Community Report-Back February, 2005 1
Community Partners - SF Black Coalition on AIDS, Inc. South East Health Clinic NIA Project/Action Point 2 Rafiki House Proyecto Contra. SIDA Por Vida Arriba Juntos Walden House Urban Health Study Lyon Martin Women’s Health Services Instituto Familiar de la Raza Tenderloin Self-Help Center TARC Continuum Mission Neighborhood Health Center Mission Neighborhood Resource Center Tom Waddell Lutheran Social Services Shanti Restoration House—Ark of Refuge SFGH, Ward 86; Ward 93 AIDS Health Project 2 Positive Resource Center S. F. AIDS Foundation
Community Partners – East Bay The Center for AIDS Services La Clinica de la Raza HEPPAC NEED Bay Area Consortium for Quality Health Care: EIP Program APEB Neighborhood House of North Richmond WORLD Berkeley Free Clinic Tranquilium African American AIDS Support Service 14 th Street Clinic AIDS Housing and Information Project Oasis Clinic Alameda County Office of AIDS EBAC Alameda Public Health Dept. CAL-PEP Ark of Refuge Highland Hospital, Adult Immunology Clinic 3
History TO 1997 -1999 4 1999 -2005
National Partners – INSPIRE Intervention for Seropositive Injectors: Research & Evaluation l l l 5 Centers for Disease Control & Prevention (CDC) David Purcell, Yuko Mizuno, Richard Garfein, Scott Santibanez, Ann O’Leary, Craig Borkowf, Cindy Lyles. Health Resources & Services Administration (HRSA) Lois Eldred, Kathleen Handley. New York Academy of Medicine Mary Latka, David Vlahov, Julia Arnsten, Bob Gern, Mark Gourevich University of Miami Lisa Metsch, Jay Wilkinson, Eduardo Valverde, Clyde Mc. Coy, Rob Malow John Hopkins School of Public Health Carl Latkin, Amy Knowlton, Susan Sherman, Phillip Coffin
Bay Area Team - UCSF Cynthia Gomez, Kelly Knight, Carol Dawson-Rose, Starley Shade, Paula Lum, Catherine Lyons, Sonja Mackenzie, Caryn Pelegrino, Debra Allen, Barbara Garcia, Jeff Moore, Dinah Usog, Gilda Mendez, Erin Rowley, Greg Austin, Reggie Payne, Charles Pearson, 6 Principal Investigator Co-Investigator & Project Director Co-Investigator & Clinical Coordinator Statistician Medical Director Clinical consultant Evaluation Coordinator; Project Coordinator Recruitment/PVA Coordinator; Project Coordinator Recruitment Team & Tracker Interventionist Phlebotomist & Assessment Team Phlebotomist Project Assistant, Assessment Team Coordinator Assessment Team Qualitative Interviewer Recruiters: Senobia Ellis; Maria Pedrosa, Natalie Isaac, Duaniel Menifee, Askia Muhammad, Hazel Betsy, Shawnna Demmons, Andrew Reynolds, Michael Northcutt
Goals of the study • To reduce sexual and drug use practices that could transmit HIV • To increase access to and use of HIV primary health care • To increase access and adherence to HIV treatments 7
INSPIRE Study Description § Each site attempted to recruited about 250 HIV+ IDUs with opposite sex partners and a history of IDU in the past year. § Eligible participants completed a baseline survey on ACASI and provided blood samples for CD 4 and viral load testing. § Participants who came to initial intervention visit were randomly assigned to one of two program conditions. § Participants attended 8 -10 intervention visits. § Participants returned for follow-up ACASI survey at 3, 6, and 12 months post intervention. § Participants provided blood samples for lab testing at 6 and 12 months. § Some participants returned for qualitative de-brief interview post-study. 8
Total Number of Participants Baltimore Miami 298 New York 271 Bay Area 279 Total 9 313 1161
Bay Area Participant Characteristics (N = 279) l l l 10 Gender: Male Female Transgender Race/Ethnicity African American API/AN Latino White Age: 58% 34% 9% l Education: Less than H. S. diploma Some college+ l Ever 65% 7% 18% 10% incarcerated: In last 6 months: l Sexual 32% 35% 33% 71% 73% orientation: M W T Straight 45% 72% 20% Bi 35% 23% 20% 42 years old (mean) Gay 16% 2% 48% (Range: 24 -58)
Participant Retention l Overall FU Rate: 91% – l 12 Mo FU Rate: 92% – l l 11 615/675 3 -, 6 -, + 12 -Mo FU visits 207/225 12 Mo FU visits Overall FU Rate of reachable participants: 95% 12 Mo Fu Rate of reachable participants: 96%
Overview of PMI & VDI l Peer Mentor Intervention: – l Video Discussion Intervention: – 12 Seven group sessions, two individual sessions, and one Peer Volunteer Activity at a community agency 8 group sessions based on watching and discussing videos on a range of topics including criminal justice system, overdose, disclosure of HIV to children
Video Discussion Intervention Summary Session I Introduction to VOICE, HIV health care, sexual and drug transmission risk Session II Group Workshop Drinking Apart Session III Group Workshop Don’t Shut Me Out: disclosing HIV to children Session IV Group Workshop Understanding Prejudice Session V Group Workshop Red Cross Emergency Test, overdose Session VI Group Workshop The Farm: Angola, USA Session VII Group Workshop Black Is, Black Ain’t Session VIII 13 Group Workshop How to Get a Job, How to Keep a Job
Peer Mentoring Intervention Summary Session I Group Workshop Introduction to Peer Mentoring Session II Group Workshop Health Care Decision-Making, Disclosing HIV Status to Providers Session III Individual Meeting Your Relationship to HIV Care, HIV Medications and Adherence Session IV Group Workshop Peer Mentoring: Talking to Peers Session V Group Workshop Introduction to Harm Reduction, Sex, Drugs and HIV Risk Session VI Group Workshop Disclosing Status to Partners, Taking Responsibility for Protecting Partners Session VII Individual Meeting Barriers to Protecting Partners, Strategies to Overcome Barriers Session VIII Group Workshop Session IX 14 Male and Female Condom Demo Condom Use Skills-Building, Negotiating Condom Use Individual Activity Peer Volunteer Activity: Participation in an AIDS Service Organization Session X Group Workshop Debrief from Peer Volunteer Activity, Intervention Review, Plans for the Future
Session 1 - Introduction to Program l l l Identity as HIV+ people Group Composition Years since HIV Diagnosis (mean = 8 years): – 15 Less than 3 years 12%
Sessions 2 & 3: Health Care Utilization, Adherence & Relationship with Providers 16
Primary Healthcare Visits in the Past 6 months % None 21 One to Three 30 Four or more 49 Total 100 Currently on HIV medication = 47% Not on meds but CD 4 less than 200 = 9% 100% Adherence: Yesterday = 81% Past 7 days = 67% 17
Session 4: Communication Skills & Peer Mentoring 18
Session 5: Harm Reduction for Sexual and Drug Risk Number of Sexual Partners % 0 8. 3 1 40. 2 2 14. 5 3 13. 0 4+ 24. 0 Total 100. 0 Mean 19 5 Range 0 – 188
Drug Risk Behaviors with HIV-/? in the Past 3 Months % Injected Lending Used Needles 8. 3 Sharing Cooker, Cotton or Rinse Water 20 85 22. 8
Unprotected Vaginal and/or Anal Sex with HIV-/? by Respondent’s Gender Men Women 37% (33/90) Transgender 21 33% (52/156) 36% (8/22)
Sessions 6 -8: HIV Disclosure & Responsibility 22
Condom Use Consistency with Main HIV-/? Partner by Respondent’s Gender Male Female Transgender n n % Consistent 16 35 14 44 3 43 Inconsistent 4 9 7 22 1 14 Non-User 26 57 11 34 3 43 Total 23 % 46 100. 0 32 100. 0 7 100. 0
Condom Use Consistency with Non-Main HIV/? Partner by Respondent’s Gender Male Female Transgender n n % Consisten t 14 18 8 24 2 18 Inconsiste nt 23 29 10 30 4 36 Non-User 43 54 15 46 Total 24 % 80 100. 0 33 100. 0 11 100. 0
Session 9: Peer Volunteer Activity Goals: l Provide an opportunity to act as peer volunteer in a community setting l Increase utilization of community resources Logistics: l Created MOUs with community service providers l Established volunteer activities for study participants at each site l Participants signed-up for their preferred site and activity during 8 th session 25
PVA Partner Sites SF: East Bay: TARC NIA Project WORLD Action Point 2 HEPPAC Lyon Martin Tranquilium Urban Health Study Highland Hospital, C 2 Clinic APAN (Redwood City) 26
Session 10: Graduation 27
How to reach us l l 28 CAPS www. caps. ucsf. edu Caryn Pelegrino: Tel: 415 -597 -8118; cpelegrino@psg. ucsf. edu Kelly Knight: Tel: 415 -597 - 4651; kknight@psg. ucsf. edu Cynthia Gomez: Tel: 415 -597 -9267; cgomez@psg. ucsf. edu
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