Posts classified under: Education

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.

HIV Technology Transfer in Los Angeles

The aims of the HIV Technology Transfer in Los Angeles project are to document and develop resources for technology transfer among HIV/AIDS community-based organizations (CBOs) serving Los Angeles communities. Several CBOs have publicly commented on the gap between current mandates to implement and evaluate evidence-based HIV interventions and the resources that are available to meet these requirements. A long-term objective is to share CBOs insights into using science-based interventions and to increase the training, materials and other resources they need to carry out HIV prevention. CHIPTS and the City of Los Angeles AIDS Coordinator (ACO) seek to assist CBOs in meeting these objectives. The potential impact of the study is enhanced implementation of evidence-based interventions in Los Angeles and throughout California.

The process of adapting evidence-based interventions into CBO settings is known as technology transfer. The Technology Transfer Model (TTM) outlines three primary phases of this process: pre-implementation, implementation, maintenance and evolution. The pre-implementation phase consists of identifying the need for an intervention, acquiring information, assessing the fit between an intervention and the goals and activities of the organization, and preparing the organizational staff. Implementation includes obtaining technical assistance and conducting process evaluation of the interventions. Finally, maintenance and evolution includes ensuring the presence of staff that can continue to implement the intervention, organizational change, and program evolution.

CBO staff who have been involved in the three phases of technology transfer can offer rich insights on best practices and lessons learned in their communities. Up to 18 science-based programs have been or are being implemented in Los Angeles. Up to two staff from each of these programs are eligible to participate (N = 36). Eligible participants for this study completed close-ended background surveys regarding their organization’s characteristics and were interviewed for up to 90 minutes. Participants were paid $30 for each interview completed. Interviews were conducted twice with staff from these programs. The first wave of interviews asked about pre-implementation and implementation phases of technology transfer. The second wave of interviews, scheduled when many of the programs finished at least one cycle of implementation, asked about maintenance and evolution. Surveys were summarized and used to describe the general organizational characteristics of CBOs using evidence-based programs. Interviews were transcribed, coded and analyzed for techniques, challenges, strategies, and resources used or needed by the CBOs.

Interventions, Training Manuals, etc. :

  1. HIV Technology Transfer in LA (developing resources for technology transfer among HIV/AIDS community-based organizations)- Interview Questions
  2. [Download not found]
  3. [Download not found]

Los Angeles County Methamphetamine Prevention Initiative

There is a significant unmet need in Los Angeles County for methamphetamine-specific training, and community service agencies and outreach workers need education and training on effective approaches to engage and serve persons in the community at risk. Training and technical assistance is also needed for service providers on the latest evidence-based methamphetamine treatment approaches.

More specifically, trainings are needed that cover methamphetamine-specific issues crucial for the development of skills by medical providers, clinicians and outreach workers serving clients who use methamphetamine and address specific concerns around providing culturally appropriate care for specific populations. These trainings address issues such as: mental health considerations, psychological complications, sexual and cybersex addiction and current evidence based treatments.

This training project included the following activities:

  • Providing consultation and technical assistance to the Los Angeles County Alcohol and Drug Program Administration (ADPA) and the Office of AIDS Programs and Policy (OAPP)
  • Developing training curricula and module for ADPA or OAPP-funded substance abuse or HIV/AIDS treatment providers
  • Developing and disseminating web-based training module
  • Providing in-service trainings for Los Angeles County Methamphetamine Task Forces
  • Providing in-service trainings for ADPA and OAPP-funded Drug Abuse and HIV prevention agencies serving young women
  • Providing tailored technical assistance

Vietnam – Development of a Family Intervention to Address Drug Use and HIV in Vietnam

This two-year study will be conducted in Phu Tho Province, Vietnam in collaboration with the Vietnam National Institute of Hygiene & Epidemiology (NIHE). This study will develop and pilot an intervention aimed at increasing family support for IDU’s behavior change and family capacities to effectively cope with the impact of IDUs and HIV.

Targeted Risk Group: 

IDUs, family members

Intervention model: 

Planned behavior change, Stages of change, and Psych-education

Research Methods: 

• Focus group to develop the content, format and delivery plan for the intervention
• Intervention will be delivered to 40 IDUs and 40 their family members
• Assessments will be conducted with 80 IDUs and 80 Family members at baseline, 3-month and 6-month follow-ups.

Local Significance: 

The findings from the study will inform the design of the full-scale intervention trial for families coping with IDU and/or HIV in Vietnam. By addressing HIV and IDUs, this intervention could potentially reduce the psychological, physical and emotional demands of living with chronic HIV, coping with drug use, and improve the safety of society. A dissemination of the intervention design to district hospitals in Vietnam can improve the lives of families in dealing HIV and IDUs.

International Significance: 

This study demonstrates a model to combine traditional drug use treatment with psychosocial and behavioral intervention. This can be applied to other countries with different cultures.

Grief Interventions for PLAs, Adolescents and Guardians

By the year two thousand, 80,000 children will be orphaned by AIDS in the U.S. and this number will continue to rise. Parental death during one’s childhood has been consistently associated with negative outcomes for children, however, there have been no prospective studies of adolescent bereavement from any type of parental death, including death from AIDS. This continuation study is aimed at delivering and evaluating an intervention to alleviate grief associated with the death of a parent. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 US adolescents bereaved annually by parental death.

Scope:

Over the last two and a half years, 310 parents living with AIDS (PLAs) and their 498 adolescent children, age 12-18 were recruited. They were randomly assigned to receive: (1) a standard care condition in which extensive social welfare services are provided; or (2) an enhanced care condition in which three modules of coping skills intervention (Project TALC: Teens and Adults Learning to Communicate) plus social services are provided. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are schedule to meet individually and jointly in over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last two years, about two thirds of the sample of PLAs continue to live longer than anticipated, delaying the delivery of the final intervention module. Over the next 18 months, the investigator anticipates that the PLAs will die, and the final, post-death module of the intervention will be delivered. The present continuation study will allow the investigator to complete the delivery and the evaluation of the intervention, and in addition, pursue the following activities: (1) follow youths of PLAs prospectively and longitudinally for four additional years to evaluate their mental health, behavioral, and social outcomes; (2) complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; and (3) develop new measures of grief to describe the bereavement process over time.

Parents living with AIDS reported a mean of 3.3 (SD=1.3) areas of conflict with their adolescents and 1.5 (SD=1.7) stressful parenting events over the previous three months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use: stressful parent events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African-American parents, but not white parents. In contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents’ health status, but were significantly influenced by substance use and sexual lifestyles. Both mothers (87%) and fathers were significantly more likely to disclose their serostatus to adolescents (73%), compared to younger children (23%). Only 44% disclosed to all their children; 11% disclosed to none. Most PLAs (80%) discussed custody plans; however, only 30% initiated legal plans, typically for younger children. Adolescents informed of their PLA’s serostatus engaged in more sexual risk acts, smoked more cigarettes, reported more severe substance use, and greater emotional distress than did uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or followup.

National Institute of Mental Health, grant 2R01MH49958-06

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. : 

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

PRIDE

Adherence to therapy is now more important than ever in HIV/AIDS care due to recent advances in HIV therapeutics. Poor adherence to antiretroviral drugs can result in the development of resistance by HIV to multiple drugs–and to whole classes of drugs. Such development of resistant HIV strains poses a potential public health danger. Large, multidisciplinary trials to determine how to effectively improve medication adherence for HIV+ patients are urgently needed. Prior to such major trials, preliminary work is needed in a number of areas: (1) successful models of adherence and barriers to adherence need to be determined; (2) information regarding antiretroviral treatment needs to be simplified so that it is easily understandable to general populations; (3) interventions that rely on multiple disciplines and that utilize the best intervention strategies from the research on patient education, behavior change, and social support need to be developed; and (4) pilot trials need to be conducted.

The purpose of this study is to pilot an adherence intervention; this would be accomplished by the following four aims of this proposed study.

  1. Simplify antiretroviral treatment information regarding the rationale for adherence, benefits of adherence, and risks of nonadherence, so that the material is easily comprehensible to patients and can be utilized in a treatment adherence intervention.
  2. Through a series of small focus groups (total N = 35) with HIV-infected individuals currently prescribed antiretroviral therapy, identify successful techniques for adherence that they have utilized, as well as barriers; and obtain feedback on the simplified treatment information.
  3. Utilize focus group information to finalize an adherence intervention protocol that is preliminarily designed as a 5-session, tailored behavioral, mixed format intervention co-facilitated by a cognitive-behavioral therapist and a nurse: (1) a group session in which information regarding treatment and the rationale for adherence is discussed, and behavioral strategies are reviewed; (2) an individual meeting in which the patient receives assistance in developing their personal adherence plan by tailoring behavioral strategies; (3) a group session in which progress is reinforced, barriers are discussed, and participants engage in exercises designed to help them gain a sense of control in their health care planning and role-play ways to discuss issues with their providers; (4) an individual session to modify and strengthen the patient’s personal adherence program; and (5) a group session focused on long-term adherence maintenance.
  4. Conduct a small pilot, randomized, controlled trial in which 50 HIV-infected patients who have been prescribed antiretroviral therapy are assigned to one of two conditions: the tailored behavioral intervention or an assessment only control group, to determine if the intervention significantly increases medication regimen adherence, with patients assessed post-intervention and at 3 and 6 month follow-ups.

Because of the the rapid development of resistance, the fact that when resistance develops drug efficacy is lost forever, and due to cross-resistance several drugs may be lost, there is an urgent need to develop effective interventions. This multidisciplinary project seeks to provide information needed for large intervention trials.

 

 

Teaching, Raising, and Communicating with Kids (TRACK)

The purpose of this 3-year R01 is to test the preliminary efficacy of an intervention to assist HIV-infected mothers to disclose their serostatus to their young (age 6 – 12 year old), well children.

The basis for development of this intervention is work from two R01s (MH # 5R01MH057207, currently Yr. 09) designed to longitudinally assess HIV-positive mothers and their children, which included studies on maternal disclosure (e.g., Murphy, Marelich, & Hoffman, 2002; Murphy, Marelich, Hoffman, & Schuster, 2006; Murphy, Roberts, & Hoffman, 2002; Murphy, Roberts, & Hoffman, 2003; Murphy, Roberts, & Hoffman, 2006; Murphy, Steers, & Dello Stritto, 2001).  This research suggests disclosure is difficult for mothers living with HIV (MLWHs), and that outcomes for both mothers and children could be improved by the proposed intervention.

Information gathered in the previous two R01s will be used to develop a brief disclosure intervention.  MLWHs (N = 80) will be randomly assigned to the intervention or control condition.  MLWHs and children (N = 160) will be assessed at baseline, 3, 6, and 9-month follow-ups. A random subset of intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview after their last follow-up, to obtain detailed process information on their experiences in the study.

The aims of the intervention are to:  improve mother-child communication and parenting skills—particularly as they relate to disclosure.  As a result of the intervention aims, other primary and secondary outcomes include:  increasing readiness to disclose, and disclosure itself; improving both MLWH and child mental health indicators; reducing child behavioral problems, and improving the parent-child relationship and family functioning.

This study will provide important prospective, longitudinal data on MLWHs’ adjustment to having disclosed their serostatus, and their children’s adjustment to the disclosure. Previous research indicates that for some families, maternal and child psychological distress may increase immediately following disclosure, but will decrease over time; the longitudinal design of this study will allow us to follow mothers and children throughout the disclosure process.

The study will allow evaluation of maternal and child characteristics that may moderate or mediate the impact of disclosure. Finally, process evaluations for each intervention session as well as in-depth qualitative interviews with a subset of MLWHs who attended the intervention will provide information on issues that need to be addressed prior to a full-scale trial of the disclosure intervention.  Few interventions, other than for prevention or medication adherence, are available for women living with HIV; this study will evaluate an intervention that will help HIV-positive mothers deal with a serious family issue.

CLEAR Uganda; SUUBI Project

Choosing Life Empowerment Action Results is a behavioral change research project being implemented by Uganda Youth development Link (UYDEL) in collaboration with support from University of California, Los-Angeles. It is a result project known as CLEAR tried in the USA in the cities of Los Angeles and New York by the Center for Community Health (CHIPTS) to assist young people living with HIV/AIDS. Uganda and Kampala in particular, face increasing numbers of HIV/AIDS infections among young people living on the streets and slums. This project targets street and slum youth, 13-23 years living with HIV/AIDS in Rubaga and Kawempe Divisions of Kampala district.

Interventions, Training Manuals, etc. : 

Original RCT Protocol 1998-2002

  • Module 1
  1.   CLEAR- Mod 1, Sess 1: Identifying My Strengths: Creating A Vision for the Future. (1.5 hrs)
  2.   CLEAR- Mod 1, Sess 2: I'm HIV-Positive: Attitudes as Barriers to Future Goals. (1.5 hrs)
  3.   CLEAR- Mod 1, Sess 3: Making Commitments: Evaluating and Changing Substance Use. (1.5 hrs)
  4.   CLEAR- Mod 1, Sess 4: Seeing the Patterns: Why Do I Use Drugs and Alcohol? (1.5 hrs)
  5.   CLEAR- Mod 1, Sess 5: Beliefs: Thoughts That Influence My Substance Use Patterns. (1.5 hrs)
  6.   CLEAR- Mod 1, Sess 6: Future Goals: The Impact of Using Drugs and Alcohol. (1.5 hrs)
  • Module 2
  1.   CLEAR- Mod 2, Sess 7: Higher Self and Sexual Decisions: Facing the Challenges. (1.5 hrs)
  2.   CLEAR- Mod 2, Sess 8: Higher Self and Sexual Decisions: Changing Risk Behaviors. (1.5 hrs)
  3.   CLEAR- Mod 2, Sess 9: Making Sexual Decisions: Having Safety and Pleasure. (1.5 hrs)
  4.   CLEAR- Mod 2, Sess 10: Making Sexual Decisions: Can I Use Condoms (Correctly)? (1.5 hrs)
  5.   CLEAR- Mod 2, Sess 11: Making Sexual Decisions: Can I Influence My Partner To Use Condoms? (1.5 hrs)
  6.   CLEAR- Mod 2, Sess 12: Making Sexual Decisions: How Do I Refuse Unprotected Sex? (1.5 hrs)
  • Module 3
  1.   CLEAR- Mod 3, Sess 13: Motivation for Change: Wanting to Stay Healthy (1.5 hrs)
  2.   CLEAR- Mod 3, Sess 14: Attending Health Care Appointments (1.5 hrs)
  3.   CLEAR- Mod 3, Sess 15: Participating In Medical Care: Communication and Decision-making Skills (1.5 hrs)
  4.   CLEAR- Mod 3, Sess 16: Medication Schedules: Can I Stay on Track? (1.5 hrs.)
  5.   CLEAR- Mod 3, Sess 17: Medication Schedules: More Tools to Stay on Track (1.5 hrs)
  6.   CLEAR- Mod 3, Sess 18: Maintaining My Progress: Focus on the Future. (1.5 hrs)
  •  Workbooks
  1. CLEAR Individual Workbook I (Prevention for HIV Positive Adult and Youths)
  2. CLEAR Individual Workbook II (Prevention for HIV Positive Adult and Youths)
  3. CLEAR Individual Workbook III (Prevention for HIV Positive Adult and Youths)

 

 

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.

Original RCT Protocol 1998-2002

  • Module 1
  1.   CLEAR- Mod 1, Sess 1: Identifying My Strengths: Creating A Vision for the Future. (1.5 hrs)
  2.   CLEAR- Mod 1, Sess 2: I'm HIV-Positive: Attitudes as Barriers to Future Goals. (1.5 hrs)
  3.   CLEAR- Mod 1, Sess 3: Making Commitments: Evaluating and Changing Substance Use. (1.5 hrs)
  4.   CLEAR- Mod 1, Sess 4: Seeing the Patterns: Why Do I Use Drugs and Alcohol? (1.5 hrs)
  5.   CLEAR- Mod 1, Sess 5: Beliefs: Thoughts That Influence My Substance Use Patterns. (1.5 hrs)
  6.   CLEAR- Mod 1, Sess 6: Future Goals: The Impact of Using Drugs and Alcohol. (1.5 hrs)
  • Module 2
  1.   CLEAR- Mod 2, Sess 7: Higher Self and Sexual Decisions: Facing the Challenges. (1.5 hrs)
  2.   CLEAR- Mod 2, Sess 8: Higher Self and Sexual Decisions: Changing Risk Behaviors. (1.5 hrs)
  3.   CLEAR- Mod 2, Sess 9: Making Sexual Decisions: Having Safety and Pleasure. (1.5 hrs)
  4.   CLEAR- Mod 2, Sess 10: Making Sexual Decisions: Can I Use Condoms (Correctly)? (1.5 hrs)
  5.   CLEAR- Mod 2, Sess 11: Making Sexual Decisions: Can I Influence My Partner To Use Condoms? (1.5 hrs)
  6.   CLEAR- Mod 2, Sess 12: Making Sexual Decisions: How Do I Refuse Unprotected Sex? (1.5 hrs)
  • Module 3
  1.   CLEAR- Mod 3, Sess 13: Motivation for Change: Wanting to Stay Healthy (1.5 hrs)
  2.   CLEAR- Mod 3, Sess 14: Attending Health Care Appointments (1.5 hrs)
  3.   CLEAR- Mod 3, Sess 15: Participating In Medical Care: Communication and Decision-making Skills (1.5 hrs)
  4.   CLEAR- Mod 3, Sess 16: Medication Schedules: Can I Stay on Track? (1.5 hrs.)
  5.   CLEAR- Mod 3, Sess 17: Medication Schedules: More Tools to Stay on Track (1.5 hrs)
  6.   CLEAR- Mod 3, Sess 18: Maintaining My Progress: Focus on the Future. (1.5 hrs)
  •  Workbooks
  1. CLEAR Individual Workbook I (Prevention for HIV Positive Adult and Youths)
  2. CLEAR Individual Workbook II (Prevention for HIV Positive Adult and Youths)
  3. CLEAR Individual Workbook III (Prevention for HIV Positive Adult and Youths)

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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