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Jiménez AL, Cruz-Gonzalez M, Forsyth Calhoun T, Cohen L, Alegría M. Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2024; 30:22-34. [PMID: 35113605 PMCID: PMC9519187 DOI: 10.1037/cdp0000524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults. METHOD Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors. RESULTS 28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only. CONCLUSIONS There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Aida L. Jiménez
- Department of Psychology, University of Puerto Rico, San
Juan, Puerto Rico
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
| | | | - Lauren Cohen
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
- Departments of Medicine and Psychiatry, Harvard Medical
School
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Duamor CT, Hampson K, Lankester F, Lugelo A, Mpolya E, Kreppel K, Cleaveland S, Wyke S. Development, feasibility and potential effectiveness of community-based continuous mass dog vaccination delivery strategies: Lessons for optimization and replication. PLoS Negl Trop Dis 2022; 16:e0010318. [PMID: 36067231 PMCID: PMC9481168 DOI: 10.1371/journal.pntd.0010318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/16/2022] [Accepted: 08/22/2022] [Indexed: 12/25/2022] Open
Abstract
Objectives Dog vaccination can eliminate rabies in dogs, but annual delivery strategies do not sustain vaccination coverage between campaigns. We describe the development of a community-based continuous mass dog vaccination (CBC-MDV) approach designed to improve and maintain vaccination coverage in Tanzania and examine the feasibility of delivering this approach as well as lessons for its optimization. Methods We developed three delivery strategies of CBC-MDV and tested them against the current annual vaccination strategy following the UK Medical Research Council’s guidance: i) developing an evidence-based theoretical framework of intervention pathways and ii) piloting to test feasibility and inform optimization. For our process evaluation of CBC-MDV we collected data using non-participant observations, meeting reports and implementation audits and in-depth interviews, as well as household surveys of vaccination coverage to assess potential effectiveness. We analyzed qualitative data thematically and quantitative data descriptively. Results The final design included delivery by veterinary teams supported by village-level one health champions. In terms of feasibility, we found that less than half of CBC-MDV’s components were implemented as planned. Fidelity of delivery was influenced by the strategy design, implementer availability and appreciation of value intervention components, and local environmental and socioeconomic events (e.g. elections, funerals, school cycles). CBC-MDV activities decreased sharply after initial campaigns, partly due to lack of supervision. Community engagement and involvement was not strong. Nonetheless, the CBC-MDV approaches achieved vaccination coverage above the critical threshold (40%) all-year-round. CBC-MDV components such as identifying vaccinated dogs, which village members work as one health champions and how provision of continuous vaccination is implemented need further optimization prior to scale up. Interpretation CBC-MDV is feasible to deliver and can achieve good vaccination coverage. Community involvement in the development of CBC-MDV, to better tailor components to contextual situations, and improved supervision of activities are likely to improve vaccination coverage in future. Annual mass dog vaccination campaigns that reach at least 70% of the dog population, should maintain sufficient herd immunity (sustain vaccination coverage above 40%) between campaigns to interrupt rabies transmission. However, it is often challenging to reach 70% of the dog population with annual vaccination campaigns. We hypothesized that a community-based continuous approach to dog vaccination could better maintain high levels of vaccination coverage all-year-round. We describe the development of a community-based continuous approach to dog vaccination in Tanzania, and assessed the feasibility of delivering its components, its potential effectiveness and lessons for its optimization. We found that the approach was well accepted, as its development involved key stakeholders. Although less than half of the components of the community-based continuous approach were delivered exactly as planned, over 70% of dogs were vaccinated and the approach maintained coverage above the critical vaccination threshold throughout the year. We conclude that it is feasible to deliver a community-based continuous approach to dog vaccination, but that some components need further improvement; more supervision and community involvement should lead to better outcomes.
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Affiliation(s)
- Christian Tetteh Duamor
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha–Tanzania
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute–Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Felix Lankester
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
- Global Animal Health Tanzania, Arusha, Tanzania
| | - Ahmed Lugelo
- Sokoine University of Agriculture, Morongoro–Tanzania
| | - Emmanuel Mpolya
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha–Tanzania
| | - Katharina Kreppel
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha–Tanzania
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sally Wyke
- School of Social and Political Sciences, School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
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Stanton MC, Ali SB, McCormick K. Harm reduction implementation among HIV service organizations (HSOs) in the U.S. south: a policy context analysis and results from a survey of HSOs. BMC Health Serv Res 2022; 22:913. [PMID: 35831861 PMCID: PMC9281157 DOI: 10.1186/s12913-022-08277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV service organizations are integral to serving communities disproportionately impacted by the HIV and opioid epidemics in the U.S. South. Addressing these intersecting epidemics requires implementation of evidence-based approaches, such as harm reduction. However, little is known about the extent to which Southern HIV service organizations implement harm reduction. This manuscript examines: 1) the implementation context of harm reduction in the South, 2) Southern HIV service organization implementation of harm reduction, and 3) the impact of different contexts within the South on HIV service organization implementation of harm reduction. METHODS To examine implementation context, authors analyzed nation-wide harm reduction policy and drug-related mortality data. To examine HIV service organization implementation of harm reduction, authors performed frequency distributions on survey data (n = 207 organizations). Authors then constructed logistic regressions, using state mortality data and policy context as predictors, to determine what contextual factors predicted HIV service organization implementation of harm reduction. RESULTS Drug-related mortality data revealed an increased need for harm reduction, and harm reduction policy data revealed an increased political openness to harm reduction. Frequency distributions revealed that approximately half of the HIV service organizations surveyed reported that their organizations reflect a harm reduction orientation, and only 26% reported providing harm reduction services. Despite low utilization rates, HIV service organizations indicated a strong interest in harm reduction. Logistic regressions revealed that while increased mortality rates do not predict HIV service organization implementation of harm reduction, a harm reduction-friendly policy context does. DISCUSSION This study highlights how regions within a high-income country can face unique barriers to healthcare and therefore require a unique understanding of implementation context. Study findings indicate a rapidly changing implementation context where increased need meets increased political opportunity to implement harm reduction, however there is a lag in HIV service organization adoption of harm reduction. Financial resources, capacity building, and continued policy advocacy are required for increased HIV service organization adoption of harm reduction.
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Affiliation(s)
- Megan C Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA.
| | - Samira B Ali
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Katie McCormick
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA
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Robillard AG, Julious CH, Smallwood SW, Douglas M, Gaddist BW, Singleton T. Structural Inequities, HIV Community-Based Organizations, and the End of the HIV Epidemic. Am J Public Health 2022; 112:417-425. [PMID: 35196039 PMCID: PMC8887177 DOI: 10.2105/ajph.2021.306688] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/04/2022]
Abstract
Community-based organizations (CBOs) are integral to achieving the goal of Ending the HIV epidemic (EHE). Their familiarity with and proximity to communities position them to effectively implement strategies necessary to address determinants of health through their formal and informal medical and social services. However, structural inequities have contributed to the demise of many organizations that were instrumental in early responses to the HIV epidemic. We define structural inequities for HIV CBOs as systems in which policies, institutional practices, organizational (mis)representations, and other norms work to produce and maintain inequities that affect CBOs' ability to survive and thrive. In this discussion, we describe the organizational threats to grassroots HIV CBOs and the risks to livelihood and longevity, including examples. The invaluable role of HIV CBOs in EHE and their role in responding to existing and novel infectious diseases like COVID-19 should not be overlooked. Recommendations to promote structural equity are offered. (Am J Public Health. 2022;112(3):417-425. https://doi.org/10.2105/AJPH.2021.306688).
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Affiliation(s)
- Alyssa G Robillard
- At the time of the writing of this essay, Alyssa G. Robillard was with the Institute for Families in Society, University of South Carolina, and Palmetto AIDS Life Support Services, Columbia, SC. Carmen H. Julious is with Palmetto AIDS Life Support Services. Stacy W. Smallwood is with the Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Douglas was with My Brothaz HOME Inc, Savannah, GA. Bambi W. Gaddist was with South Carolina HIV Council doing business as Wright Wellness Center, Columbia. Tyler Singleton was with the University of South Carolina School of Medicine, Columbia
| | - Carmen H Julious
- At the time of the writing of this essay, Alyssa G. Robillard was with the Institute for Families in Society, University of South Carolina, and Palmetto AIDS Life Support Services, Columbia, SC. Carmen H. Julious is with Palmetto AIDS Life Support Services. Stacy W. Smallwood is with the Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Douglas was with My Brothaz HOME Inc, Savannah, GA. Bambi W. Gaddist was with South Carolina HIV Council doing business as Wright Wellness Center, Columbia. Tyler Singleton was with the University of South Carolina School of Medicine, Columbia
| | - Stacy W Smallwood
- At the time of the writing of this essay, Alyssa G. Robillard was with the Institute for Families in Society, University of South Carolina, and Palmetto AIDS Life Support Services, Columbia, SC. Carmen H. Julious is with Palmetto AIDS Life Support Services. Stacy W. Smallwood is with the Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Douglas was with My Brothaz HOME Inc, Savannah, GA. Bambi W. Gaddist was with South Carolina HIV Council doing business as Wright Wellness Center, Columbia. Tyler Singleton was with the University of South Carolina School of Medicine, Columbia
| | - Mark Douglas
- At the time of the writing of this essay, Alyssa G. Robillard was with the Institute for Families in Society, University of South Carolina, and Palmetto AIDS Life Support Services, Columbia, SC. Carmen H. Julious is with Palmetto AIDS Life Support Services. Stacy W. Smallwood is with the Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Douglas was with My Brothaz HOME Inc, Savannah, GA. Bambi W. Gaddist was with South Carolina HIV Council doing business as Wright Wellness Center, Columbia. Tyler Singleton was with the University of South Carolina School of Medicine, Columbia
| | - Bambi W Gaddist
- At the time of the writing of this essay, Alyssa G. Robillard was with the Institute for Families in Society, University of South Carolina, and Palmetto AIDS Life Support Services, Columbia, SC. Carmen H. Julious is with Palmetto AIDS Life Support Services. Stacy W. Smallwood is with the Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Douglas was with My Brothaz HOME Inc, Savannah, GA. Bambi W. Gaddist was with South Carolina HIV Council doing business as Wright Wellness Center, Columbia. Tyler Singleton was with the University of South Carolina School of Medicine, Columbia
| | - Tyler Singleton
- At the time of the writing of this essay, Alyssa G. Robillard was with the Institute for Families in Society, University of South Carolina, and Palmetto AIDS Life Support Services, Columbia, SC. Carmen H. Julious is with Palmetto AIDS Life Support Services. Stacy W. Smallwood is with the Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Douglas was with My Brothaz HOME Inc, Savannah, GA. Bambi W. Gaddist was with South Carolina HIV Council doing business as Wright Wellness Center, Columbia. Tyler Singleton was with the University of South Carolina School of Medicine, Columbia
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Belden M, Reif S, Cooper H, Shilling S, Mouhanna F, Hipp P, Siegler A. The geographic reach of community-based organizations in addressing HIV-related stigma in the Deep South. AIDS Care 2022; 34:60-68. [PMID: 34632864 PMCID: PMC8758532 DOI: 10.1080/09540121.2021.1978379] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/25/2021] [Indexed: 01/03/2023]
Abstract
Community-based organizations (CBOs) have been instrumental in addressing the needs of people living with HIV, however, little is known about their efforts to address HIV-related stigma through stigma reduction efforts. This study examined practices of CBOs related to mitigating HIV-related stigma in nine Deep South states. CBOs were surveyed as part of a larger study through the Gilead COMPASS Initiative. The CBO survey asked CBO leadership about stigma in their communities and services available to address this stigma. Survey respondents (n = 207) indicated that HIV-related stigma was perceived as a substantial barrier to both HIV care and CBO services. Although just over two-thirds of survey participants reported that there were group-level programs to address HIV-related stigma, 73% reported that there were not enough interventions to meet the need in their community. Further, 68% reported a lack of individual-level stigma reduction interventions. A majority reported a lack of public media campaigns to address stigma and a lack of training available to assist CBOs to address stigma. In addition, services to address stigma were reportedly less available in rural areas compared to their urban counterparts. Study findings indicate a need to identify, implement, and scale-up effective interventions to reduce HIV stigma in the US Deep South.
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Affiliation(s)
- Micha Belden
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Haley Cooper
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Sara Shilling
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Farah Mouhanna
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Palmer Hipp
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ventuneac A, Li DH, Mongrella MC, Moskowitz DA, Weingardt KR, Brown CH, Parsons JT, Mustanski B. Exploring potential implementation barriers and facilitators of the SMART Program, a stepped-care package of eHealth HIV prevention interventions for adolescent men who have sex with men. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2020; 17:378-388. [PMID: 32884583 PMCID: PMC7462358 DOI: 10.1007/s13178-019-00402-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about how to best implement eHealth HIV interventions for adolescent men who have sex with men (AMSM) in real-world settings. In response, our current study describes formative implementation research with community-based organizations (CBOs) in preparation for future implementation of the SMART Program, a stepped-care package of three interventions adapted for AMSM. In-depth interviews focusing on eHealth implementation were conducted with a convenience sample of 12 stakeholders from nine CBOs that actively implemented sexual-minority-focused HIV/AIDS prevention programs. Qualitative analysis was conducted using Dedoose to identify salient themes. Most programs implemented at the CBOs engaged adult MSM for HIV prevention, but CBOs reported less experience with outreach of AMSM for HIV prevention. While comfortable with and skilled at implementing traditional in-person HIV prevention programs, interviewees reported that eHealth programs fell outside of their organizations' technical capacities. They suggested specific strategies to facilitate successful implementation of SMART and other eHealth programs, including technical-capacity-building at CBOs, better training of staff, and partnering with a national coordinating center that provides support for the technology. Overall, the CBOs reported enthusiasm for the SMART Program and thought it an efficient way to bridge their current gaps in online programming and lack of AMSM HIV prevention strategies.
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Affiliation(s)
- Ana Ventuneac
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, New York, NY, USA
| | - Dennis H. Li
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Melissa C. Mongrella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - David A. Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | | | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Northwestern University, Chicago, IL, USA
| | - Jeffrey T. Parsons
- Department of Psychology, Hunter College and the Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Northwestern University, Chicago, IL, USA
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7
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D’Angelo AB, Lopez-Rios J, Flynn AWP, Pantalone DW, Holloway IW, Grov C. What motivates gay and bisexual men to participate in PrEP-related research? INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2019; 31:283-290. [PMID: 32864033 PMCID: PMC7454037 DOI: 10.1080/19317611.2019.1634173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/24/2019] [Accepted: 06/16/2019] [Indexed: 06/01/2023]
Abstract
Pre-Exposure Prophylaxis (PrEP) has been demonstrated effective at preventing HIV among key populations like gay and bisexual men (GBM). Yet, there remains a continued need to engage GBM in PrEP behavioral and clinical research (e.g., to monitor adherence and retention in the PrEP treatment cascade). We report on the factors motivating GBM to participate in a PrEP behavioral study, with the aim of our results to inform future recruitment efforts for future PrEP research. In 2015-2016, 103 PrEP-using GBM in NYC completed qualitative interviews about their experiences on PrEP. Participants were also asked about factors that motivated them to join the study. Thematic analysis was used analyze the data. We identified five salient themes as rationale for joining the study: 58.3% cited altruistic reasons, 32% reported intellectual curiosity in the subject matter, 30.1% indicated that remuneration inspired them, 18.4% indicated that familiarity or referral to the research institute influenced their decision. Researchers attempting to enroll PrEP-using GBM may benefit from attending to the altruistic and intellectually curious nature of this population. Further, researchers may benefit from establishing familiarity among diverse communities of GBM. This in turn may contribute to the successful engagement of GBM for PrEP research.
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Affiliation(s)
- Alexa B. D’Angelo
- CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - Javier Lopez-Rios
- CUNY Graduate School of Public Health and Health Policy, New York, NY
| | | | - David W. Pantalone
- University of Massachusetts Boston, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | | | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
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Quinn KG, Wolfe H, Vergeront J. "Don't Deny Yourself a Seat at the Table": Supporting the Leadership Development of MSM of Color in HIV Services. Health Promot Pract 2019; 21:838-848. [PMID: 31148482 DOI: 10.1177/1524839919850563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIDS service organizations have played a vital role in responding to the HIV epidemic, yet many are plagued by an underrepresentation of racial, ethnic, and sexual minorities in leadership positions. In response, the Wisconsin Department of Health Services, HIV Division, created the Wisconsin Health Leaders Fellowship program to provide training and skills to gay and bisexual men of color in HIV service organizations in Milwaukee, Wisconsin. The program was evaluated using in-depth pre- and post-Fellowship interviews with fellows, their agency preceptors, and Fellowship staff (n = 23 interviews). Results indicate that the Fellowship was successful at developing leadership skills and increasing the confidence of the fellows. However, findings revealed the need to address larger social and structural issues alongside supporting individuals in order to create effective, sustainable change. There is a need for cultural diversity trainings for organizational leaders, changes to organizational hiring and promotion practices, and improving opportunities for formal education for racial and ethnic minority men.
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Affiliation(s)
| | - Hester Wolfe
- Wisconsin Department of Health Services, Madison, WI, USA
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Salazar X, Núnez-Curto A, Villayzán Aguilar J, Lusquiños M, Motta Ochoa A, Cáceres CF. Confluent paths: Research and community participation to protect the right to health among transgender women in Peru. Glob Public Health 2019; 14:954-962. [PMID: 30929572 DOI: 10.1080/17441692.2019.1599982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The recognition of transgender women (TGW) as the most vulnerable population to HIV/AIDS in Peru and their inclusion as a specific key affected population in health research was the outcome of an extended process that culminated when TGW community organisations succeeded in articulating themselves as a population separate from men who have sex with men (MSM) and, in alliance with some academic research groups, documented their HIV prevalence and vulnerability factors. Prior to that process, TGW remained subsumed under the epidemiological category of men who have sex with men (MSM), invisible in the context of public health policies. Based on a growing body of academic research evidence, coupled with the increasing number and capacities of TGW representatives in technical and policy-related gatherings, a consensus emerged for the establishment of TGW health statistics separate from MSM by 2010. During the past decade, social and health research has contributed conclusive evidence on the living conditions of TGW and the structural barriers they face, beyond the focus of HIV/AIDS research. Despite such progress, pervasive barriers in public policies continue to hinder the use of existing research evidence and community experience in the development of sensitive HIV prevention and care strategies as part of a comprehensive health model for TGW in Peru.
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Affiliation(s)
- Ximena Salazar
- a Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Arón Núnez-Curto
- a Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia , Lima , Peru
| | | | | | - Angélica Motta Ochoa
- a Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Carlos F Cáceres
- a Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia , Lima , Peru
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Shapatava E, Rios A, Shelley G, Milan J, Smith S, Uhl G. Community-Based Organization Adaptations to the Changing HIV Prevention and Care Landscape in the Southern United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:516-527. [PMID: 30966767 DOI: 10.1521/aeap.2018.30.6.516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Community-based organizations (CBOs) provide HIV prevention services throughout the United States, including the South where HIV/AIDS burden is high. We assessed Southern CBO response to changes in the HIV prevention landscape, including the National HIV/AIDS Strategy, and the Centers for Disease Control and Prevention's (CDC's) High Impact Prevention. Both strategies aim to improve outcomes for people living with or at high risk for HIV. Inductive qualitative analysis of interviews and consultations with CBOs, capacity building assistance providers, and CDC staff revealed CBOs are building clinical service capacity and cross-agency partnerships to adapt, but face inadequate or reduced funding. A holistic approach to HIV prevention and care in the South is critical, where stigma and other socio-structural factors limit health care options for persons affected by HIV. Health care organizations may benefit by partnering with CBOs because CBOs have the skillsets and community rapport to effectively improve health outcomes of persons living with HIV.
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Affiliation(s)
- Ekaterine Shapatava
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Gene Shelley
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Shuenae Smith
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gary Uhl
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lindeman PT, Bettin E, Beach LB, Adames CN, Johnson AK, Kern D, Stonehouse P, Greene GJ, Phillips G. Evaluation capacity building-Results and reflections across two years of a multisite empowerment evaluation in an HIV prevention context. EVALUATION AND PROGRAM PLANNING 2018; 71:83-88. [PMID: 30223173 DOI: 10.1016/j.evalprogplan.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
As the need for rigorous evidence of program efficacy increases, integrating evaluation activities into program implementation is becoming crucial. As a result, external evaluators are placing increased focus on evaluation capacity building as a practice. However, empirical evidence of how to foster evaluation capacity in different contexts remains limited. This study presents findings from an evaluation capacity survey conducted within a multisite Empowerment Evaluation initiative, in which an external evaluator worked with 20 project teams at diverse community agencies implementing HIV prevention projects. Survey results revealed representatives from project teams (n = 33) reported significantly higher overall evaluation capacity after engaging with the external evaluator on planning and implementing their evaluation. Improvements differed across organization type, intervention type, staff position, and reported engagement on various activities throughout the course of the evaluation. Results indicated empowerment evaluation and other stakeholder-focused evaluation approaches are broadly applicable when evaluation capacity building is a desired outcome, particularly when able to engage project staff in the planning of the evaluation and in delivering technical assistance services. Accordingly, efforts should be made by program funders, staff, and evaluators to encourage active engagement starting in the early stages of program and evaluation planning.
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Affiliation(s)
- Peter T Lindeman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14thFloor, Chicago, IL, 60611, USA.
| | - Emily Bettin
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14thFloor, Chicago, IL, 60611, USA.
| | - Lauren B Beach
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14thFloor, Chicago, IL, 60611, USA.
| | - Christian N Adames
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14thFloor, Chicago, IL, 60611, USA.
| | - Amy K Johnson
- Center for Gender, Sexuality and HIV Prevention, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL, 60611, USA; AIDS Foundation of Chicago, 200 W. Jackson Blvd. #2100, Chicago, IL, 60606, USA.
| | - Dave Kern
- HIV/STI Bureau, Chicago Department of Public Health, 333 S. State Street, Chicago, IL, 60604, USA.
| | - Patrick Stonehouse
- HIV/STI Bureau, Chicago Department of Public Health, 333 S. State Street, Chicago, IL, 60604, USA.
| | - George J Greene
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14thFloor, Chicago, IL, 60611, USA.
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14thFloor, Chicago, IL, 60611, USA.
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12
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Implementation of Evidence-Based HIV Interventions for Gay, Bisexual, and Other Men Who Have Sex with Men. AIDS Behav 2017; 21:3000-3012. [PMID: 28597344 DOI: 10.1007/s10461-017-1813-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Centers for Disease Control and Prevention provides trainings to support implementation of five evidence-based HIV prevention interventions (EBIs) for men who have sex with men (MSM): d-up: Defend Yourself!; Many Men, Many Voices; Mpowerment; Personalized Cognitive Counseling; and Popular Opinion Leader. We evaluated trainees' implementation of these EBIs and, using multivariable logistic regression, examined factors associated with implementation. Approximately 43% of trainees had implemented the EBIs for which they received training. Implementation was associated with working in community-based organizations (vs. health departments or other settings); acquiring training for Mpowerment or Popular Opinion Leader (vs. Personalized Cognitive Counseling); having ≥3 funding sources (vs. one); and having (vs. not having) sufficient time and necessary EBI resources. Findings suggest that implementation may vary by trainee characteristics, especially those related to employment setting, EBI training, funding, and perceived implementation barriers. Efforts that address these factors may help to improve EBI implementation among trainees.
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Asiimwe S, Ross JM, Arinaitwe A, Tumusiime O, Turyamureeba B, Roberts DA, O’Malley G, Barnabas RV. Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers. J Int AIDS Soc 2017; 20:21633. [PMID: 28770598 PMCID: PMC5577731 DOI: 10.7448/ias.20.5.21633] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/25/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Achieving the UNAIDS goals of 90-90-90 will require more than doubling the number of people accessing HIV care in Uganda. Community-based programmes for entry into HIV care are effective strategies to expand access to HIV care, but few programmes have been evaluated with a particular focus on scale-up. METHODS Integrated Community Based Initiatives, a Uganda-based non-governmental organization, designed and implemented a programme of community-based HIV counselling and testing and facilitated linkage to care utilizing community health extension workers (CHEWs) in rural Sheema District, Uganda. CHEWs performed programme activities during 1 October 2015 through 31 March 2016. Outcomes for this evaluation were (1) the number of people tested for HIV, and (2) the proportion of those testing positive who were seen at an ART clinic within three months of their positive test, and (3) the cost of the programme per person newly diagnosed with HIV. Microcosting methods were used to calculate the programme costs. Program scalability factors were evaluated using a published framework. RESULTS Sixty-two CHEWs attended a five-day training that introduced the biology of HIV, the conduct of confidential HIV testing, HIV prevention messages, and linkage, referral, and reporting requirements. CHEWs received a $30 monthly stipend and a field testing kit that included a bicycle, field bag, umbrella, gumboots, reporting booklet, pens, and HIV testing materials. Trained CHEWs tested 43,696 persons for HIV infection during the six-month programme period. Nine-hundred seventy-four participants (2.2%) were identified as HIV positive, and 623 participants (64%) were linked to HIV care. An estimated 69% of adult residents received testing as part of this campaign. The programme cost $3.02 per person test, $135.70 per positive person identified, and $212.15 per HIV-positive person linked to care. CONCLUSIONS Lay community health extension workers (CHEWs) can be rapidly trained to scale-up home-based HIV testing and counselling (HTC) and linkage to care in a high-quality and low-cost manner to large numbers of people in a rural, high burden setting. A combination HIV testing approach, such as adding partner testing to community-based testing, could increase the proportion of HIV-positive persons identified.
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Affiliation(s)
| | - Jennifer M. Ross
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Ruanne V. Barnabas
- Departments of Global Health, Medicine (Allergy and Infectious Disease), and Epidemiology, University of Washington, Seattle, WA, USA
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Hangulu L, Akintola O. Perspectives of policy-makers and stakeholders about health care waste management in community-based care in South Africa: a qualitative study. BMC Health Serv Res 2017; 17:290. [PMID: 28424046 PMCID: PMC5395807 DOI: 10.1186/s12913-017-2236-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 04/06/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In South Africa, a new primary health care (PHC) re-engineering initiative aims to scale up the provision of community-based care (CBC). A central element in this initiative is the use of outreach teams comprising nurses and community health workers to provide care to the largely poor and marginalised communities across the country. The provision of care will inevitably lead to an increase in the amount of health care waste (HCW) generated in homes and suggests the need to pay more attention to the HCW that emanates from homes where there is care of a patient. CBC in South Africa is guided by the home-based care policy. However, this policy does not deal with issues about how HCW should be managed in CBC. This study sought to explore health care waste management (HCWM) in CBC in South Africa from the policy-makers' and stakeholders' perspective. METHODS Semi-structured interviews were conducted with 9 policy-makers and 21 stakeholders working in 29 communities in Durban, South Africa. Interviews were conducted in English; were guided by an interview guide with open-ended questions. Data was analysed thematically. RESULTS The Durban Solid waste (DSW) unit of the eThekwini municipality is responsible for overseeing all waste management programmes in communities. Lack of segregation of waste and illegal dumping of waste were the main barriers to proper management practices of HCW at household level while at the municipal level, corrupt tender processes and inadequate funding for waste management programmes were identified as the main barriers. In order to address these issues, all the policy-makers and stakeholders have taken steps to collaborate and develop education awareness programmes. They also liaise with various government offices to provide resources aimed at waste management programmes. CONCLUSIONS HCW is generated in CBC and it is poorly managed and treated as domestic waste. With the rollout of the new primary health care model, there is a greater need to consider HCWM in CBC. There is need for the Department of Health to work together with the municipality to ensure that they devise measures that will help to deal with improper HCWM in the communities.
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Affiliation(s)
- Lydia Hangulu
- Discipline of Psychology, Howard College Campus, University of KwaZulu-Natal, MTB Ground Floor, 4041 Durban, South Africa
| | - Olagoke Akintola
- Discipline of Psychology, Howard College Campus, University of KwaZulu-Natal, MTB Ground Floor, 4041 Durban, South Africa
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15
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Vosvick M, Fritz S, Henry D, Prybutok V, Sheu S, Poe J. Correlates and Racial/Ethnic Differences in Bareback Sex Among Men Who Have Sex with Men with Unknown or Negative HIV Serostatus. AIDS Behav 2016; 20:2798-2811. [PMID: 26983950 DOI: 10.1007/s10461-016-1366-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Men who have sex with men (MSM), particularly racial/ethnic minority MSM, are disproportionately affected by HIV in the United States and Texas. Bareback sex or condomless anal intercourse (CAI) can be a high HIV risk behavior. Despite this, a majority of MSM continues to engage in barebacking. Research suggests racial/ethnic differences in barebacking exist; however, these conclusions remain unclear due to insufficient sample sizes to compare racial/ethnic groups. Our cross-sectional correlational design explores barebacking correlates (substance use during sex, safe sex fatigue, and optimistic HIV treatment beliefs) within and between racial/ethnic groups among 366 MSM. Regression models are significant for Latino and African-American MSM alone and for all MSM combined, though not significant for European-American and Other Race/Ethnicity MSM alone. Our findings suggest motivations and behaviors underlying barebacking among MSM vary by racial/ethnic membership with clinical implications for informing culturally sensitive HIV interventions and prevention programs for target racial/ethnic groups.
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Affiliation(s)
- Mark Vosvick
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
| | - Sarah Fritz
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Doug Henry
- Department of Anthropology, University of North Texas, Denton, TX, USA
| | - Victor Prybutok
- Department of Information Technology & Decision Sciences, University of North Texas, Denton, TX, USA
| | - Shane Sheu
- TB/HIV/STD Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Jonathon Poe
- TB/HIV/STD Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
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16
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Smith DK, Maier E, Betts J, Gray S, Kolodziejski B, Hoover KW. What Community-Based HIV Prevention Organizations Say About Their Role in Biomedical HIV Prevention. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:426-439. [PMID: 27710082 DOI: 10.1521/aeap.2016.28.5.426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Community-based organizations (CBOs) are critical to delivery of effective HIV prevention because of their reach to key populations. This online survey of a national sample of CBOs assessed their awareness of, interest in, and resources needed to provide nonoccupational postexposure prophylaxis (nPEP), preexposure prophylaxis (PrEP), and HIV treatment as prevention (TasP). One hundred seventy-five CBOs participated: 87 clinical and 88 nonclinical CBOs. For nPEP, PrEP, and TasP, program managers reported that awareness was high (94%, 90%, 85%), meeting current client need was low (20%, 13%, 18%), and the likelihood of increasing their current provision with additional resources was somewhat high (62%, 64%, 62%). Clinical CBOs were more prepared to support expansion of these biomedical interventions than nonclinical CBOs. Meeting the information, training, and resource needs of CBOs is critical for effective collaboration to reduce the number of new HIV infections through expanded delivery of PrEP, nPEP, and TasP.
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Affiliation(s)
- Dawn K Smith
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Emily Maier
- Emory Rollins School of Public Health, Atlanta, Georgia
| | - Joshua Betts
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Simone Gray
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Brian Kolodziejski
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Karen W Hoover
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Danielson CK, McCauley JL, Gros KS, Jones AM, Barr SC, Borkman AL, Bryant BG, Ruggiero KJ. SiHLEWeb.com: Development and usability testing of an evidence-based HIV prevention website for female African-American adolescents. Health Informatics J 2016; 22:194-208. [PMID: 25167865 PMCID: PMC4344934 DOI: 10.1177/1460458214544048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African-American adolescent girls are at disproportionate risk for HIV infection. Although numerous evidence-based risk-reduction interventions exist, dissemination and implementation resources remain limited, and prevention services remain notably inaccessible to the very populations at highest risk for HIV infection. Internet delivery of HIV risk-reduction programming has promise as a mechanism for extending the reach of existing prevention efforts and overcoming barriers associated with traditional service delivery. This article (1) details the development process for the creation of SiHLEWeb, a web-adapted version of an evidence-based, culturally informed HIV prevention program traditionally delivered to female African-American adolescents via an in-person group format, and (2) presents findings from quantitative and qualitative usability testing conducted among 18 African-American girls (13-18 years). Results suggest that users found the website improved knowledge and learning, was helpful, efficient to use, and generally attractive. Users reported some concerns about website navigation. Implications for Internet delivery of health prevention programming are discussed.
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Affiliation(s)
| | | | | | | | - Simone C Barr
- The University of Texas Medical School at Houston, USA
| | | | | | - Kenneth J Ruggiero
- Medical University of South Carolina (MUSC), USA; Ralph H. Johnson VA Medical Center, USA
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18
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Mckay VR, Dolcini MM, Conte KP, Catania JA. ADAPTATIONS TO AN HIV COUNSELING AND TESTING INTERVENTION FROM A COUNSELOR PERSPECTIVE. JOURNAL OF COMMUNITY PSYCHOLOGY 2014; 42:891-906. [PMID: 32341602 PMCID: PMC7184937 DOI: 10.1002/jcop.21659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Understanding the balance between fidelity and adaptation for evidence-based interventions has the potential to improve their translation from research to practice. The Translation into Practice study explores variation in program implementation within organizations utilizing the RESPECT program, an HIV counseling and testing intervention. Counselors (N = 70) were interviewed using a semistructured interview guide to examine both the influential factors on, and the subsequent adaptations to, RESPECT. Almost all counselors reported making adaptations (N = 69). Adaptations were made both to key characteristics (mean [M] = 2.24, standard deviation [SD] = 1.3) and to core components (M = 0.5, SD = 0.8). Counselors identified the environmental context and factors within the counseling context as common influences leading to adaptation. These findings suggest adaptations were a routine part of program usage. To improve implementation of the RESPECT program, further research is needed to assess the degree to which adaptations can be made to better meet the needs of agencies and clients without compromising fidelity.
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Guta A, Strike C, Flicker S, Murray SJ, Upshur R, Myers T. Governing through community-based research: lessons from the Canadian HIV research sector. Soc Sci Med 2014; 123:250-61. [PMID: 25074512 DOI: 10.1016/j.socscimed.2014.07.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 05/22/2014] [Accepted: 07/12/2014] [Indexed: 11/20/2022]
Abstract
The "general public" and specific "communities" are increasingly being integrated into scientific decision-making. This shift emphasizes "scientific citizenship" and collaboration between interdisciplinary scientists, lay people, and multi-sector stakeholders (universities, healthcare, and government). The objective of this paper is to problematize these developments through a theoretically informed reading of empirical data that describes the consequences of bringing together actors in the Canadian HIV community-based research (CBR) movement. Drawing on Foucauldian "governmentality" the complex inner workings of the impetus to conduct collaborative research are explored. The analysis offered surfaces the ways in which a formalized approach to CBR, as promoted through state funding mechanisms, determines the structure and limits of engagement while simultaneously reinforcing the need for finer grained knowledge about marginalized communities. Here, discourses about risk merge with notions of "scientific citizenship" to implicate both researchers and communities in a process of governance.
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DiClemente RJ, Jackson JM. Towards an integrated framework for accelerating the end for the global HIV epidemic among young people. SEX EDUCATION 2014; 14:609-621. [PMID: 25197260 PMCID: PMC4153437 DOI: 10.1080/14681811.2014.901214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
For decades the HIV epidemic has exacted an enormous toll worldwide. However, trend analyses have discerned significant declines in the overall prevalence of HIV over the last two decades. More recently, advances in biomedical, behavioural, and structural interventions offer considerable promise in the battle against generalised epidemics. Despite advances in the prevention of transmission and new infections, morbidity and mortality of HIV among young people remains a considerable concern for individuals, couples, families, communities, practitioners, and policy makers around the globe. To accelerate the end of the global HIV epidemic among young people, we must merge existing efficacious interventions with more novel, cost-effective implementation strategies to develop integrated, multilevel combination interventions. The benefits of conceptualising the HIV epidemic more broadly and adopting ecological frameworks for the development of HIV prevention programmes are critical.
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Affiliation(s)
- Ralph J. DiClemente
- Department of Behavioral Sciences & Health Education, Center for AIDS Research, Prevention Sciences & Epidemiology Core, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Rachlis B, Sodhi S, Burciul B, Orbinski J, Cheng AHY, Cole D. A taxonomy for community-based care programs focused on HIV/AIDS prevention, treatment, and care in resource-poor settings. Glob Health Action 2013; 6:1-21. [PMID: 23594416 PMCID: PMC3629264 DOI: 10.3402/gha.v6i0.20548] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 11/25/2022] Open
Abstract
Community-based care (CBC) can increase access to key services for people affected by HIV/AIDS through the mobilization of community interests and resources and their integration with formal health structures. Yet, the lack of a systematic framework for analysis of CBC focused on HIV/AIDS impedes our ability to understand and study CBC programs. We sought to develop taxonomy of CBC programs focused on HIV/AIDS in resource-limited settings in an effort to understand their key characteristics, uncover any gaps in programming, and highlight the potential roles they play. Our review aimed to systematically identify key CBC programs focused on HIV/AIDS in resource-limited settings. We used both bibliographic database searches (Medline, CINAHL, and EMBASE) for peer-reviewed literature and internet-based searches for gray literature. Our search terms were ‘HIV’ or ‘AIDS’ and ‘community-based care’ or ‘CBC’. Two co-authors developed a descriptive taxonomy through an iterative, inductive process using the retrieved program information. We identified 21 CBC programs useful for developing taxonomy. Extensive variation was observed within each of the nine categories identified: region, vision, characteristics of target populations, program scope, program operations, funding models, human resources, sustainability, and monitoring and evaluation strategies. While additional research may still be needed to identify the conditions that lead to overall program success, our findings can help to inform our understanding of the various aspects of CBC programs and inform potential logic models for CBC programming in the context of HIV/AIDS in resource-limited settings. Importantly, the findings of the present study can be used to develop sustainable HIV/AIDS-service delivery programs in regions with health resource shortages.
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Affiliation(s)
- Beth Rachlis
- Global Health Division Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Kerr ZY, Miller KR, Galos D, Love R, Poole C. Challenges, coping strategies, and recommendations related to the HIV services field in the HAART era: a systematic literature review of qualitative studies from the United States and Canada. AIDS Patient Care STDS 2013; 27:85-95. [PMID: 23336722 DOI: 10.1089/apc.2012.0356] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Qualitative research methods have been utilized to study the nature of work in the HIV services field. Yet current literature lacks a Highly Active Anti-Retroviral Treatment (HAART) era compendium of qualitative research studying challenges and coping strategies in the field. This study systematically reviewed challenges and coping strategies that qualitative researchers observed in the HIV services field during the HAART era, and their recommendations to organizations. Four online databases were searched for peer-reviewed research that utilized qualitative methods, were published from January 1998 to February 2012, utilized samples of individuals in the HIV services field; occurred in the U.S. or Canada, and contained information related to challenges and/or coping strategies. Abstracts were identified (n=846) and independently read and coded for inclusion by at least two of the four first authors. Identified articles (n=26) were independently read by at least two of the four first authors who recorded the study methodology, participant demographics, challenges and coping strategies, and recommendations. A number of challenges affecting those in the HIV services field were noted, particularly interpersonal and organizational issues. Coping strategies were problem- and emotion-focused. Summarized research recommendations called for increased support, capacity-building, and structural changes. Future research on challenges and coping strategies must provide up-to-date information to the HIV services field while creating, implementing, and evaluating interventions to manage current challenges and reduce the risk of burnout.
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Affiliation(s)
- Zachary Y. Kerr
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Katye R. Miller
- Student Wellness Center, Office of Student Life, The Ohio State University, Columbus, Ohio
| | - Dylan Galos
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Randi Love
- Division of Health Behavior/Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Rodriguez-García R, Wilson D, York N, Low C, N'Jie N, Bonnel R. Evaluation of the community response to HIV and AIDS: learning from a portfolio approach. AIDS Care 2013; 25 Suppl 1:S7-19. [PMID: 23745633 PMCID: PMC4003575 DOI: 10.1080/09540121.2013.764395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/30/2012] [Indexed: 10/26/2022]
Abstract
While communities have played a large role in the HIV/AIDS response, their contributions and innovative approaches to HIV prevention, treatment, care and support have not always been the focus of systematic and rigorous evaluations. To address this gap, the World Bank led an evaluation of the impact of the community response to HIV, including country studies in Burkina Faso, India, Kenya, Lesotho, Nigeria, Senegal, South Africa and Zimbabwe over a three-year period. Due to the complexity and varied nature of community responses, the evaluation attempted to determine the results that investments have produced at the community level by applying a mixed method approach: Randomized Controlled Trials, quasi-experimental studies, qualitative studies and analytical studies including financial data. Specifically, the studies examined a typology of community response and the flow of funds to community-based organizations, while investigating the impact of the community responses on (1) knowledge and behavior, (2) use of services, (3) social transformation, and (4) HIV incidence. This editorial summarizes the results of this evaluation portfolio, finding that investments in communities have produced significant results, including, improved knowledge and behavior, and increased use of health services, and even decreased HIV incidence. Evidence on social transformation was more mixed, with community groups found to be effective only in some settings. Each study in the evaluation provides a partial view of how communities shape the local response; however, taken together they corroborate the common wisdom that communities can be a vital part of the global HIV/AIDS response.
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Wilson MG, Lavis JN, Guta A. Community-based organizations in the health sector: a scoping review. Health Res Policy Syst 2012; 10:36. [PMID: 23171160 PMCID: PMC3511187 DOI: 10.1186/1478-4505-10-36] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/25/2012] [Indexed: 11/28/2022] Open
Abstract
Community-based organizations are important health system stakeholders as they provide numerous, often highly valued programs and services to the members of their community. However, community-based organizations are described using diverse terminology and concepts from across a range of disciplines. To better understand the literature related to community-based organizations in the health sector (i.e., those working in health systems or more broadly to address population or public health issues), we conducted a scoping review by using an iterative process to identify existing literature, conceptually map it, and identify gaps and areas for future inquiry. We searched 18 databases and conducted citation searches using 15 articles to identify relevant literature. All search results were reviewed in duplicate and were included if they addressed the key characteristics of community-based organizations or networks of community-based organizations. We then coded all included articles based on the country focus, type of literature, source of literature, academic discipline, disease sector, terminology used to describe organizations and topics discussed. We identified 186 articles addressing topics related to the key characteristics of community-based organizations and/or networks of community-based organizations. The literature is largely focused on high-income countries and on mental health and addictions, HIV/AIDS or general/unspecified populations. A large number of different terms have been used in the literature to describe community-based organizations and the literature addresses a range of topics about them (mandate, structure, revenue sources and type and skills or skill mix of staff), the involvement of community members in organizations, how organizations contribute to community organizing and development and how they function in networks with each other and with government (e.g., in policy networks). Given the range of terms used to describe community-based organizations, this scoping review can be used to further map their meanings/definitions to develop a more comprehensive typology and understanding of community-based organizations. This information can be used in further investigations about the ways in which community-based organizations can be engaged in health system decision-making and the mechanisms available for facilitating or supporting their engagement.
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Affiliation(s)
- Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, ON L8S 4L6, Canada.
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Trapence G, Collins C, Avrett S, Carr R, Sanchez H, Ayala G, Diouf D, Beyrer C, Baral SD. From personal survival to public health: community leadership by men who have sex with men in the response to HIV. Lancet 2012; 380:400-10. [PMID: 22819662 PMCID: PMC3805044 DOI: 10.1016/s0140-6736(12)60834-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Community leadership and participation by gay men and men who have sex with men (MSM) have been central to the response to HIV since the beginning of the epidemic. Through a wide array of actions, engagement of MSM has been important in the protection of communities. The connection between personal and community health as drivers of health advocacy continue to be a powerful element. The passion and urgency brought by MSM communities have led to the targeting and expansion of HIV and AIDS research and programming, and have improved the synergy of health and human rights, sustainability, accountability, and health outcomes for all people affected by HIV. MSM are, however, frequently excluded from the evidence-based services that they helped to develop, despite them generally being the most effective actors in challenging environments. Without MSM community involvement, government-run health programmes might have little chance of effectively reaching communities or scaling up interventions to lessen, and ultimately end, the HIV pandemic.
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Affiliation(s)
- Gift Trapence
- Centre for the Development of People, Lilongwe, Malawi
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Gandelman A, Dolcini MM. The influence of social determinants on evidence-based behavioral interventions-considerations for implementation in community settings. Transl Behav Med 2011. [PMID: 23181146 DOI: 10.1007/s13142-011-0102-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Over the last decade, the Centers for Disease Control and Prevention's Diffusion of Effective Behavioral Interventions (DEBI) program funded several hundred community-based organizations (CBOs) and health departments in a wide-scale HIV prevention national diffusion effort. We interviewed six California agencies funded to implement one of three group-level DEBIs to identify facilitators and/or challenges to effective implementation. We identified several social and structural factors affecting community members' participation in DEBIs, including language issues, stigma associated with HIV and sexual orientation, homelessness, and incarceration. Age, class, and socioeconomic status also significantly influenced member participation and CBO implementation success. Although changing individual behaviors is the ultimate measure of behavioral intervention/DEBI success, attention must be given to the larger social and structural factors that significantly affect risk for HIV. In fact, the National HIV/AIDS Strategy recognizes these factors as major barriers to HIV prevention and has developed recommendations that address health disparities. We present short-term, intermediate, and long-term strategies addressing social determinants of health and offer suggestions for adapting DEBIs to meet the broader needs of persons prioritized for DEBIs.
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Affiliation(s)
- Alice Gandelman
- California STD/HIV Prevention Training Center, University of California, San Francisco, 300 Frank Ogawa Plaza, Ste. 520, Oakland, CA 94612, USA
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Robillard AG, L. Braithwaite R, Gallito-Zaparaniuk P, Kennedy S. Challenges and Strategies of Frontline Staff Providing HIV Services for Inmates and Releasees. JOURNAL OF CORRECTIONAL HEALTH CARE 2011; 17:344-60. [DOI: 10.1177/1078345811413088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alyssa G. Robillard
- African and African American Studies, Arizona State University, Tempe, Arizona
| | - Ronald L. Braithwaite
- Community Health and Preventive Medicine, Morehouse School of Medicine, East Point, Georgia
| | - Paige Gallito-Zaparaniuk
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Stein R, Green K, Bell K, Toledo CA, Uhl G, Moore A, Shelley GA, Hardnett FP. Provision of HIV counseling and testing services at five community-based organizations among young men of color who have sex with men. AIDS Behav 2011; 15:743-50. [PMID: 20945158 DOI: 10.1007/s10461-010-9821-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the context of monitoring and improving CDC-funded HIV prevention programs, we describe HIV tests and infections, provision of results, previous HIV tests, and risk behaviors for young (aged 13-29) men of color who have sex with men who received HIV tests at five community-based organizations. Of 1,723 tests provided, 2.1% were positive and 75.7% of positives were previously unaware of their infection. The highest positivity rate was among men aged 25-29 (4.7%). Thirty-four percent of tests were provided to men who were tested for the first time. Over half the tests (53.2%) were provided to men who reported sex with a person of unknown HIV status, and 34% to men who reported sex with an anonymous partner. Continued and more focused prevention efforts are needed to reach and test young men of color who have sex with men and to identify previously undiagnosed HIV infections among this target population.
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Affiliation(s)
- Renee Stein
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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A Prevention Response That Fits America's Epidemic: Community Perspectives on the Status of HIV Prevention in the United States. J Acquir Immune Defic Syndr 2010; 55 Suppl 2:S148-50. [DOI: 10.1097/qai.0b013e3181fbcb22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bowen SAK, Saunders RP, Richter DL, Hussey J, Elder K, Lindley L. Assessing levels of adaptation during implementation of evidence-based interventions: introducing the Rogers-Rütten framework. HEALTH EDUCATION & BEHAVIOR 2010; 37:815-30. [PMID: 21051771 DOI: 10.1177/1090198110366002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers's diffusion theory and Rütten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention.
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Affiliation(s)
- Shelly-Ann K Bowen
- Bureau of Community Health and Chronic Disease Prevention, South Carolina Department of Health and Environmental Control, Columbia, USA.
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Dryden E, Hyde J, Livny A, Tula M. Phoenix Rising: use of a participatory approach to evaluate a federally funded HIV, hepatitis and substance abuse prevention program. EVALUATION AND PROGRAM PLANNING 2010; 33:386-393. [PMID: 20233628 DOI: 10.1016/j.evalprogplan.2010.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 02/11/2010] [Accepted: 02/21/2010] [Indexed: 05/28/2023]
Abstract
This paper highlights the value of utilizing a participatory evaluation approach when working with community agencies receiving federal funding for prevention and intervention services. Drawing from our experience as evaluators of a SAMHSA-funded substance abuse, HIV and Hepatitis prevention program targeting homeless young adults, we describe the importance of and strategies for creating a participatory evaluation partnership with program implementers. By participatory evaluation we mean the active involvement of program implementers in defining the evaluation, developing instruments, collecting data, discussing findings, and disseminating results. There are a number of challenges faced when using this approach with federally funded programs that require the use of standardized measurement tools and data collection procedures. Strategies we used to strike a balance between federal requirements and local needs are presented. By increasing the understanding of and participation in the evaluation process, program implementers have greater support for data collection requirements and are appreciably more interested in learning from the evaluation data. This approach has helped to build the capacity of a program and stimulated new possibilities for learning, growing, and ultimately improving the services offered to those the program strives to reach.
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Affiliation(s)
- Eileen Dryden
- Institute for Community Health, 163 Gore Street, Cambridge, MA 02141, USA.
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Jemmott JB, Jemmott LS, Fong GT, Morales KH. Effectiveness of an HIV/STD risk-reduction intervention for adolescents when implemented by community-based organizations: a cluster-randomized controlled trial. Am J Public Health 2010; 100:720-6. [PMID: 20167903 PMCID: PMC2836337 DOI: 10.2105/ajph.2008.140657] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations (CBOs). METHODS In a cluster-randomized controlled trial, 86 CBOs that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. CBOs agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. RESULTS Participants were 1707 adolescents, 863 in HIV/STD-intervention CBOs and 844 in control-intervention CBOs. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.06, 1.84) than were control-intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom-protected intercourse (beta = 0.06; 95% CI = 0.00, 0.12) than did the control group. CONCLUSIONS This is the first large, randomized intervention trial to demonstrate that CBOs can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.
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Affiliation(s)
- John B Jemmott
- University of Pennsylvania, School of Medicine, Center for Health Behavior and Communication Research, Philadelphia, PA. 19104-3309, USA.
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Strauss SM, Tiburcio NJ, Munoz-Plaza C, Gwadz M, Lunievicz J, Osborne A, Padilla D, McCarty-Arias M, Norman R. HIV care providers' implementation of routine alcohol reduction support for their patients. AIDS Patient Care STDS 2009; 23:211-8. [PMID: 19866539 DOI: 10.1089/apc.2008.0008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Screening and brief intervention (SBI) for alcohol reduction is an important health promoting strategy for patients with HIV, and HIV care providers are optimally situated to support their patients' reduction efforts. We report results from analyses that use data collected from providers (n = 115) in 7 hospital-based HIV care centers in the New York City metropolitan area in 2007 concerning their routine use of 11 alcohol SBI components with their patients. Providers routinely implemented 5 or more of these alcohol SBI components if they (1) had a specific caseload (and were therefore responsible for a smaller number of patients), (2) had greater exposure to information about alcohol's effect on HIV, (3) had been in their present positions for at least 1 year, and (4) had greater self efficacy to support patients' alcohol reduction efforts. Findings suggest the importance of educating all HIV care providers about both the negative impact of excessive alcohol use on patients with HIV and the importance and value of alcohol SBIs. Findings also suggest the value of promoting increased self efficacy for at least some providers in implementing alcohol SBI components, especially through targeted alcohol SBI training.
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Affiliation(s)
| | | | | | - Marya Gwadz
- National Development and Research Institutes, Inc., New York, New York
| | - Joseph Lunievicz
- National Development and Research Institutes, Inc., New York, New York
| | - Andrew Osborne
- National Development and Research Institutes, Inc., New York, New York
| | - Diana Padilla
- National Development and Research Institutes, Inc., New York, New York
| | | | - Robert Norman
- College of Dentistry New York University, New York, New York
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Edmundo K, Souza CDME, Carvalho MLD, Paiva V. [HIV vulnerability in a shantytown: the impact of a territorial intervention, Rio de Janeiro, Brazil]. Rev Saude Publica 2008; 41 Suppl 2:127-34. [PMID: 18094796 DOI: 10.1590/s0034-89102007000900019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 02/15/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the impact of a participatory sexual health promotion program implemented in a poor community and describe how the use of public and private spaces for sex is a factor that exacerbates vulnerability to HIV/Aids. METHODS This ethnographic study was conducted in a Rio de Janeiro shantytown in 2002. Six thousand people live in precarious living conditions in which the lack of public policies, health posts, recreational activities, employment opportunities, and security consolidates power in criminal groups. Issues related to sexual health were addressed in addition to a participatory sexual health program implemented by a Community HIV Prevention Center established by a non-governmental organization. After two months of participatory observation, 35 semi-structured in-depth interviews were conducted with community members between the ages of 17 and 65. Eleven life histories of community leaders and HIV prevention promoters and seven focus groups formed from pre-existent community groups were analyzed. The material was categorized and analyzed qualitatively. RESULTS The precarious nature of living conditions contributes to increased exposure to sexual practices while also enhancing the stigma experienced by the community for living in a shantytown. Through the implementation of the program by the Community HIV Prevention Center, children, teenagers and adults have become familiar with and knowledgeable of HIV/AIDS prevention; and teenagers and adults gained access to condoms. CONCLUSIONS Although vulnerability to HIV was not affected, research results reveal that HIV prevention can become part of the local culture. HIV/AIDS prevention can be fomented by a local approach based on community participation and strengthening collective organizing.
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Affiliation(s)
- Kátia Edmundo
- Centro de Promoção da Saúde, Rio de Janeiro, RJ, Brasil
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Morisky DE, Stein JA, Chiao C, Ksobiech K, Malow R. Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: a multilevel analysis. Health Psychol 2007; 25:595-603. [PMID: 17014277 PMCID: PMC2435363 DOI: 10.1037/0278-6133.25.5.595] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors assessed the relative impact of structural and social influence interventions on reducing sexually transmitted infections (STIs) and HIV risk behavior among female sex workers in the Philippines (N = 897). Four conditions included manager influence, peer influence, combined manager-peer influence, and control. Intervention effects were assessed at the establishment level in multilevel models because of statistical dependencies among women employed within the same establishments. Control group membership predicted greater perceived risk, less condom use, less HIV/AIDS knowledge, and more negative condom attitudes. Combination participants reported more positive condom attitudes, more establishment policies favoring condom use, and fewer STIs. Manager-only participants reported fewer STIs, lower condom attitudes, less knowledge, and higher perceived risk than peer-only participants. Because interventions were implemented at the city level, baseline and follow-up city differences were analyzed to rule out intervention effects due to preexisting differences.
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Affiliation(s)
- Donald E Morisky
- Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, CA 90095, USA.
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Indyk D, Rier DA. Requisites, benefits, and challenges of sustainable HIV/AIDS system-building: where theory meets practice. SOCIAL WORK IN HEALTH CARE 2006; 42:93-110. [PMID: 16687377 DOI: 10.1300/j010v42n03_07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This paper is the third and final of a series that has previously presented the rationale (Rier and Indyk, this volume) and major program elements (Indyk and Rier, this volume) of an approach to link community and tertiary sociomedical providers, clients/patients, sites, and systems into an integrated response to HIV/AIDS. The primary goal has been to improve sociomedical HIV/AIDS services for a hard-to-reach inner city population. The current paper first summarizes the main advantages (e.g., greater efficiency; more realistic, effective programs with greater credibility among the community; stimulation of knowledge production and dissemination amongst players rarely formally engaged in such activities; creation of a platform useful for other applications) of this work. It then examines some of the main organizational challenges in conducting the work (involving issues such as personnel, coordination, funding, turf conflicts, sustainability). From this discussion emerge organizational requisites to conducting this work (e.g., development of key boundary-spanning figures; attention to the specific interests of potential linkage partners; translation efforts to demonstrate the value of participation; a continuous quality improvement approach featuring wide distribution of feedback in user-friendly form; flexibility, tact and patience), so that others can adapt and apply the linkage approach to manage HIV/AIDS or other problems. Finally, we explain how theory and practice have driven one another in this work.
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Affiliation(s)
- Debbie Indyk
- Mount-Sinai School of Medicine, New York, NY, USA
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Edmundo K, Guimarães W, Vasconcelos MDS, Baptista AP, Becker D. Network of communities in the fight against AIDS: local actions to address health inequities and promote health in Rio de Janeiro, Brazil. ACTA ACUST UNITED AC 2005; Suppl 3:15-9. [PMID: 16161843 DOI: 10.1177/10253823050120030107x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
When combined with major social inequities, the AIDS epidemic in Brazil becomes much more complex and requires effective and participatory community-based interventions. This article describes the experience of a civil society organisation, the Centre for Health Promotion (CEDAPS), in the slum communities (favelas) of Rio de Janeiro, Brazil. Using a community-based participatory approach, 55 community organisations were mobilised to develop local actions to address the increasing social vulnerability to HIV/AIDS of people living in squatter communities. This was done through on-going prevention initiatives based on the local culture and developed by a Network of Communities. The community movement has created a sense of "ownership" of social actions. The fight against AIDS has been a mobilising factor in engaging and organising communities and has contributed to raising awareness of health rights. Local actions included targeting the determinants of local vulnerability, as suggested by health promotion workers.
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Affiliation(s)
- Kátia Edmundo
- General Coordination Team, Centre for Health Promotion, CEDAPS, Centro Rio Janeiro, Brazil.
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Guenter D, Majumdar B, Willms D, Travers R, Browne G, Robinson G. Community-based HIV education and prevention workers respond to a changing environment. J Assoc Nurses AIDS Care 2005; 16:29-36. [PMID: 15903276 DOI: 10.1016/j.jana.2004.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to understand the culture, values, skills and activities of staff involved in education and prevention activities in community-based AIDS Service Organizations (ASOs) in Ontario, Canada, and to understand the role of evaluation research in their prevention programming. In this qualitative study, 33 staff members from 11 ASOs participated in semi-structured interviews that were analyzed using the grounded theory approach. ASO staff experience tension between a historical grassroots organizational culture characterized by responsiveness and relevance and a more recent culture of professionalization. Target populations have changed from being primarily gay men to an almost unlimited variety of communities. Program emphasis has shifted from education and knowledge dissemination to a broadly based mandate of health promotion, community development, and harm reduction. Integration of evidence of effectiveness, social-behavioral theory, or systematic evaluation is uncommon. Understanding these points of tension is important for the nursing profession when it is engaged with ASOs in programming or evaluation research.
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Affiliation(s)
- Dale Guenter
- Department of Family, McMaster University, Hamilton, Ontario, Canada
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