Lessons from the CDC/RTC HIV Integration Project Marianne Zotti, DrPH, MS, FAAN Team Leader Services Management, Research & Translation Team NCCDPHP/DRH/ASB.

Lessons from the CDC/RTC HIV Integration Project

Marianne Zotti, DrPH, MS, FAAN

Team Leader

Services Management, Research & Translation Team

NCCDPHP/DRH/ASB

Content

History of the HIV Integration ProjectCurrent Project OverviewLogic ModelRegional Training Center (RTC) RoleHIV Integration Toolkit Monitoring & Evaluation

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

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

Levels of HIV Prevention

HIV Prevention Education

HIV Prevention Counseling

HIV Testing Services

Health Care for HIV + Women

Strategies of the Project

Build clinic capacities through training & technical assistance by RTCs

Establishment & use of model clinics

Logic Model

CDC RoleRTC RoleCapacity Building OutcomesShort-term & Intermediate OutcomesLong-term Outcomes

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

Essential CapacitiesManagement awareness

& motivation to integrate

Staff awareness & motivation

Clinical staff skills

Adequate referral systems

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

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

Essential CapacitiesManagement awareness

& motivation to integrate

Staff awareness & motivation

Clinical staff skills

Adequate referral systems

Management Awareness & Motivation

Established policies and procedures for HIV prevention integration

Motivated management staffAdequate resources for servicesEstablished clinic flow proceduresEstablished commitment to quality

assurance

Staff Awareness & Motivation

HIV-related knowledge of most staff

Staff motivation to provide HIV prevention services

Staff comfort in delivering HIV prevention services

Clinical Staff Skills

Knowledge & skills for HIV prevention education

Skills in client-centered HIV prevention counseling

Skills in HIV testing (traditional and/or rapid)

Adequate Referral Systems

Referral lists continually documented and updated

Established mechanisms to monitor success of referrals

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

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

Monitoring & Evaluation (continued)

Outcome monitoring (clinics with Intensive TA) Short-term = Capacities Intermediate Other factors Case studies

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

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

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.

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

Questions and Discussions