To learn from existing PCM projects, CDC staff conducted one-hour telephone interviews with program managers who oversaw the 25 PCM programs implemented by CBOs directly funded by CDC in 1996. A standard questionnaire was used to assess each program's PCM activities, the extent of their HIV prevention components, staffing patterns and staff qualifications, evaluation activities, and recommendations for revised PCM guidelines. After these interviews, seven programs were selected for site visits. A more detailed description of PCM practices at directly funded CBOs is provided elsewhere (Purcell, DeGroff, and Wolitski, submitted for publication).

From an examination of PCM practice at the 25 directly funded CBOs, the following summary emerged:

• PCM was being implemented by CBOs in a variety of settings and with a wide array of populations.
• Most programs were serving both HIV-seropositive and HIV-seronegative clients.
• PCM clients have medical and psychosocial needs, but many do not perceive a need for HIV prevention.
• PCM client recruitment and retention have been difficult.
• Recruitment has been particularly difficult in stand-alone PCM programs - those independent from other preventive, medical, or social services - that do not have an internal source of referrals.
• The quality of assessment and case planning differed from program to program.
• Programs had well-documented case records and treatment plans, but many lacked clearly defined HIV-related behavioral objectives.
• The most common referrals by PCM case managers were for medical treatment, HIV antibody counseling and testing, housing, substance-abuse treatment, and mental health counseling.
• Most PCM programs were providing some substance abuse and mental health counseling, the extent of which seemed influenced by staff skills.
• Sixteen percent of PCM programs used a standardized risk-reduction curriculum; 68% used a client-centered model.
• Many PCM programs had incorporated a group-level intervention, which was used as a support group or as a means of providing risk-reduction information and counseling.
• Protocols for coordination between PCM and Ryan White case management were seldom in place - some duplication of these two services was evident. • Whether multisession risk-reduction counseling was taking place was unclear - the acute psychosocial needs of clients may have superseded efforts for risk-reduction counseling. • Staff models and related staff credentials for PCM differed across programs. • Attention to quality assurance measures differed (this may be particularly important for an intervention for which outcome data is difficult to obtain).

In addition to examining the PCM practices of directly funded CBOs, CDC staff wanted to deter- mine whether state and local health departments are supporting PCM. To accomplish this, CDC worked with the National Alliance of State and Territorial AIDS Directors (NASTAD), which sent a six-item survey to all AIDS directors about their PCM activities. A total of 32 responses were received (28 states and 4 cities) from the 65 NASTAD members, a 49% response rate. Most of the states with the highest number of AIDS cases responded to the survey. Many of the health departments are involved, in some way, with PCM; 72% (19 states and 4 cities) fund PCM activities; and 34% (9 states and 2 cities) implement at least one PCM program. When asked how many CBOs they fund to implement PCM, responses ranged from 0 to 17, for a total of 107 CBOs currently funded by the 32 respondents. Fifteen health departments provide PCM-specific training and technical assistance to agencies. Regarding the need for new PCM programmatic guidelines, 81% of the directors thought that new guidelines were needed.

Go to section 4.0 Summary