April 2003

Current Knowledge

Because of the use of newer and more effective treatments, increasing numbers of persons living with HIV in the United States are living longer. CDC estimates that 850,000 to 950,000 persons in the United States are living with HIV, and that 25% of these individuals are unaware of their serostatus.^1,2 Although numerous effective prevention interventions have concentrated on HIV-negative populations, to date only a small number have focused on HIV-positive persons.^3-5

Most people who find out that they are HIV-positive reduce their sexual and drug-use behaviors⁵. However, some HIV-positive persons have intermittent or ongoing difficulties with changing their behaviors and focusing on HIV prevention. For some people, a relatively less intensive intervention (e.g., a support group or structured risk-reduction, skills-building group) will be sufficient to lead to significant change in behavior. Other HIV-positive persons may need more intensive prevention services (e.g., a couples or individual-level approach) or may benefit from a combination of prevention services.

Often people who require more intensive services are struggling with other psychosocial factors (e.g., mental illness, substance abuse, domestic violence, homelessness, and economic stressors) that affect their risk behaviors. The presence of psychosocial challenges may adversely affect HIV-positive persons, decreasing their ability to obtain and adhere to proper medical care or to reduce their HIV risk behaviors. Integrating consideration of these issues into prevention programs for HIV-positive persons is crucial. Agencies should 1) provide or have access to referrals for a range of services of different intensities, including psychosocial services and medical care; and 2) screen HIV-positive persons and refer them to the needed level of services.

Initially, it is important that persons who are newly diagnosed with HIV are enrolled into medical care. Helping HIV-infected persons enter into medical care so they can receive treatment, e.g., combination antiretroviral therapy can help suppress viral loads to very low levels and slow disease progression. HIV-infected persons who are receiving medical care may also benefit from prophylaxis for opportunistic infections and receive treatment for other health problems. Recent data from the Antiretroviral Treatment Access Studies (ARTAS) found that newly diagnosed persons or those otherwise not in medical care were more likely to get into care if they had a case manager to help them compared to those persons who were provided with passive referrals to care.⁶ In the ARTAS study, the case managers helped clients find a provider and then assisted with insurance, transportation, childcare, and other issues. This emphasizes the role for Ryan White Case Managers (RWCMs), funded by the Health Resources and Services Administration (HRSA) through their numerous grantees. These case managers actively link their clients with HIV/AIDS primary care and help them to overcome other barriers to supportive services. The work of the case managers usually results in more clients actually becoming a part of the HIV primary care system. A similar system tested in a statewide program in Minnesota used disease intervention specialists (DIS) to actively and successfully link HIV-positive youth, ages 13-22 years, to medical care and other relevant services.⁷

Agencies helping HIV-positive persons enter into medical care and providing a broad range of other services, either directly or through actively linked referrals, could have a significant effect on reducing the toll of the HIV epidemic in the United States. Important ancillary services for HIV-positive persons may include

• Behavioral interventions to reduce risk behavior
• Interventions to improve adherence to complex medication schedules
• Substance abuse treatment
• Mental health treatment
• Domestic violence prevention
• Benefits counseling
• Family planning services
• Housing

Many of these services may be obtained through referrals from a HRSA-funded RWCM. The Ryan White CARE Act is the purchaser of HIV care and services for persons without insurance or eligibility for other programs.⁸ The RWCMs attempt to link HIV-positive persons to care and other services through benefits counseling and referrals. While the RWCMs are permitted to discuss HIV risk reduction with clients, this is not the focus of their work, and they usually are not trained to do risk-reduction counseling.

Agencies that choose to focus on prevention interventions for persons living with HIV may be challenged by the newness of prevention activities for this target population and the small number of programs that have been evaluated for effectiveness. Several programs do exist for HIV-positive persons that range from less intensive, group-based interventions, to intensive, individualized interventions. These established interventions give agencies a range of prevention options to offer to HIV-positive persons. More than 10 other interventions are now being tested by researchers. Those found to be effective should be available for wider use in the next few years.

While the number of existing, effective interventions is limited, a recent review examined the correlates of sexual risk among HIV-positive persons.⁹ This article provides some guidance for agencies developing programs by highlighting what is known to be and not to be associated with sexual risk among HIV-positive persons. In addition, it is likely (but not known) that existing interventions for HIV-negative persons could be adapted for HIV-positive populations. Messages in adapted interventions should reflect the needs of HIV-positive persons to protect their partners as well as themselves.

This document provides a brief overview of interventions with a range of intensities from the less intensive group-level interventions to the most intensive risk-reduction intervention for persons with HIV, prevention case management.

Group-Level Interventions for HIV-Positive Persons
Since the beginning of the AIDS epidemic, many of the interventions designed for HIV-positive persons were used in support groups or in structured group programs in which the focus of the program and the outcomes of interest were improving mental health, social support, or coping rather than decreasing risk behavior.^10-15 Some of these programs did measure changes in risk behaviors, and some have found that a focus on coping or mental health is related to decreased risk behaviors.¹⁶ After 1996, when new, more successful HIV medications began to be used, risk reduction interventions for HIV-positive persons became a major focus of research and programmatic interest. More studies of HIV risk-reduction programs for HIV-positive persons have been conducted in the past few years, although the results are available for only three studies.

All three studies that have evaluated group-level interventions designed to reduce HIV risk behaviors among HIV-infected persons have found that the participants receiving the intervention reduced their HIV risk behaviors more than the comparison group(s) on at least one measure of risk behavior.^{3, 4, 17} In one study, small groups of HIV-infected men and HIV-infected women attended a 5-session intervention based on social-cognitive theory or a 5-session health maintenance support group.³ The intervention condition focused on strategies for practicing safer sexual behaviors; developing coping skills; enhancing decision-making skills for disclosure of HIV status to families, friends, and sex partners; and developing skills to maintain safer sex. Those who received the intervention reported less unprotected intercourse and greater condom use 6 months after the intervention ended than did the participants in the comparison groups.

In another study, participants were HIV-positive persons who inject drugs and who were entering a methadone maintenance program.4 For 6 months, participants received one of two interventions:

1. Comparison intervention, which included daily methadone, weekly individual substance abuse counseling, case management, and a 6-session HIV risk-reduction intervention
2. Harm-reduction intervention, which included everything in the comparison condition plus manual-guided group psychotherapy sessions two times a week.

At follow-up, people assigned to the harm-reduction intervention reported lower addiction severity scores, and they were less likely to engage in high-risk sex- and drug-related behaviors

Finally, in the study by Rotheram-Borus and her colleagues, HIV-positive youth were provided with 1 or 2 different modules (Stay Healthy, a 12-session group, and Act Safe, an 11-session group).¹⁷ Those who participated in the first module had increased coping in various domains, while participants in the second module had fewer unprotected sexual acts, fewer sex partners, fewer HIV-negative sex partners, and less substance use. This intervention was tested prior to HAART and has now been updated and is named “CLEAR: Choosing Life: Empowerment, Action, Results Intervention for youth living with HIV.” (The manuals for the updated intervention for youth and for other interventions by that research group are available online. The website is included in the Resources section below.)

Two of the three effective group interventions are targeted to particular HIV-positive populations (i.e., persons entering a methadone program⁴ or youth¹⁷). Agencies working with these populations should review the intervention materials available and use these interventions with the identified populations when possible. Agencies working with a more general population of HIV-positive persons should consider adopting the intervention by Kalichman and his colleagues for persons more suited for a group-level intervention.³

Two other studies highlight promising interventions for men with haemophilia and their partners and men being released from prison.^18,19 In both studies, however, the research or evaluation design was inadequate to measure the effect on behavior change. Agencies working with men with haemophilia or men about to be released from prison should review these interventions and talk to the authors about more recent information they might have about these programs.

Individual-Level Interventions for HIV-Positive Persons
Individual-level interventions may be appropriate for persons for whom group-level interventions are inappropriate or are not effective in accomplishing reductions in risk behavior. Studies that have evaluated the effectiveness of individual-level interventions have reported mixed results.

The study with the most successful outcome focused on HIV-positive women and found that peer support and services, including a component that is similar to peer-based case management, were effective in reducing risk behavior.²⁰ In this study, HIV-positive women were randomized to one of two 6-month interventions. The interventions included a comparison condition, which provided comprehensive reproductive health services including health education and counseling on relevant topics, or the enhanced condition, which included comprehensive reproductive health services plus peer advocate services. HIV-positive peer advocates worked with the women individually or in groups to share information on condom use with the primary and secondary partners. The peer advocate also provided information on contraceptive use. Optional support groups met weekly while individual sessions occurred on an as-needed basis. Three types of individual sessions were held:

1. Warm-up encounters to help develop rapport
2. Stage-of-change encounters in which peers counseled the participants on specific target behaviors using stage-appropriate messages
3. Other encounters in which the peers addressed other urgent needs, such as housing or
   child custody. This last type of encounter appears similar to peer case management.

At follow-up, the researchers found that women who were in the enhanced intervention had improved consistency in condom use, perceived condoms as more advantageous, and increased their level of self-efficacy for condom use. The researchers cited four reasons for the intervention’s success:

1. Use of HIV-positive peers, which, during formative research, the women said they preferred,
2. Close collaboration with case managers and community referral agencies due to the high unmet needs of participants,
3. Tailoring of the behavior change message to address current motivations, intentions, and partner characteristics, and
4. Reinforcement of intervention messages for women in primary care settings because most were receiving medical care.

Two studies of individual-level interventions for HIV-positive persons found no differences in risk-reduction behaviors between the intervention group(s) and the comparison group.^{21, 22} In the study that found no differences in risk reduction between peer-based case management and usual care,²² the authors proposed that their findings may have been due to the brevity of contact between the peer case managers and the participants, or to the extensive services for HIV-positive persons available in the study city (San Francisco) which may have made it harder for their intervention to make a difference in the risk behavior of the participants.

Prevention Case Management
A more intensive intervention may be necessary to meet the specialized needs of HIV-positive persons with multiple medical, social, and economic challenges. Prevention case management (PCM) is an intensive intervention that combines individual HIV risk-reduction with case management to provide intensive on-going support.^23-24 The intervention is intended for persons having or likely to have difficulty initiating or sustaining practices to reduce or prevent HIV transmission.²³

As defined by CDC’s PCM Guidance, PCM consists of the following components:

1. Identifying, recruiting into the program, and engaging clients with the greatest need
2. Screening and assessment to determine a client’s risk behavior and psychosocial needs
3. Developing a client-centered plan for reducing risk behaviors
4. Conducting multiple sessions of HIV risk-reduction counseling to maintain preventive behaviors
5. Coordinating services with follow-up regarding success of referrals and need for additional services including coordinating with other types of case managers such as Ryan White funded case managers, Medicaid case managers, or other case managers, if appropriate.
6. Monitoring and reassessment of clients’ needs, risks, and progress
7. Discharging from PCM upon attainment of risk-reduction goals

PCM guidelines also indicate that the following are essential:

1. Small client load (12–20 clients) to allow intensive case management
2. Integrated services and coordination of community and other service providers
3. Well-defined evaluation plan

Objective
The purpose of this document is to encourage and guide health departments and community-based organizations in providing specialized assistance through PCM to HIV-positive persons with multiple and complex HIV risk-reduction needs.

Procedures

1. Identify potential clients and collaborate with community-based organizations (CBOs), health departments, sexually transmitted disease (STD) clinics, HIV clinics, hospitals, clients, and others to refer high-risk HIV-infected clients to PCM. The PCM approach is based on the premise that some people may not be able to give high priority to HIV prevention when faced with problems that they view as being more important or more immediate. PCM should be reserved for persons willing to discuss intimate sexual and drug-use behaviors. Eligibility for PCM should be prioritized to include clients presenting with multiple risk factors, such as a recently acquired STD, multiple sex or needle-sharing partners in the past 3 months whose HIV status is unknown or negative, and psychosocial issues that impact these risk factors (e.g., mental illness, substance abuse, homelessness, and violence/coercion).
2. Engage in PCM with HIV-infected persons who report high-risk behaviors for HIV transmission. Because the clients who need PCM have multiple risk factors, substantial resources may be needed to identify, engage, and recruit them.
3. PCM should be conducted by professional counselors and social workers with experience working with high-risk clients (e.g., licensed social workers). Client case loads should remain small (12–20 per prevention case manager). If a jurisdiction has ample case management resources, the prevention case manager may perform fewer case management tasks and more risk-reduction activities. In such a case, the case load may be slightly larger for the prevention case manager.
4. Develop screening and assessment instruments customized to the target population, including some or all of the following topic areas: health, adherence to treatment, incidence of STD, substance/alcohol use, history of incarceration, mental health, sexual history, social support, skills to reduce transmission, barriers to safer behavior, strengths and competencies, and demographic information. Develop guidelines for data collection and performance evaluation measures. These data are crucial for determining referral and client needs and providing effective PCM.
5. At the time of initial assessment, case managers must provide clients with a voluntary informed consent document to be signed that assures confidentiality for the activities related to PCM. Communication with other providers or referral sources about a particular client requires obtaining written, informed consent from that client to allow for sharing relevant information. All information about clients should be securely stored in locked cabinets, and this should be communicated to clients. Providing these safeguards is one of the first steps to building a trusting relationship with PCM clients and engaging them in the process.
6. Prevention case managers, in collaboration with individual clients, should develop a client-centered prevention plan with measurable behavioral outcomes for reducing high-risk behaviors and maintaining low-risk behaviors. Risk-reduction activities should include an individualized risk-reduction session and may be supplemented by counseling for couples or groups. Risk-reduction activities should be theory-based and tailored to a person’s life circumstances. Clients must be provided education about the increased risk of HIV transmission associated with having other STDs. In addition, clients must be provided with partner counseling and referral services (PCRS) so that partner may be confidentially notified of their potential exposure to HIV.
7. Prevention case managers should provide active coordination of and linking to supportive services such as medical services, psychological treatment, substance abuse treatment, STD treatment, various social services, and other HIV prevention services. Agreements should be established to ensure availability and access to key service referrals for the target population. A standardized referral process should be developed including a referral tracking system.
8. Prevention case managers should meet with clients regularly so that they can provide monitoring and reassessment of the clients’ needs, risks. At regularly designated times the case manager and the client should revise the Prevention Plan and accompanying activities as appropriate.
9. Prevention case managers should establish a time frame for discharge from PCM after the client meets his or her risk-reduction goals or if the client is no longer participating in the program.
10. Incentives may be considered for use any time during PCM from engagement until discharge, if the jurisdiction and the funding source approve of their use. Appropriate incentives may include transportation cards or tokens, vouchers for food or other necessities, or in some cases, cash. The use of cash and non-cash incentives should not be excessive so as to be coercive.
11. Prevention programs should provide a well-defined evaluation plan.

Working with Partners and Integration into Existing Services

1. Clients may be identified and referred to PCM through a variety of sources including HIV testing facilities, such as public clinics and primary care facilities. Agencies that currently serve HIV-infected persons in an integrated setting (e.g., a setting where numerous services related to HIV are available, such as medical and pharmacy services and psychosocial support resources) or CBOs that are closely linked to these services, in a way that makes them highly accessible, are most appropriate for PCM programs. Clients who are referred to PCM but are not eligible should be referred to other appropriate services.
2. In some PCM settings, clients may already have a Ryan White or other case manager. The PCM Guidance provided two standards that should be followed in all jurisdictions:
   1. Explicit protocol in place for structuring the relationship with Ryan White CARE Act case management providers or other case management providers must be established and should detail how to transfer and/or share clients
   2. No duplication of Ryan White or other case management for persons living with HIV, but PCM may be integrated into these services.

   In practice this means that jurisdictions should work together to coordinate services between these two programs. Generally, Ryan White-funded case management is intended to ensure coordination and continuity of needed entitlements, medical care and treatment, housing, and other social services. They are allowed to discuss risk-reduction behaviors with clients, but they often do not have the time or the training in behavioral theory to do so in an effective manner. PCM is first and foremost an HIV-prevention activity to reduce the transmission of HIV infection. The integration of these two services is affected by the services available in the community and the eligibility requirements for the various programs.

Programmatic Considerations

1. Risk reduction needs vary across persons and time. Agencies working with HIV-infected clients should avoid a one-size-fits-all approach to helping clients reduce their risk, but they should focus their PCM efforts on those with the greatest prevention need (e.g., those who are most likely to transmit HIV to their sexual or drug using partners).
2. Intervention science has not developed to the point where there is an easy formula to match clients to interventions. But given scarce resources, agencies should focus on the most effective interventions for clients who are at greatest risk for transmitting the HIV virus.

Vignette
In May 2000, the Kansas City Free Clinic, an AIDS service organization offering a broad range of services to HIV-positive persons, established a PCM program for high-risk HIV-negative persons and newly diagnosed HIV-positive persons who were not already connected with the community’s system of care and support. Clients are referred into PCM services through a variety of clinic programs including HIV counseling and testing, HIV primary care, Ryan White HIV-funded case management, and prevention education, as well as from a variety of providers in the community. Once they are eligible, the prevention case manager initially meets weekly with participants and has telephone contact between visits as needed. The content of a typical case management session includes the review of the risk-reduction plan, follow-up on community referrals, and utilization of behavior change techniques such as motivational interviewing. Disclosure of HIV status is addressed in the ongoing risk reduction counseling. Incentives such as bus passes, movie passes, gift certificates, and safer sex supplies are utilized as funding permits.

PCM is integrated into the clinic through staff training, development, joint client case conferencing, and client service delivery protocols. The prevention case managers coordinate prevention services with the Ryan White-funded case managers, HIV primary care providers, and the peer-to-peer treatment adherence program. Prevention case managers have completed training in HIV/AIDS/STD knowledge, prevention counseling, CDC PCM Guidance, and prevention with HIV-positive persons, and they receive ongoing training. Case managers each have between 30-60 individuals on their caseloads each month, they meet with 40% of their clients monthly for risk reduction counseling services, and in each quarter, about 5 clients are discharged from PCM. The clinic employs a variety of quality assurance and evaluation methods for the staff and the program. For example, in December 2002, the PCM staff conducted a focus group with their HIV-positive clients, who were primarily MSM, to educate staff about the prevention needs of MSM and strengthen the clinic’s PCM program. The staff found that clients needed: 1) more support and information on substance abuse, 2) flexible times to meet with PCM staff, and 3) more information about topics such as daily struggles, medications, HIV health conditions, and general health issues.

Monitoring Implementation
CDC grantees receiving HIV prevention funds will be required to routinely report the following indicators to monitor their HIV prevention interventions with persons living with HIV, including prevention case management programs.

CDC’s HIV Prevention Program Performance Indicators*:

1. Proportion of HIV infected persons who completed the intended number of sessions in PCM (I.1)
2. Proportion of the intended number of HIV infected individuals to be reached who were actually reached (H.2)
3. The mean number of outreach contacts required to get one HIV infected person to access prevention case management services (H.3)
4. Percentage of HIV infected persons who, after a specific period of participation in a prevention case management program, report a reduction in sexual or drug using risk behaviors or maintain protective behaviors with seronegative partners or with partners of unknown status (I.2)

Other program measures:

5. Number of persons receiving prevention interventions that are diagnosed with a new STDs, indicating transmission risk behavior
6. Demographics of persons receiving prevention interventions and overall HIV-infected persons in the community (e.g., race/ethnicity, gender, socioeconomic status)
7. Collection of HIV transmission risk data in accordance with CTR Guidelines

* The CDC Technical Assistance Guidelines for Health Department HIV Prevention Program Performance Indicators provides information on setting baseline, target, and indicator specification including appropriate data sources, calculations and reporting issues. Note: Performance indicators may have been modified to reflect specific population or setting characteristics.

References

1. Centers for Disease Control and Prevention. (2003). Advancing HIV Prevention: New Strategies for a Changing Epidemic–United States, 2003. MMWR, 52, 329-332.
2. Centers for Disease Control and Prevention. (2002). Update: AIDS—United States, 2000. MMWR, 51, 592-5.
3. Kalichman SC, Rompa D, Cage M, DiFonzo K, Simpson D, Austin J, Buckles J, Kyomugisha F, Benotsch E, Pinkerton S, Graham J. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV-Positive people. American Journal of Preventive Medicine,21(2):84-92.
4. Margolin A, Avants SK, Warburton LA, Hawkins A, Shi J. (2003). A randomized clinical trial of a manual-guided risk reduction intervention for HIV-Positive injection drug users. Health Psychology, 22(2):223-8.
5. Marks G, Burris S, Peterman TA. (1999). Reducing sexual transmission of HIV from those who know they are infected: The need for personal and collective responsibility. AIDS, 13, 297-306.
6. Gardner L, Metsch L, Loughlin A, Mahoney P, Del Rio C, Strathdee S, Gaul Z, Greenberg AE, Holmberg S, for the ARTAS Study Group (July 2003). Initial results of the Antiretroviral Treatment Access Studies (ARTAS): Efficacy of the case management trial. Presentation at the 2003 National HIV Prevention Conference, Atlanta, GA.
7. Remafedi G. (1998). The University of Minnesota Youth and AIDS Projects' Adolescent Early Intervention Program: A model to link HIV-seropositive youth with care. Journal of Adolescent Health, 23, 115-121.
8. Parham D, Conviser R. (2002). A brief history of the Ryan White CARE Act in the USA and its implications for other countries. AIDS Care, 14 (suppl 1), S3-S6.
9. Crepaz N, Marks G. (2002). Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS, 16, 135-149.
10. Blanch J, Rousaud A, Hautzinger M, Martinez E, Peri J, Andres S, Cirera E, Gatell J, Gasto C. l (2002). Assessment of the efficacy of a cognitive-behavioural group psychotherapy programme for HIV-infected patients referred to a consultation-liaison psychiatry department. Psychotherapy and Psychosomatics, 71, 77-84.
11. Coates TJ, McKusick L, Kuno R, Stites DP. (1989). Stress reduction training changed number of sexual partners but not immune function in men with HIV. American Journal of Public Health, 79, 885-887.
12. Lechner SC, Antoni M H, Lydston D, LaPerriere A, Ishii M, Devieux J, Stanley H, Ironson G, Schneiderman N, Brondolo E, Tobin JN, Weiss S. (2003). Cognitive-behavioral interventions improve quality of life in women with AIDS. Journal of Psychosomatic Research, 54, 253-261.
13. Perry S, Fishman B, Jacobsberg L, Young J, Frances A. (1991). Effectiveness of psychoeducational interventions in reducing emotional distress after human immunodeficiency virus antibody testing. Archives of General Psychiatry, 48, 143-147.
14. Rotheram-Borus MJ, Murphy DA, Wight RG, Lee MB, Lightfoot M, Swendeman D, Birnbaum JM, Wright W. (2001). Improving the quality of life among young people living with HIV. Evaluation and Program Planning, 24, 227-237.
15. Rotheram-Borus MJ, Lee MB, Gwadz M, Draimin B. (2001). An intervention for parents with AIDS and their adolescent children. American Journal of Public Health, 91, 1294-1302.
16. Kelly JA, Murphy DA, Bahr G R, Kalichman SC, Morgan MG, Stevenson Y, Koob JJ, Brasfield TL, Bernstein BM. (1993). Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. American Journal of Psychiatry, 150, 1679-1686.
17. Rotheram-Borus MJ, Lee MB, Murphy DA, Futterman D, Duan N, Birnbaum JM, Lightfoot M. (2001). Efficacy of a preventive intervention for youths living with HIV. American Journal of Public Health, 91, 400-405.
18. Parsons JT, Huszti HC, Crudder SO, Rich L, Mendoza J. (2000). Maintenance of safer sexual behaviors: Evaluation of a theory-based intervention for HIV seropositive men with haemophilia and their female partners. Haemophilia, 6, 181-190.
19. Grinstead O, Zack B, Faigeles B. (2001). Reducing postrelease risk behavior among HIV seropositive prison inmates: The health promotion program. AIDS Education and Prevention, 13, 109-119.
20. Fogarty LA, Heilig CM, Armstrong K, Cabral R, Galavotti C, Gielen AC, Green BM. (2001). Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women. Public Health Reports, 116, 103-119.
21. Patterson TL, Shaw WS, Semple SJ. (2003). Reducing the sexual risk behaviors of HIV+ individuals: Outcome of a randomized controlled trial. Annals of Behavioral Medicine, 25, 137-145.
22. Sorensen JL, Dilley J, London J, Okin RL, Delucchi KL , Phibbs CS. (2003). Case management for substance abusers with HIV/AIDS: A randomized controlled trial. American Journal of Drug and Alcohol Abuse, 29, 133-150.
23. Purcell DW, DeGroff AS, Wolitski R J. (1998). HIV prevention case management: Current practice and future directions. Health & Social Work, 23:282-9.

Resources

CDC. HIV prevention case management: Guidance. (1997).

CDC. HIV prevention case management: Literature review and current practice. (1997).

Interventions developed by Mary Jane Rotheram-Borus, Ph.D. and her research team at UCLA.

San Francisco Department of Public Health. (2000). HIV prevention case management: Standards and guidelines for the delivery of services in San Francisco. Available from: Project Director, Prevention Case Management Standardization and Evaluation Project, AIDS Office, San Francisco Department of Public Health, 25 Van Ness Ave. Suite 500, San Francisco, CA 94102, (415) 554-9031.

CDC. Technical Assistance Guidelines for CDC’s HIV Prevention Program Performance Indicators.

UCSF, AIDS Policy Research Center, Prevention with Positives Resources