Enhancing Prevention with Postivies Evaluation Center
Culturally Appropriate Interventions of Outreach, Access and Retention among Latina/o Populations Initiative Evaluation and Technical Assistance Center (ETAC) University of California, San Francisco Outline
Goal of initiative Goal of cross-site evaluation Cross-site evaluation framework Cross-site evaluation methods Eligibility Global unique ID Process evaluation Outcomes evaluation Economic evaluation Timeline Goal of Initiative To enhance HIV testing and diagnosis
among out-of-care Latino/as, and to link and retain these populations in high quality HIV care To engage intervention approaches tailored to Latino cultural beliefs as they relate to health seeking behavior Goal of Cross-site Evaluation To facilitate and conduct a rigorous evaluation of innovative and effective service delivery interventions for Latino/as living with HIV across demonstration sites. Evaluation Components
Quantitative HIV testing data Interventio n exposure Medical data abstraction Participant survey
Evaluation Objectives To assess the effect of demonstration projects on: Engagement in HIV care continuum, and Patient health outcomes. To assess how pre-disposing factors, enabling factors and need mediate or moderate the effectiveness of demonstration projects Identification of factors guided by Transnational Framework specific to Latino/a experiences in the US
Objectives To assess the cost, cost-efficiency and costeffectiveness of demonstration projects Evaluation Theory Behavioral Model (Andersen, 1968, 1995) Predisposin g Factors Enabling Factors Need
Health Behavior Traditional Populations Predisposing Factors Demographics - Age - Gender - Relationship status Health Beliefs - Knowledge of healthcare resources - Satisfaction with HIV care
- Patient/provider communication Social Structure - Education - Employment - Faith traditions Enabling Factors Need Personal/Family Evaluated Health Resources
- HIV-related health status - Income - Health Insurance - Social support Community Resources - HIV healthcare resources Evaluation Theory Behavioral Model for Vulnerable Populations (Gelberg, Andersen, Leake 2000) Predisposin g Factors
Traditiona l population s Vulnerable population s Enabling Factors Traditiona l population
s Vulnerable population s Need Health Behavior Vulnerable Populations Predisposing Factors Enabling Factors
Need Social Structure - Transgender - Ethnicity - Skin color - Sexual orientation Lived Experience - Housing - Incarceration - HIV disclosure - Depression - Drug use
-Intimate partner violence Cultural Beliefs - Racial socialization Stigma - HIV, MSM, transgender, criminal record Personal/Family Resources - Competing needs - Public benefits - Coping skills - Transportation Community Resources
- Social service resources No additional factors Evaluation Theory Behavioral Model for Transnational Populations (proposed) Transnational Populations Predisposing Factors Enabling Factors Need
Health Beliefs - Knowledge of healthcare resources for immigrants Lived Experience - Country of origin - Migration - Transnational travel - Acculturation - English language literacy Cultural beliefs - Familismo, Machismo, Marianismo, Fatalismo Stigma
- National origin Personal/Family No additional factors Resources - Transnational social support - Economic transnationalism - Transnational communication - Transnational information sources Community Resources -Transnational density
- Transnational HIV medical provider Evaluation Framework Innovative Interventions Stigma reduction Community engagement Identification Outreach Social network testing Linkage
Patient navigation Retention Case management Cross-site Evaluation Primary Outcomes HIV Care Continuum HIV positivity Late HIV diagnosis Linkage to HIV medical care Retention in HIV medical care
Antiretroviral therapy Viral suppression Cross-site Evaluation Cross-site Quantitative Evaluation Methods HIV Testing Aggregate data Number tested Number tested HIV-positive Number enrolled
Number of new HIV diagnoses Number enrolled Eligibility Cross-site evaluation HIV-infected Mexican and Puerto Rican individuals HIV-infected Latino/Hispanic race
Identifies as Mexican or Puerto Rican Not fully engaged in HIV care Demonstration project participation Sites may include HIV-infected Latino/a individuals from other places of origin in demonstration interventions. However, these individuals will not be counted toward totals or included in the cross-site evaluation. Global Unique ID (GUI) GUI will be used to identify participants across all data collection methods GUI components
Name (first three letters of first and last name) Date of birth (month and year) Sex (on birth certificate) Gender (current) Race Ethnicity Zip code of current residence / sleeping (first three letters)
Participant Survey Eligible participants will be surveyed at baseline and every six months until six months before the end of the demonstration project. ETAC will be responsible for tool creation, training, technical support, maintenance of the web portal and data analysis. Participant Survey Demonstration sites will be responsible for consent, data collection and weekly transfer of data to secure web portal.
Ideally, data collection staff will not be intervention staff. If sites plan to conduct interviewer-administered surveys, these may NOT be conducted by intervention staff. Intervention Exposure Routinely collected data on units of service Community engagement Outreach HIV testing Patient navigation Case management
Intervention Exposure Demonstration sites will be responsible for uploading data for eligible participants every month to secure web portal. Demonstration sites will create and use their own tools for data collection Data must be submitted in a standardized format Intervention Exposure Data elements Date Participant ID Intervention provider Outreach worker, patient navigator, case manager, etc.
Provider type Peer, non-clinical provider, clinical provider Intervention target Stigma reduction, identification, linkage, retention, etc. Minutes Data Abstraction Abstraction of routinely collected data from: HIV testing Patient care HRSA Ryan White Services Report (RSR)
ETAC will be responsible for tool creation, training, technical support, maintenance of the web portal and data analysis. Demonstration sites will be responsible for uploading data for eligible participants every six months to secure web portal. Costing ETAC will work with demonstration sites to report the annual cost of planning and implementation of demonstration site interventions. Costing categories include:
Personnel Recurring costs Capital investment (one-time costs) Infrastructure (space) Costing Demonstration sites will be asked to report on costs by: Period (pre-implementation vs. post-implementation) Activity (community engagement, testing, patient navigation, case management) Intervention target (identification, linkage, retention, etc.) Source of resources (HRSA SPNS grant vs. inkind costs)
Costing Costs associated with local and cross-site evaluation will be represented separately and are not included in the cost of demonstration site intervention implementation. Timeline Participant Survey Development Program ACASI Pilot (est. July 14) Finalize survey (est. August 18)
IRB Approval UCSF (est. June 30) Sites Intervention implementation Thank You Questions?
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