Adults – Page 2 – CHIPTS – Center for HIV Identification, Prevention and Treatment Services

24Jan

Angola – Acceptability of Handheld Computers to Collect Self-reported Sexual Behavior Data in Angola

Acceptability of Handheld Computers to Collect Self-reported Sexual Behavior Data in Angola

This study evaluates the cultural acceptability and cost-effectiveness of using handheld computers to collect sexual behavior data, in order to reduce disparities in access to HIV/AIDS prevention and care services in Angola, a country severely impacted by HIV/AIDS. Specifically, this study aimed 1) to assess how comfortable Angolans feel in disclosing sexual behavior in handheld computer surveys compared to paper surveys, and 2) to assess how comfortable Angolan interviewers feel in administering handheld computer surveys vs. paper surveys.

Targeted Risk Group:

Sexually active adults, 18-45

Intervention model:

Randomized Control Trial

Research Methods:

We conducted an experiment in three neighborhoods of Luanda, Angola to assess the impact of the technology on people’s comfort and willingness to disclose sensitive personal information, such as sexual behavior. Participants were asked about their HIV/AIDS-related knowledge, attitudes, and practices by local interviewers using either handheld computers or paper surveys. T-tests showed no differences between participants’ self-reported comfort across handheld and paper conditions. However, participants in the handheld condition were more likely to give socially desirable responses to the sexual behavior questions than participants in the paper condition.

International Significance:

Handheld computers have potential to improve HIV/AIDS programs in healthcare settings in low-income countries, by improving the speed and accuracy of collecting data. However, the acceptability of the technology (i.e., user attitude and reaction) is critical for its successful implementation. Acceptability is particularly critical for HIV/AIDS behavioral data, as it depends on respondents giving accurate information about a highly sensitive topic – sexual behavior. These results suggest that using handheld computers in data collection in Angola may lead to biased reports of HIV/AIDS-related risk behaviors.

24Jan

¡Tu Vales!: An HIV Testing Campaign for Latino Day Laborers

Project Name:

¡Tu Vales!: An HIV Testing Campaign for Latino Day Laborers

Some Latino men involved in high risk behaviors have been found to be more likely to choose to get tested for HIV when the HIV test is “bundled” with other tests.

A recent study of Latino male immigrant day labors in Los Angeles County found that engaging in risk behaviors, such as having sex with men, was not associated with HIV testing. Thus some day laborers at high risk may not be accessing HIV testing services. However, increasing HIV testing among Latino day laborers may not solely be a function of offering the HIV test to them. Unique ways of offering HIV testing may be required in order to increase HIV testing. Some Latino men involved in high risk behaviors have been found to be more likely to choose to get tested for HIV when the HIV test is “bundled” with other tests compared to when it is offered by itself. The objective of this study is to increase HIV testing among day laborers at risk for HIV. The specific aims of this study are:

(1) to determine if a “bundled” HIV testing protocol directed at day laborers results in more immigrants accessing HIV testing compared to an HIV-only testing protocol., and

(2) to determine if a “bundled” HIV testing protocol results in more men engaging in HIV prevention services among those involved in high-risk activities compared to when an HIV-only testing protocol is used.

The “bundled” HIV testing protocol will include tests or screeners for syphilis, gonorrhea, chlamydia, alcohol problems, drug dependence, depression and HIV. Individuals in the HIV-bundled protocol will be able to choose to be tested for all conditions or just some of them.

Targeted Risk Group:

Latino day laborers engaged in high-risk activities

Research Methods:

In contrast to previous studies with day laborers, this study will involve a random recruitment of day laborers using a spatial-temporal sampling frame. Two HIV testing protocols, one “bundled” and the other “HIV-only,” will be carried out at day labor sites in Los Angeles County. In the formative stage of our project, we plan to determine which day labor sites contain the largest number of day laborers reporting high-risk activities. We will use the Service Planning Areas (SPAs) of Los Angeles County. We will utilize SPAs 4, 6, 7 and 8. By doing so, we will be focusing on the areas in which 73.9% of all male Latino HIV/AIDS cases were identified between 2004 and 2007. Once all day labor sites in these SPAs are identified, we will visit them at randomly selected times and randomly sample 15% of the individuals who are present when we arrive. These participants will be administered a short screener to assess HIV-related high-risk behaviors. After determining which sites contain the largest number of day laborers reporting high-risk activities, we will develop a sampling unit of “site-day-shift,” where “site” refers to the day labor site, “day” to the day of the week, and “shift” to a 5-hour time period within the day. The sampling plan for the study recruitment for the main part of the study will involve 4 stages: the random assignment of the 4 SPAs to either the HIV-only protocol or the HIV-bundled protocol, the monthly random selection of the day labor sites, the monthly random selection of the sampling units and the random selection of participants at the day labor sites.

A total of 800 participants will be recruited, with one-half being recruited through the HIV-testing only protocol and the other half through the HIV-bundled protocol. Tallies will be kept of the number of people who are approached and asked to participate for each testing protocol and those who accept and decline HIV testing. Rates of HIV testing for the two HIV testing protocols will then be compared.

This study is interested also in which protocol results in greater engagement in HIV prevention services among those reporting high-risk activities. Those reporting HIV-related high risk behaviors will be contacted 2 months later for a brief phone interview to determine if they subsequently utilized the referrals to HIV prevention programs. The two HIV testing protocols will then be compared to determine which resulted in a greater use of HIV prevention services by day laborers.

Local significance:

Information on potential increased HIV testing by day laborers using a “bundled” testing protocol would contribute to advancing HIV prevention science and also provide important information for prevention programs throughout California. Thus, this project is very attentive to the needs of public health and community based organizations in California attempting to counter the present trend of late testing among Latinos.

24Jan

HIV Prevention Capacity Building Assistance and Technical Assistance for Community-Based Organizations and Health Departments

This CDC-funded project is a collaboration between AIDS Project Los Angeles (APLA) and CHIPTS aimed to deliver capacity building assistance (CBA) services to community based organizations (CBOs) and health departments in the areas of (1) organizational infrastructure and program sustainability, (2) evidence based interventions and public health strategies, and (3) monitoring and evaluation.

The project will provide a wide range of CBA services to CBOs, including individually-tailored CBA (ICBA) services to address specific HIV prevention programmatic needs for organizations serving racial and ethnic minority communities and other high risk populations. The project will conduct an individual CBA needs assessment as the foundation of ICBA services, through which we will jointly develop an action plan with the CBO to address identified needs.

ICBA services may include: individualized technical assistance and consultation; skills building trainings (both inperson and web-based formats); web seminars; information transfer and technology transfer through the broad dissemination of technical information; participation in an online discussion forum to promote peer-to-peer sharing of best practices; and promotion of program collaboration and service integration across public health initiatives. In addition, the project will implement similar CBA services to health departments as it does to CBOs. However, we will tailor information and materials, skills building trainings, web seminars, etc. to address the unique needs and problems of health departments. The project will also work closely with health departments to provide training in the evaluation of community planning methodologies. We also propose to collaborate with other CBA providers to develop a Professional Development Certificate Program for health department staff, ensuring a basic level of knowledge across all four component areas.

For more information, please visit the Shared Action website at www.sharedaction.org.

23Jan

Popular Opinion Leader HIV Intervention among Chinese Market Workers

This project is part of the NIMH Collaborative HIV/STD Prevention Trial which adopts a two-arm, randomized community-level design to test the Popular Opinion Leader (POL) HIV prevention intervention model at five international sites (China, India, Peru, Russia, and Zimbabwe). CCH is the lead on the China site.

China, representing 1/4th of the world’s population, has a rapidly emerging HIV epidemic with about 1.2 million individuals already infected, more than the total of all the Asian nations combined. Similar to Africa and India, the country’s 200-250 million labor migrants are a key to the epidemic’s future; however, HIV infection is predominantly occurring in rural settings (75% of population) and migrants transmit the virus heterosexually when moving to the cities annually.

The goals of this project are: 1) to adapt a comprehensive community-level preventive intervention – The Popular Opinion Leader – to populations in China based on data from ethnographic studies and compare the results with the other four international sites which follow the same research procedure; 2) to test the efficacy of this community-level preventive intervention in China as well as the four international sites utilizing both behavioral and biological outcomes; and, 3) to develop a manual that will permit different health care agencies and service providers to conduct rapid ethnographic studies, translate this community-level intervention to different settings and populations, and assess intervention efficacy.

The ability of CCH investigators to successfully implement the project is based on previous successful HIV prevention trials including interventions in China and participation in HIV-related cooperative agreements; support of the project from experienced Chinese collaborators, officials, and organizations; access to sites in China; collaboration with experienced Chinese investigators, several of whom have trained at UCLA; collaboration of the Qualitative Core of the UCLA-NPI with considerable cross-national and cross-site experience; and previous experience in conducting interventions and assessments that are culturally sensitive and appropriate.

23Jan

Safety Counts

Drug users have a high risk of HIV infection. Because certain neighborhoods have higher levels of substance abuse, HIV risk becomes related to geography as well. Thus, there is need for local street outreach programs such as Safety Counts.

Research Methods:

In a quasi experimental, cross-over design, two Los Angeles neighborhoods were randomly assigned to receive either (1) Voluntary HIV Counseling and Testing (VCT) or (2) Safety Counts. In Phase 1, injection drug users and crack users in these neighborhoods attended the respective intervention. In Phase 2, each neighborhood and therefore its participants received the alternative intervention. Participants were reassessed at 5–9 months. Data collected included demographics, sexual risk behavior, and substance abuse.The Safety Counts intervention differed from the VCT intervention in that Safety Counts offered skill-building and goal-setting workshops, one-on-one counseling sessions to implement goals, street contacts to support other participants, and social events.

Local Significance:

Drug users in the Safety Counts program reported significantly greater reductions in risky sex, crack and hard drug use, and risky drug injection. The more sessions of Safety Counts attended, the greater were the reductions in risky acts. Different analytic decisions result in very different findings for the same intervention. Safety Counts is an effective intervention for injection drug users and crack users.

20Jan

MD for Life: Making Decisions for Life

MD for Life is a study that will help health-care professionals and researchers learn how well an intervention works with people living with HIV. Funded by the University-wide AIDS Research Program, the intervention is designed to reduce sexual risk and substance behavior by increasing motivation and intention for behavior change among individuals living with HIV. The intervention will be delivered in two different modalities. The first intervention delivery strategy will have a health care professional, trained in counseling techniques, talk with patients about their sexual and substance use risk behaviors. The second delivery strategy will have the patient receive the counseling via an interactive and engaging computer program. The counseling is based on a proven technique called motivational interviewing. This counseling technique has been successful in reducing alcohol use in multiple populations. A total of 400 patients are being recruited from four health clinics (100 patients from each clinic) that primarily serve individuals living with HIV.

While other HIV prevention programs have been successful, they have been expensive, needed multiple small group sessions, and required coordination of many schedules and extensive training for staff. This project builds on previous prevention successes and utilizes existing staff, treatment delivery settings, and new technology to deliver a brief innovative intervention that can be repeatedly delivered to a diverse population of individuals living with HIV. If successful, this program would be an inexpensive and fairly effortless program to implement in health clinics nationwide.

Links to Interventions, Training Manuals, etc. :

Please call us, 310-794-8278, regarding the computerized based intervention.

Survey and Scales:

20Jan

Healthy Living Project (HLP): Multi-Institutional Collaborative Research Project

The UCLA Healthy Living Project was funded by the National Institute of Mental Health (NIMH) and was designed to promote health-related behavior changes in adults living with HIV. This project aimed to reduce sexual and injection drug use risk behaviors among 1,200 HIV positive men and women in order to decrease the likelihood of secondary HIV transmission. The research study focused on four subgroups: women, heterosexual men, men who have sex with men, and injection drug users. The study was conducted at four sites: Los Angeles, Milwaukee, New York, and San Francisco.

Targeted Risk Group:

Adults living with HIV

Interventions, Training Manuals, etc. :

Surveys/Scales Used:

Intervention model:

Cognitive behavioral intervention comprised of 15 individually delivered counseling sessions covering three areas: “Stress, Coping, and Adjustment,” “Risk Behaviors,” and “Health Behavior.”

Research Methods:

In a random assignment study, individuals assigned to take part in the intervention were compared with individuals assigned to a control group, i.e. delayed intervention, on HIV-transmission behaviors, including unprotected sex and substance use. Because participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

Local Significance:

The intervention was demonstrated to reduce risky sexual behavior and substance use.
At the end of the study, the goal was to train service provider staff to deliver the intervention to their clients. By collaborating with service providers early on in the intervention study, it was possible to learn how to tailor the intervention to the specific needs of the agencies involved and the people they serve.

International Significance:

HLP provided a behavioral intervention that can be adapted for other countries and cultures to reduce HIV-transmission risk behaviors

20Jan

Staying healthy: Taking Antiretrovirals Regularly (STAR)

Adherence with prescribed medication regimens is critically important for patients with HIV infection, due to recent advances in HIV therapeutics. Due to the unique nature of the drugs they take (e.g., rapid development of viral resistance when only minimal doses are missed) as well as complexity of the medication regimens, there is an urgent need to develop interventions to assist patients in medication compliance. Poor adherence to antiretroviral drugs not only can result in the development of resistance by HIV to multiple drugs, but to whole classes of drugs; resistant HIV strains pose a public health danger.

In this proposal the best strategies from prior adherence and behavior change research are utilized in an intervention trial that expands previous work in that it is: (1) interdisciplinary; (2) provides sufficient “dosage” or amount of intervention; and (3) includes booster maintenance sessions.

A sample of 144 HIV-infected men and women having difficulty adhering to their antiretroviral regimen will be randomly assigned to one of two conditions: a tailored behavioral group (TBG) intervention facilitated by a behavioral psychologist and a nurse practitioner, which includes social support and patient education; or a standard care condition (SC). Extended intervention and relapse prevention are needed for long-term adherence: this intervention consists of an initial 5 sessions and 4 booster sessions. All participants will be assessed at pre- and post-intervention, and at 3, 9, 15, and 21 month follow-ups.

The aims of the study are:
1. to determine whether a tailored, behavioral intervention that includes social support and patient education components and maintenance booster sessions promotes medication adherence and effective problem-solving related to medication compliance among HIV-positive individuals over long-term follow-up;
2. to determine the level of adherence that is maintained over time in the intervention group;
3. to determine if improvement in medication adherence is associated with less evidence of emotional and behavioral distress, and better quality of life;
4. to explore how medication adherence is associated with sexual transmission risk behaviors; and
5. to explore relationships between medication adherence and potential moderating and mediating variables (including self-efficacy and outcome expectancies related to adherence, behavioral intentions, coping methods, and health care satisfaction).
The results of this study will provide empirical data urgently needed by medical providers, public health agencies, community clinics, and other organizations as they attempt to develop medication adherence interventions for HIV-infected populations.

Interventions, Training Manuals, etc. :

Staying Healthy: Taking Antiretrovirals Regularly (STAR) Facilitator Manual

Staying Healthy: Taking Antiretrovirals Regularly (STAR) Intervention Manual

[Download not found]

20Jan

Choosing Life: Empowerment, Action, Results! (CLEAR) for Comprehensive Risk Counseling and Services (CRCS)

CLEAR-CRCS is an evidence based HIV prevention and health promotion intervention developed for people living with HIV enrolled in Comprehensive Risk Counseling and Services (CRCS). It is a client-centered program delivered one-on-one with clients who are having difficulty initiating or sustaining behaviors that prevent HIV transmission and reinfection. The program teaches clients cognitive-behavioral strategies to cope with triggers and other stressful situations that lead to risky behaviors and unhealthy choices. The goal of CLEAR-CRCS is to help these people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. CLEAR-CRCS is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

CLEAR-CRCS is structured such that the CRCS provider can individually tailor the program to address the unique needs of each client. The program consists of six foundational sessions that teach the core behavioral strategies of the program. Within these initial sessions, the client also develops a personal life goal and his or her prevention plan which will direct the focus of subsequent sessions. The provider then has a menu of 21 sessions to choose from in which the client can practice and apply the core strategies to realize his or her goals. The sessions in the menu address five domains: sexual behavior, substance use, treatment adherence, mental health, and successful disclosures.

Research on the original CLEAR Intervention: The original CLEAR study was conducted from 1999-2003 with an ethnically and culturally diverse group of substance using young people living with HIV/AIDS. The intervention was conducted as a multi-site trial in Los Angeles, San Francisco, and New York. The study demonstrated a significant increase in protected sexual acts, such as using condoms, with all partners and with HIV-negative partners.

Underlying Theory and Principles: The intervention was developed based on the social action theory. Social action theory stresses the importance of social interactions and environmental factors in a person’s ability to control behaviors that may endanger his or her health. It incorporates the principles that are expressed in traditional social-cognitive models of health-behavior change, including social-cognitive theory, the health belief model, and the transtheoretical model (stages of change). CLEAR-CRCS is predicated on the notion that behavior change depends both on a person’s belief that he or she can change a behavior (self-efficacy) and the beliefs that changing the behavior will result in a desired outcome (response efficacy).

Interventions, Training Manuals, etc. :

For the most current CDC manuals please CLICK HERE visit the DEBI website.

CURRENT Manuals from CDC funded work for DEBI:

Original RCT Protocol 1998-2002

Module 1

Module 2

Module 3

Workbooks

Telephone Conference Call Groups

NOTE: The original randomized controlled trial had a telephone group format that was not feasible for youth at that time. Only the 1st module was completed, but it is in included here for reference. The activities can be adapted and used for more current interventions.

Surveys and Scales Used:

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CURRENT Manuals from CDC funded work for DEBI: