National/Regional Minority Organizations (NRMO) Evaluation Project
Year 1
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
CHPS Collaborating Projects
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
Saint Louis University School of Public Health is conducting an evaluation of National/Regional Minority Organizations (NRMO), a project authorized by the U.S. Centers for Disease Control and Prevention (CDC). The NRMO project is led by Dan Gentry, who received the three-year $800,000 grant from the CDC.
The NRMO project was created by the CDC in 1988 to strengthen HIV/AIDS prevention efforts among minority communities throughout the country by providing training and technical assistance.
The study will provide valuable feedback to the NRMOs and the CDC in order to evaluate models of training and technical assistance in terms of building HIV/STD prevention capacity among minority organizations. It will also result in the development of a management tool, to be used by the CDC and NRMO program staff, which will guide and facilitate national program development and implementation, program monitoring, quality assurance, and continuous improvement in a manner that is both consistent with the findings of the formal evaluation and logic in terms of program management and oversight.
The study will include an evaluation of approximately 100 process-and-outcome indicators based on site visits to all 22 NRMOs, and questionnaires sent to client organizations. NRMO clients include community-based organizations and coalitions, local government agencies or any group that provides HIV education and prevention services to minority communities. These local agencies receive on-site technical assistance and training on how to apply for and be awarded grants, and make their organizations more efficient at providing prevention services.
CHPS has received a third, and final, year of funding from the CDC for the Evaluation of national HIV/STD-prevention capacity-building efforts, in the amount of $88,800. This brings the total amount of the cooperative agreement to $638,761. The third year activities are primarily directed toward dissemination, in the form of several monographs, a training document for practice, and peer-reviewed publications.
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
The Jody Clark AIDS Project funds are being used for several different areas. One part of the project is developing an AIDS class to be taught in the spring of 1999, primarily to the Health Science Center students. It will cover a wide range of topics ranging from the virus itself to public health interventions. Professors will give lectures on the various topics such as natural history, prevention issues, treatment issues, ethical issues, AIDS policy and politics. Special population issues such as gay and bisexual men, women and children, substance abusers, and prison populations will be covered. The class is tentatively titled "AIDS at the Turn of the Century: A Public Health Perspective."
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
Saint Louis University School of Public Health's Center for HIV/STD Policy Studies has a new research study beginning this fall. The project, "AIDS, Ethics, and the Catholic Church," is a collaboration with Boston College. Dan Gentry and Father Gerald Magil at the Center for Health Ethics will lead the project.
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
Background: The purpose of this study is to assess knowledge of Missouri's HIV testing and reporting laws, attitudes and behavior concerning HIV testing; and HIV-related knowledge, attitudes, beliefs, and behavior among populations at high risk for HIV infection, specifically men who have sex with men, injection drug users, and heterosexuals who suspect they have a current STD. The HITS II study replicates the HITS I study, also funded by CDC, which was conducted in Missouri in 1996. Seven of the original nine states from HITS I are participating in HITS II.
Specific Study Aims: The study's four main objectives are: 1) to pilot HIV behavioral surveillance methodology, protocols and instruments; 2) to evaluate the impact of recent events on persons' decisions to seek HIV testing; 3) continued evaluation of HIV surveillance systems and the representativeness of HIV surveillance data; and 4) to corroborate the results of the HITS I study.
Research Design and Methods: 324 subjects from high-risk populations were surveyed in face-to-face interviews by trained interviewers in St. Louis, Kansas City and Springfield, MO. Interviews were conducted in designated private settings in gay bars, STD clinics, and through street outreach. The survey and the protocols were developed by CDC. Subjects were randomly selected, at least 18 years old, and were residents of Missouri. No names were recorded; subjects remained anonymous. Subjects were free to end the interview at any time. Subjects were compensated for their time in cash.
The HIV Testing Survey (HITS) was initiated in 1990 under a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to assess knowledge, attitudes, behaviors and beliefs of people in 3 high-risk groups for HIV infection regarding state HIV testing and reporting laws and policies. The pilot study of HITS I was completed February 1995; the Missouri component of the actual study was conducted 3/96 through 7/96. Interviews were conducted in St. Louis, Kansas City, and Columbia, Missouri in gay bars, STD clinics and outreach settings for drug users. A total of 302 individuals participated in the study: 102 from gay bars and a gay bathhouse, 98 from STD clinics and 102 from drug outreach settings. The results of the HITS I Study in Missouri appeared to indicate that, regarding HIV testing, a small proportion of at-risk persons are concerned about giving identifying information and having this information reported to the health department if their tests are positive. In addition, there appears to be a misunderstanding among some at-risk individuals regarding the exact meaning and availability of anonymous HIV testing. These concerns are likely to cause some at-risk persons to delay testing or choose not to be tested.
The HITS Phase II Study replicated the 1996 HIV Testing Survey I Study in Missouri. The HITS II questionnaire was largely based on the original HITS questionnaire. The study assessed health behaviors among high risk populations for HIV infection and their knowledge, beliefs, and attitudes regarding HIV reporting laws. The Missouri component of the actual study was conducted from 8/98 through 11/98. A total of 324 anonymous surveys were administered at three high risk venues including gay bars, injection drug users (IDUs) counseling/treatment sites/ street outreach, and STD clinics in St. Louis, Kansas City, Springfield, Missouri. Of the 324 partcipants the break down of venues were 114 from gay bars, 100 from STD clinics, and 110 from IDUs.
A summary of the literature that is highly relevant to the background rationale of this proposed study shows that for persons likely to be exposed to HIV through sexual activity, there is a positive correlation between condom use and likelihood of recent or repeat testing, but that the complexity of testing and behavioral control issues requires continuing research and more intensive interventions to encourage safe sex. IDUs were more likely to get tested if they knew someone who had tested positive for HIV. Changes in state reporting policies from anonymous to named reporting have had a detrimental effect on testing rates in some states, though in others the resulting changes were insignificant.
Results from HITS I in Missouri indicated that, regarding HIV testing, some at-risk persons are concerned about giving identifying information and having the information given to the state if their test results are positive. Such concerns likely cause some at-risk persons to avoid or delay testing. In addition, there appears to be misunderstanding among some at-risk individuals regarding the meaning and availability of anonymous HIV testing.
This study has four primary aims or objectives:
Objective 1- Pilot behavioral surveillance - HITS II will be piloted as a behavioral surveillance methodology for monitoring behaviors that put persons at increased risk for HIV among specific high-risk groups. These data will be collected to broaden the scope of HIV/AIDS Surveillance.
Objective 2- Evaluate the impact of recent events on persons' decisions to seek HIV testing. Several important events have occurred since HITS I was conducted that may have affected the HIV testing and surveillance environment. The potential impact of these events on persons' risk behaviors and decisions to seek HIV Testing will be assessed. These events include: 1) availability of drug therapies that have significantly improved the prognosis of HIV infected persons; 2) potential for increases in risky behaviors if the perceived consequences of becoming HIV infected are diminished by improved drug therapy; 3) two new HIV testing technologies (home collection kits, and the Orasure Test) are now widely available; 4) the first documented breach of confidentiality from the AIDS surveillance system occurred in Florida in 1996; and
5) CDC has stated that all states should implement HIV case surveillance as an extension of their AIDS surveillance system.
Objective 3- Continued evaluation of HIV surveillance systems. A key HIV surveillance evaluation objective is determining the representativeness of persons recently diagnosed with HIV infection compared to all persons recently diagnosed with HIV infection. Representativeness of HIV surveillance data is determined, in part, by HIV testing patterns. Therefore, the questions on high risk person's HIV testing history, intent to seek HIV testing in the future, and the likely venues and reasons for future testing will provide important data to help interpret HIV surveillance data and to make and implement national and state policy.
Objective 4- Corroborate the results of HITS I. The key study findings related to knowledge of HIV reporting laws, reasons for delaying or avoiding HIV testing, and the likelihood of seeking HIV testing in the future will be reassessed in HITS II.
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
Purpose
The purpose of the Prevention Marketing Campaign is the prevention of HIV/STDs at the state and local level through a collaborative effort between health departments and the representatives of the community involved. In essence, the main goal of the campaign is to change behavior, prevent disease, and to preserve life.
Description of the Project
This project is an extension of the Missouri Department of Health's HIV/STD education and prevention programs which currently include abstinence-based education, programs designed to encourage the postponing of sexual involvement, and a formal module for HIV/STDs in elementary and secondary educational curricula. The Missouri Department of Health also educates using targeted approaches to reduce harm to those that are at high risk for HIV/STDs and include groups such as IV and substance drug abusers, men who have sex with men, women, youth, and partners of persons already infected with HIV. The Prevention Marketing Campaign will involve gathering baseline data on rates of HIV/STDs in the St. Louis area, conducting focus groups to design appropriate and effective prevention marketing campaign messages for those most at risk for HIV/STDs in St. Louis, and the measurement of changes in HIV/STD rates over the time period of the program. The media will also be used in the Prevention Marketing Campaign to deliver the public health messages created by the focus groups. St. Louis has been chosen as the site for this program because Saint Louis University is the only school of public health in Missouri and the Bureau of HIV/STD Prevention has an existing relationship with the Center for HIV/STD Policy Studies and in the future, similar prevention marketing campaigns may be used in other parts of Missouri.
Update
The condom social marketing campaign is being implemented in certain target zip codes in the city of St. Louis. The target zip codes were chosen based on high rates of HIV and STDs in those areas. To date, media marketing surveys were distributed at various venues in the campaign zip codes with the help of St. Louis Effort for AIDS (EFA) and Blacks Assisting Blacks Against AIDS (BABAA). Media surveys are being used for the purpose of media placement and condom venues. Focus groups were also conducted with people in the community thought to be of high-risk for HIV or STDs in order for us to know about specific behaviors, in addition to perceived benefits and barriers to condom use. Currently, CHPS, along with EFA, BABAA, and the St. Louis City Health Department, are designing media messages and condom packaging. The campaign is expected to kick off around Valentine's Day next year. Keep your eyes open!
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
"Partnership for Empowerment" was nominated for the U.S. Conference of Mayors Innovations Award for 1997-1998. "Partnership for Empowerment" was a Case Management Assessment Report. It was prepared for the Metropolitan St. Louis AIDS Program, St. Louis City Department of Health and Hospitals, and it was prepared by Dan Gentry and Susan Lehrman. Special assistance was contributed by Emily Gantz. The Case Management Assessment Report was prepared with the intent to provide a beginning, overall assessment which could help answer the question "What specific improvements are needed in this case management-based program to better serve those in our community living with HIV/AIDS?" The team also examined the provision of case management for people living with HIV infection, both in St. Louis and nationally, and made recommendations for entering a developmental phase for change based on examination.
Overview of Comprehensive Project
In the Spring of 1996, the Saint Louis Metropolitan AIDS Program initiated an effort to reengineer the HIV Case Management System for the Saint Louis community. The goal of this effort is to plan, implement, and maintain the country's best case management program for people living with HIV/AIDS.
A plan was developed to accomplish this goal in four stages: (1) assessment, (2) development, (3) implementation, and (4) evaluation. A final report from the first phase, assessment, was submitted in October 1996. Since that time, several events have occurred. First, the process, as originally planned, proceeded with the designation of four work groups. These groups were charged with accomplishing the tasks of the development phase of the project. Secondly, two additional groups were brought together to advise the Director of the St. Louis City Department of Health and Hospitals and the Saint Louis HIV Services Planning Council on issues relating to HIV Case Management in Saint Louis; these advisory groups were the City of Saint Louis, Department of Health and Hospitals, HIV/AIDS Service Coordination Task Force, and the Case Management Advisory Group of the Personal and Social Support Subcommittee, Metro Saint Louis HIV Health Services Planning Council, respectively.
For more information, please contact CHPS Director, Dan Gentry, at dgentry@wpogate.slu.edu.
Aims are to increase the capacity of prevention and care planning councils to allocate resources based upon objective data concerning those communities in the population most at risk. Back to top.
Aims are to conduct an evaluation to assess the overall efficacy, design, and operation of the community planning process to include: observing, monitoring, and providing feedback of community planning activities, objectives, and goals; assessing adherence to those goals and objectives; and surveying the planning environment and membership's roles and responsibilities as defined by the CDC's supplemental guidance. Back to top.
Aims are to conduct an evaluation of selected HIV/STD Health Education and Risk Reduction programs to: determine strengths and weaknesses of the prevention program with regard to organizational and program capacity, to assist with program adaption; measure the knowledge, attitudes, beliefs, and behaviors of the clients served by the selected programs; identify barriers to clients' behavior change; determine program's effectiveness in achieving stated goals and objectives; and to determine the overall cost-effectiveness of selected programs. Back to top.
Provided training on basic evaluation techniques to HIV prevention CBOs in these two cities. Back to top.
Aims are to provide CARE Act Title I and II planning groups across the country with development tools that will allow them to assess their progress in creating a continuum of care for PLWH/A, by focusing upon purpose and mission, representation and diversity, needs assessment, comprehensive planning, prioritization and resource allocation, continuum of care, and availability and accessibility of services. Back to top.
Aims are to assess the effectiveness of HIV case management provided by 14 organizations. Some of the outcome indicators are lack of duplication of case managers, referral success, client satisfaction, and a cost-effectiveness analysis using New York Medicaid data. This work has involved client chart abstraction, interviews with case managers and clients, focus groups, and secondary analysis of the New York State Medicaid data. Back to top.
Aims are to assess the "readiness" of the HIV case management program in St. Louis for formal evaluation and implementation of continuous quality improvement methods. The primary methods being utilized for the assessment are document review, selective interviews, and focus groups. Back to top.
Aims were to evaluate the impact of CARE funding in the organization, availability and accessibility of services of PLWH/A. Back to top.
Aims are to examine the factors that facilitate community-level cooperation, agency administrative-level collaboration, and agency client-level cooperation among HIV care networks and to discern what types of organizations provide the pivotal linkages in networks that have achieved service integration in terms of client entry and retention points for care. Back to top.
These evaluation guides were designed for use by Hispanic community-based HIV education/prevention organizations without researchers on staff. Back to top.
One of the manuals was designed to help assure that all planning group members share an understanding of needs assessment and evaluation techniques; and the other manual was designed to help state and local health departments establish and maintain strong minority participation in community planning processes. Back to top.
These management standards were designed for use in small minority CBOs; it has been field-tested as an organizational tool. Back to top.
From 1990-1994, one of the evaluation team members administered the NCLR; in this capacity, she attended NMO meetings for several years. Back to top.
Consideration of HIV of other STDs is one of many components of a comprehensive needs assessment being conducted with native Americans of the Northern Cherokee-Missouri tribe. Back to top.
The evaluation, involving qualitative and quantitative components, examined the integrity of campaign implementation, the efficacy of the delivery system, and the strength of the messages. This campaign, recognizing the disproportionate impact of HIV on minority communities, was specifically targeted to these groups. Back to top.
The principal goal of this campaign was to target communities at high risk of HIV infection. The evaluation, involving qualitative and quantitative components, examined the integrity of campaign implementation, the efficacy of the delivery system, and the strength of the messages. Back to top.
The Syringe Exchange Program specifically involves outreach to African American and Latino communities in the greater Cleveland area. Ultimately, the goal of this project is to help prevent the spread of HIV. Back to top.
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Principal Projects