245 objectives with 70% categorized as structural in nature. Coalitions targeted social services, education and government as primary community sectors to adopt structural changes. A median of 12 key actors and six new key actors contributed to accomplishing structural changes. Structural change objectives required a median of seven months to complete. The structural changes achieved offer new ideas for community health educators and practitioners seeking to bolster their HIV prevention agenda.
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Affiliation(s)
- Kate S Chutuape
- Project Director for Connect to Protect at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Adaline Z Muyeed
- Senior Epidemiologist and Project Director at Westat in Rockville, MD, USA
| | - Nancy Willard
- public health researcher at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - Jonathan M Ellen
- Protocol Chair and President of All Children's Hospital in St. Petersburg, FL, USA
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10
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Boyer CB, Robles-Schrader GM, Li SX, Miller RL, Korelitz J, Price GN, Rivera Torres CM, Chutuape KS, Stines SJ, Straub DM, Peralta L, Febo I, Hightow-Weidman L, Gonin R, Kapogiannis BG, Ellen JM. A comparison of network-based strategies for screening at-risk Hispanic/Latino adolescents and young adults for undiagnosed asymptomatic HIV infection. J Adolesc Health 2014; 55:765-73. [PMID: 25223476 PMCID: PMC4252839 DOI: 10.1016/j.jadohealth.2014.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Hispanic/Latino adolescents and young adults are disproportionately impacted by the HIV/AIDS epidemic; yet little is known about the best strategies to increase HIV testing in this group. Network-based approaches are feasible and acceptable means for screening at-risk adults for HIV infection, but it is unknown whether these approaches are appropriate for at-risk young Hispanics/Latinos. Thus, we compared an alternative venue-based testing (AVT) strategy with a social and sexual network-based interviewing and HIV testing (SSNIT) strategy. METHODS All participants were Hispanics/Latinos aged 13-24 years with self-reported HIV risk; they were recruited from 11 cities in the United States and Puerto Rico and completed an audio computer-assisted self-interview and underwent HIV screening. RESULTS A total of 1,596 participants (94.5% of those approached) were enrolled: 784 (49.1%) through AVT and 812 (50.9%) through SSNIT. HIV infection was identified in three SSNIT (.37%) and four AVT (.51%) participants (p = .7213). CONCLUSIONS Despite high levels of HIV risk, a low prevalence of HIV infection was identified with no differences by recruitment strategy. We found overwhelming support for the acceptability and feasibility of AVT and SSNIT for engaging and screening at-risk young Hispanics/Latinos. Further research is needed to better understand how to strategically implement such strategies to improve identification of undiagnosed HIV infection.
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Affiliation(s)
- Cherrie B. Boyer
- University of California, San Francisco, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, San Francisco, CA, USA
| | - Grisel M. Robles-Schrader
- University of California, San Francisco, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, San Francisco, CA, USA
| | | | | | | | | | | | | | - Stephanie J. Stines
- Childrens National Medical Center, Division of Adolescent and Young Adult Medicine, Washington, DC, USA
| | - Diane M. Straub
- University of South Florida, Division of Adolescent Medicine, Tampa, FL, USA
| | - Ligia Peralta
- University of Maryland, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Baltimore, MD, USA
| | - Irma Febo
- University of Puerto Rico, San Juan, PR, USA
| | - Lisa Hightow-Weidman
- University of North Carolina, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC, USA
| | | | - Bill G. Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Pediatric, Adolescent, and Maternal AIDS Branch (NICHD/PAMAB), Bethesda, MD, USA
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Philbin MM, Tanner AE, DuVal A, Ellen JM, Xu J, Kapogiannis B, Bethel J, Fortenberry JD. Factors affecting linkage to care and engagement in care for newly diagnosed HIV-positive adolescents within fifteen adolescent medicine clinics in the United States. AIDS Behav 2014; 18:1501-10. [PMID: 24682848 PMCID: PMC4000283 DOI: 10.1007/s10461-013-0650-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Early linkage to care and engagement in care are critical for initiation of medical interventions. However, over 50 % of newly diagnosed persons do not receive HIV-related care within 6 months of diagnosis. We evaluated a linkage to care and engagement in care initiative for HIV-positive adolescents in 15 U.S.-based clinics. Structural and client-level factors (e.g. demographic and behavioral characteristics, clinic staff and location) were evaluated as predictors of successful linkage and engagement. Within 32 months, 1,172/1,679 (69.8 %) of adolescents were linked to care of which 1,043/1,172 (89 %) were engaged in care. Only 62.1 % (1,043/1,679) of adolescents were linked and engaged in care. Linkage to care failure was attributed to adolescent, provider, and clinic-specific factors. Many adolescents provided incomplete data during the linkage process or failed to attend appointments, both associated with failure to linkage to care. Additional improvements in HIV care will require creative approaches to coordinated data sharing, as well as continued outreach services to support newly diagnosed adolescents.
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Affiliation(s)
- Morgan M Philbin
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York State Psychiatric Institute, New York, NY, USA,
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12
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Harper GW, Willard N, Ellen JM. Connect to Protect®: utilizing community mobilization and structural change to prevent HIV infection among youth. J Prev Interv Community 2014; 40:81-6. [PMID: 24188350 DOI: 10.1080/10852352.2012.660119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gary W Harper
- Department of Psychology and Master of Public Health Program, DePaul University, Chicago, Illinois, USA
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13
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Willard N, Srirojn B, Thomson N, Aramrattana A, Sherman S, Galai N, Celentano DD, Ellen JM. Coalition formation to address structural determinants of methamphetamine use in Thailand. Health Promot Int 2014; 30:782-92. [PMID: 24493782 DOI: 10.1093/heapro/dau001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite two recent government-sponsored 'wars on drugs', methamphetamine use continues to be a pervasive problem in Thailand. Out of concern for reported human rights abuses, there has been a call from the international community to take a different approach from the government's 'zero tolerance'. This paper describes the adaptation of the Connect to Protect® coalition formation process from urban U.S. cities to three districts in northern Thailand's Chiang Mai province, aimed to reduce methamphetamine use by altering the risk environment. Project materials, including manuals and materials (e.g. key actor maps and research staff memos), were reviewed to describe partnering procedures and selection criteria. Potential community partners were identified from various government and community sectors with a focus on including representatives from health, police, district and sub-district government officials. Of the 64 potential partners approached, 59 agreed to join one of three district-level coalitions. Partner makeup included 25% from the health sector, 22% who were sub-district government officials and 10% were representatives from the police sector. Key partners necessary for endorsement of and commitment to the coalition work included district-level governors, police chiefs and hospital directors for each district. Initial coalition strategic planning has resulted in policies and programs to address school retention, youth development initiatives and establishment of a new drug treatment and rehabilitation clinic in addition to other developing interventions. Similarities in building coalitions, such as the need to strategically develop buy-in with key constituencies, as well as differences of whom and how partners were identified are explored.
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Affiliation(s)
- Nancy Willard
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower Suite 4200, 5200 Eastern Avenue, Baltimore, MD 21224-2780, USA
| | - Bangorn Srirojn
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Nicholas Thomson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Apinun Aramrattana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Susan Sherman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Ellen
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Reed SJ, Miller RL, Francisco VT. The influence of community context on how coalitions achieve HIV-preventive structural change. HEALTH EDUCATION & BEHAVIOR 2013; 41:100-7. [PMID: 23855017 DOI: 10.1177/1090198113492766] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community coalition action theory (CCAT) depicts the processes and factors that affect coalition formation, maintenance, institutionalization, actions, and outcomes. CCAT proposes that community context affects coalitions at every phase of development and operation. We analyzed data from 12 Connect to Protect coalitions using inductive content analysis to examine how contextual factors (e.g., economics, collaboration, history, norms, and politics) enhance or impede coalitions' success in achieving outcomes. Consistent with CCAT, context affected the objectives that coalitions developed and those they completed. Results suggest that local prevention history and political support have particular impact on coalitions' success in creating structural changes. These data underscore the heuristic value of CCAT, yet also imply that the contextual constructs that affect outcomes are issue specific.
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Affiliation(s)
- Sarah J Reed
- 1Michigan State University, East Lansing, MI, USA
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Philbin MM, Tanner AE, Duval A, Ellen J, Kapogiannis B, Fortenberry JD. Linking HIV-positive adolescents to care in 15 different clinics across the United States: creating solutions to address structural barriers for linkage to care. AIDS Care 2013; 26:12-9. [PMID: 23777542 DOI: 10.1080/09540121.2013.808730] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Linkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent Trials Network (ATN), a linkage to care outreach worker was provided to ATN clinics. Factors related to linkage were explored to better understand how to improve retention rates and health outcomes for HIV-positive adolescents. We conducted 124 interviews with staff at 15 Adolescent Trials Network clinics to better understand linkage to care processes, barriers, and facilitators. Content analysis was conducted focusing on structural barriers to care and potential solutions, specifically at the macro-, meso-, and micro-levels. Macro-level barriers included navigating health insurance policies, transportation to appointments, and ease of collecting and sharing client-level contact information between testing agencies, local health departments and clinics; meso-level barriers included lack of youth friendliness within clinic space and staff, and duplication of linkage services; micro-level barriers included adolescents' readiness for care and adolescent developmental capacity. Staff initiated solutions included providing transportation for appointments and funding clinic visits and tests with a range of grants and clinic funds while waiting for insurance approval. However, such solutions were often ad hoc and partial, using micro-level solutions to address macro-level barriers. Comprehensive initiatives to improve linkage to care are needed to address barriers to HIV-care for adolescents, whose unique developmental needs make accessing care particularly challenging. Matching the level of structural solution to the level of structural barriers (i.e., macro-level with macro-level), such as creating policy to address needed youth healthcare entitlements versus covering uninsured patients with clinic funds is imperative to achieving the goal of increasing linkage to care rates for newly diagnosed adolescents.
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Affiliation(s)
- Morgan M Philbin
- a Department of Health, Behavior & Society , Johns Hopkins School of Public Health , Baltimore , MD , USA
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Reed SJ, Miller RL. Connect to protect and the creation of AIDS-competent communities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:255-267. [PMID: 23762979 PMCID: PMC3764995 DOI: 10.1521/aeap.2013.25.3.255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The development of community capacity is integral to reducing the burden of HIV in high-risk populations (Kippax, 2012). This study examines how coalitions addressing structural level determinants of HIV among youth are generating community capacity and creating AIDS-competent communities. AIDS-competent communities are defined as communities that can facilitate sexual behavior change, reduce HIV/AIDS–related stigma, support people living with HIV/AIDS, and cooperate in HIV–related prevention practices. This study shows how the coalitions are fostering the resources indicative of AIDS-competent communities: knowledge and skills, enhanced dialogue among relevant sectors of the community, local ownership of a problem, confidence in local strengths, solidarity or bonding social capital, and bridging partnerships. These data show that the coalitions catalyzed several outcomes aside from the completion of their structural changes. Coalition members are developing the skills, resources, and relationships that can ostensibly build a heightened community response to HIV prevention.
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Affiliation(s)
- Sarah J Reed
- Department of Psychology, Michigan State University, East Lansing, MI 48824, USA.
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Cramm JM, Phaff S, Nieboer AP. The role of partnership functioning and synergy in achieving sustainability of innovative programmes in community care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:209-15. [PMID: 23176635 DOI: 10.1111/hsc.12008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This cross-sectional study (conducted in April-May 2011) explored associations between partnership functioning synergy and sustainability of innovative programmes in community care. The study sample consisted of 106 professionals (of 244 individuals contacted) participating in 21 partnerships that implemented different innovative community care programmes in Rotterdam, The Netherlands. Partnership functioning was evaluated by assessing leadership, resources administration and efficiency. Synergy was considered the proximal outcome of partnership functioning, which, in turn, influenced the achievement of programme sustainability. On a 5-point scale of increasing sustainability, mean sustainability scores ranged from 1.9 to 4.9. The results of the regression analysis demonstrated that sustainability was positively influenced by leadership (standardised regression coefficient β = 0.32; P < 0.001) and non-financial resources (β = 0.25; P = 0.008). No significant relationship was found between administration or efficiency and programme sustainability. Partnership synergy acted as a mediator for partnership functioning and significantly affected sustainability (β = 0.39; P < 0.001). These findings suggest that the sustainability of innovative programmes in community care is achieved more readily when synergy is created between partners. Synergy was more likely to emerge with boundary-spanning leaders, who understood and appreciated partners' different perspectives, and could bridge their diverse cultures and were comfortable sharing ideas, resources and power. In addition, the acknowledgement of and ability to use members' resources were found to be valuable in engaging partners' involvement and achieving synergy in community care partnerships.
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Affiliation(s)
- Jane M Cramm
- Institute of Health Policy & Management, iBMG, Erasmus University, Rotterdam, The Netherlands.
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Tanner AE, Philbin MM, Ott MA, DuVal A, Ellen J, Kapogiannis B, Fortenberry JD. Linking HIV+ adolescents into care: The effects of relationships between local health departments and adolescent medicine clinics. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2013; 12:10.1080/15381501.2013.817280. [PMID: 24273461 PMCID: PMC3835468 DOI: 10.1080/15381501.2013.817280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The fragmentation of HIV-related diagnostic and treatment services, especially for youth, is a significant barrier for transitioning to care. The study identified key elements that affected care linkage efforts. METHODS We conducted 64 interviews across 15 clinical sites. The constant comparative method was used. RESULTS Primary linkage to care processes are illustrated through three geographically diverse case studies. Factors included: inter-agency relationships, data sharing protocols, and service duplication concerns. Program improvement strategies were discussed. CONCLUSIONS A strong, citywide network is helpful in coordinating care linkage services. These partnerships will be critical in effectively realizing the goals of the National HIV/AIDS.
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Affiliation(s)
- Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC
| | - Morgan M. Philbin
- Department of Health, Behavior & Society, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mary A. Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Anna DuVal
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jonathan Ellen
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Bill Kapogiannis
- Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Fortenberry JD, Martinez J, Rudy BJ, Monte D. Linkage to care for HIV-positive adolescents: a multisite study of the adolescent medicine trials units of the adolescent trials network. J Adolesc Health 2012; 51:551-6. [PMID: 23174464 PMCID: PMC3505853 DOI: 10.1016/j.jadohealth.2012.03.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/09/2012] [Accepted: 03/12/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE To understand linkage to care practices at sites providing clinical services to newly diagnosed HIV-positive adolescents. METHODS Qualitative analysis of detailed interviews conducted with 28 personnel involved in linkage to care at 15 sites providing specialty care to HIV-positive adolescents. RESULTS We showed that multiple models exist for linkage to care, and that both formal and informal community relationships are important for successful linkage to care. Stigma was seen as a universal issue, enhancing the importance of the balance of confidentiality and social support. Barriers to care, such as mental health issues, substance use, and transportation, are common. CONCLUSIONS We conclude that the complexity of linkage to care requires thought and planning as HIV testing is expanded to lower-risk populations.
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Affiliation(s)
- J. Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine Indianapolis, IN
| | - Jaime Martinez
- Division of Adolescent Medicine, Stroger Hospital of Cook County/CORE Center Chicago, IL
| | - Bret J Rudy
- New York University School of Medicine New York City, NY
| | - Dina Monte
- Weststat Rockville MD New York City, NY And The Adolescent Trials Network for HIV/AIDS Interventions
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Miller RL, Reed SJ, Francisco VT, Ellen JM. Conflict transformation, stigma, and HIV-preventive structural change. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2012; 49:378-92. [PMID: 21805217 PMCID: PMC3348352 DOI: 10.1007/s10464-011-9465-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.
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Affiliation(s)
- Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, 48824, USA.
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21
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Cramm JM, Nieboer AP. Disease-management partnership functioning, synergy and effectiveness in delivering chronic-illness care. Int J Qual Health Care 2012; 24:279-85. [PMID: 22302071 DOI: 10.1093/intqhc/mzs004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study explored associations among disease-management partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. DESIGN This study had a cross-sectional design. SETTING AND PARTICIPANTS The study sample consists of 218 professionals (out of 393) participating in 22 disease-management partnerships in various regions of the Netherlands. MAIN OUTCOME MEASURES We assessed the relationships among partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. Partnership functioning was assessed through leadership, resources, administration and efficiency. Synergy was considered the proximal outcome of partnership functioning, which, in turn, influenced the effectiveness of disease-management partnerships [measured with the Assessment of Chronic Illness Care (ACIC) survey instrument]. RESULTS Overall ACIC scores ranged from 3 to 10, indicating basic/intermediate to optimal/comprehensive delivery of chronic-illness care. The results of the regression analysis demonstrate that partnership effectiveness was positively associated with leadership (β = 0.25; P≤ 0.01), and resources (β = 0.31; P≤ 0.001). No significant relationship was found between administration, efficiency and partnership effectiveness. Partnership synergy acted as a mediator for partnership functioning and was statistically significantly associated with partnership effectiveness (β = 0.25; P≤ 0.001). CONCLUSION Disease-management partnerships seemed better able to deliver higher levels of chronic-illness care when synergy is created between partners. Synergy was more likely to emerge with boundary-spanning leaders who understood and appreciated partners' different perspectives, could bridge their diverse cultures and were comfortable sharing ideas, resources and power. In addition, the acknowledgement of and ability to use members' resources are valuable in engaging partners' involvement and achieving synergy in disease-management partnerships.
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Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy and Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
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Willard N, Chutuape K, Stines S, Ellen JM. Bridging the gap between individual-level risk for HIV and structural determinants: using root cause analysis in strategic planning. J Prev Interv Community 2012; 40:103-17. [PMID: 24188352 PMCID: PMC3818729 DOI: 10.1080/10852352.2012.660122] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV prevention efforts have expanded beyond individual-level interventions to address structural determinants of risk. Coalitions have been an important vehicle for addressing similar intractable and deeply rooted health-related issues. A root cause analysis process may aid coalitions in identifying fundamental, structural-level contributors to risk and in identifying appropriate solutions. For this article, strategic plans for 13 coalitions were analyzed both before and after a root cause analysis approach was applied to determine the coalitions' strategic plans potential impact and comprehensiveness. After root cause analysis, strategic plans trended toward targeting policies and practices rather than on single agency programmatic changes. Plans expanded to target multiple sectors and several changes within sectors to penetrate deeply into a sector or system. Findings suggest that root cause analysis may be a viable tool to assist coalitions in identifying structural determinants and possible solutions for HIV risk.
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Affiliation(s)
- Nancy Willard
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lin AJ, Dudek JC, Francisco VT, Castillo M, Freeman P, Martinez M, Sniecinski K, Young K, Ellen JM. Challenges and approaches to mobilizing communities for HIV prevention among young men who have sex with men of color. J Prev Interv Community 2012; 40:149-64. [PMID: 24188355 PMCID: PMC3818719 DOI: 10.1080/10852352.2012.660125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Young men who have sex with men (YMSM) of color are disproportionately impacted by HIV/AIDS in the United States. More HIV prevention interventions targeting risk factors of this group are needed, particularly at the structural level. This article focuses on Connect to Protect®: Partnerships for Youth Prevention Interventions (C2P), a multisite study employing community mobilization to decrease HIV acquisition and transmission among youth. Seven C2P sites are mobilizing their communities to prevent HIV among YMSM of color. These sites have faced a number of similar challenges. This article uses qualitative data to explore three domains relating to community mobilization at YMSM sites-forming community partnerships, maintaining the coalition, and facilitating structural-level coalition objectives. Challenges and approaches across domains illustrated themes related to stigma and discrimination, mobilization around YMSM of color, coalition participation and funding.
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Affiliation(s)
- Alison J Lin
- Department of Adolescent Medicine , Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Weiss ES, Taber SK, Breslau ES, Lillie SE, Li Y. The role of leadership and management in six southern public health partnerships: a study of member involvement and satisfaction. HEALTH EDUCATION & BEHAVIOR 2011; 37:737-52. [PMID: 20930135 DOI: 10.1177/1090198110364613] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has led to greater understanding of what is needed to create and sustain well-functioning public health partnerships. However, a partnership's ability to foster an environment that encourages broad member involvement in discussions, decision making, and activities has received scant empirical attention. This study examined the relationship between partnership members' perceptions of how well leadership and management facilitated their involvement, and their satisfaction with their role and influence within the partnership. Data came from 60 individuals who participated in two waves of a quantitative process evaluation of six southern interorganizational partnerships, formed as part of a national pilot project to increase cervical and breast cancer screening rates. Results suggested that environments fostering broad partner involvement were associated with measures of member satisfaction, controlling for other partnership characteristics. Findings indicated that facilitation of member involvement deserves increased consideration from researchers and practitioners as an indicator of the quality of partnership functioning.
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Affiliation(s)
- Elisa S Weiss
- Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Deeds BG, Peralta L, Willard N, Ellen J, Straub DM, Castor J. The role of community resource assessments in the development of 15 adolescent health community-researcher partnerships. Prog Community Health Partnersh 2010; 2:31-9. [PMID: 20208189 DOI: 10.1353/cpr.2008.0010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Connect to Protect (C2P): Partnerships for Youth Prevention Interventions is an initiative that alters the community's structural elements to reduce youth HIV rates. OBJECTIVES This study details a community resource assessment and describes how resources were evaluated in the context of local needs. METHODS Fifteen sites developed a community resource list, conducted a brief survey, created a youth service directory, and mapped where disease prevalence and community resources intersected. Sites also completed a survey to review and verify local site findings. RESULTS On average, sites identified 267 potential community resources. Sites narrowed their resource list to conduct a brief survey with 1,162 agencies; the site average was 78. Final products of this process included maps comparing resources with risk data. CONCLUSIONS The evaluation of local resources is an important initial step in partnership development and is essential for the success of health promotion and disease prevention interventions that target adolescents.
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Chutuape KS, Willard N, Sanchez K, Straub DM, Ochoa TN, Howell K, Rivera C, Ramos I, Ellen JM. Mobilizing communities around HIV prevention for youth: how three coalitions applied key strategies to bring about structural changes. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:15-27. [PMID: 20166784 PMCID: PMC2850206 DOI: 10.1521/aeap.2010.22.1.15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Increasingly, HIV prevention efforts must focus on altering features of the social and physical environment to reduce risks associated with HIV acquisition and transmission. Community coalitions provide a vehicle for bringing about sustainable structural changes. This article shares lessons and key strategies regarding how three community coalitions located in Miami and Tampa, Florida, and San Juan, Puerto Rico engaged their respective communities in bringing about structural changes affecting policies, practices and programs related to HIV prevention for 12-24-year-olds. Outcomes of this work include increased access to HIV testing and counseling in the juvenile correctional system (Miami), increased monitoring of sexual abuse between young women and older men within public housing, and support services to deter age discordant relationships (Tampa) and increased access to community-based HIV testing (San Juan).
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Affiliation(s)
- Kate S Chutuape
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
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Ziff MA, Willard N, Harper GW, Bangi AK, Johnson J, Ellen JM. Connect to Protect Researcher-Community Partnerships: Assessing Change in Successful Collaboration Factors over Time. ACTA ACUST UNITED AC 2010; 1:32-39. [PMID: 21152354 DOI: 10.7728/0101201004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Fifteen research sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions launched Connect to Protect community coalitions in urban areas across the United States and in Puerto Rico. Each coalition has the same overarching goal: Reducing local youth HIV rates by changing community structural elements such as programs, policies, and practices. These types of transformations can take significant amounts of time to achieve; thus, ongoing successful collaboration among coalition members is critical for success. As a first step toward building their coalitions, staff from each research site invited an initial group of community partners to take part in Connect to Protect activities. In this paper, we focus on these researcher-community partnerships and assess change in collaboration factors over the first year. Respondents completed the Wilder Collaboration Factors Inventory at five time points, approximately once every two to three months. Results across all fifteen coalitions show significant and positive shifts in ratings of process/structure (p<.05). This suggests that during the first year they worked together, Connect to Protect researcher-community partners strengthened their group infrastructures and operating procedures. The findings shed light on how collaboration factors evolve during coalition formation and highlight the need for future research to examine change throughout subsequent coalition phases.
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Affiliation(s)
- Mauri A Ziff
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland
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