lessons from the cdc/rtc hiv integration project marianne zotti, drph, ms, faan team leader services...
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Lessons from the CDC/RTC HIV Integration Project
Marianne Zotti, DrPH, MS, FAAN
Team Leader
Services Management, Research & Translation Team
NCCDPHP/DRH/ASB
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Content
History of the HIV Integration ProjectCurrent Project OverviewLogic ModelRegional Training Center (RTC) RoleHIV Integration Toolkit Monitoring & Evaluation
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HistorySince 1993 CDC & OPA have
collaborated re HIV prevention 1993-1996 Operations research 1996-1999 Focus on counseling about
risks, Title X 1999-2004 Client centered counseling,
Title X, non Title X, also focus on teen pregnancy prevention and prenatal smoking cessation
2004-2009 HIV prevention integration
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Current HIV Integration Project
Objective To increase the number of reproductive
health clinics/settings that integrate HIV prevention services at an appropriate level into routine care
Future supplement To increase the number of reproductive health
clinics serving American Indian/Alaska Natives that integrate HIV prevention services at an appropriate level into routine care
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Levels of HIV Prevention
HIV Prevention Education
HIV Prevention Counseling
HIV Testing Services
Health Care for HIV + Women
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Strategies of the Project
Build clinic capacities through training & technical assistance by RTCs
Establishment & use of model clinics
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Logic Model
CDC RoleRTC RoleCapacity Building OutcomesShort-term & Intermediate OutcomesLong-term Outcomes
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1. Discuss desired integration level
with clinic
2. Determinecurrent level of HIV
Services
3. Determineclinic proficiencyat current level
4. Assess clinic capacities
5. Develop training and technical
assistance plan
6. Conducttraining and
technical assistance
7. Evaluatetraining and
technical assistance activities HIV
IntegrationProgram
RTC Role in Integration
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Essential CapacitiesManagement awareness
& motivation to integrate
Staff awareness & motivation
Clinical staff skills
Adequate referral systems
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Short-Term & Intermediate Goals
Increased number of clinics integrating HIV counseling & testing
Increased proficiency in HIV counselingIncreased proficiency in HIV testingIncreased number of HIV tests at clinicsMore referrals for HIV testingIncreased number of HIV+ individuals
served
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Long-term Goals
Reduced risky sexual behavior among people served in RH clinic/settings
Increased number of HIV+ individuals seeking & adhering to treatment
Reduced incidence of HIV among people in the service area
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Essential CapacitiesManagement awareness
& motivation to integrate
Staff awareness & motivation
Clinical staff skills
Adequate referral systems
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Management Awareness & Motivation
Established policies and procedures for HIV prevention integration
Motivated management staffAdequate resources for servicesEstablished clinic flow proceduresEstablished commitment to quality
assurance
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Staff Awareness & Motivation
HIV-related knowledge of most staff
Staff motivation to provide HIV prevention services
Staff comfort in delivering HIV prevention services
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Clinical Staff Skills
Knowledge & skills for HIV prevention education
Skills in client-centered HIV prevention counseling
Skills in HIV testing (traditional and/or rapid)
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Adequate Referral Systems
Referral lists continually documented and updated
Established mechanisms to monitor success of referrals
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HIV Integration ToolkitRTC product
Definition of integration Supporting literature Description of levels of HIV prevention Common barriers to integration Description of needed capacities Tools for assessment of levels & training needs Examples of training tools Technical assistance tools Monitoring & evaluation Experiences of different types of providers
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Monitoring & Evaluation
Process monitoring (all clinics) # of clinics served (Title X & non Title X) Needs assessment for technical assistance
(TA) performed # & type of training sessions & TA events # & demographics of people trained # of clinics with > 1 PFA
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Monitoring & Evaluation (continued)
Outcome monitoring (clinics with Intensive TA) Short-term = Capacities Intermediate Other factors Case studies
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Capacity Building Outcomes (Levels 1-4)
How well the clinic protocols & policies outline HIV requirements for each level
Level of motivation, knowledge and skills & comfort level of staff to deliver HIV prevention activities for each level
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Monitoring & Evaluation (continued)
Outcome monitoring (clinics with Intensive TA) Intermediate outcomes
# of clinics integrating counseling & testing Proficiency in HIV prevention counseling Proficiency in HIV testing # of HIV tests across clinics # of referrals for HIV testing across clinics # of HIV + women served
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Other Factors
Training planOPA fundingUse of HIV integration champions
HIV Integration champions are staff members who not only actively advocate but boldly lead in integrating HIV prevention services into routine care at reproductive health clinics/settings.
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Qualitative Case Studies
Potential topics Special populations State family planning
systems Non Title X providers Unique TA
methodologies Unique clinics
Potential factors Critical capacities Biggest barriers & how
they were overcome Role of RTCs & other
partners Success institutionally
or personality driven Next steps for
sustainability Needed additional
resources
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Questions and Discussions