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U.S. Department of Health and Human Services

Archival Content: 1999-2005

Training Doing the Work

Synchronicity

Reprinted from the Spring 2004 issueLink to a Non-CDC site of Village Drum, a publication of the Community Health Awareness Group (CHAG).

Community Health Awareness Group (CHAG) was successful in securing three grants last year that have allowed us to embark on an exciting new journey to reach those at highest risk for HIV. The three grants are from the Centers for Disease Control and Prevention (CDC), the Michigan Dept. of Community Health (MDCH), HIV/AIDS Prevention and Intervention Section (HAPIS) and the Blue Cross and Blue Shield of Michigan Foundation (BCBSMF).

Combined these grants with synchronous goals are allowing CHAG to expand our current mobile services to reach individuals at the highest risk, offer a new rapid HIV test, and provide clients highly personalized attention from a new prevention case management program. We can now reach and test more people in locations where risk behaviors occur, where those engaged in risky behaviors seek help, and/ or where testing has been ineffective because of poor return rates. We can provide immediate test results for those who are HIV negative as well as linkages to needed services. We can offer those testing positive immediate access to the care system as well as intense one-on-one risk reduction counseling if they are continuing to engage in risky behaviors.

Identifying the Need

A key finding of an important study in Detroit, which CHAG participated in, was that HIV occurs within the context of various socioeconomic conditions. “Poverty, discrimination, homelessness, racism, and low self-esteem…emerged as conditions that created high-risk environments,” stated the report on the Rapid Assessment Response and Evaluation (RARE) Study.

These conditions further complicate the ability to implement interventions effective in creating behavior change – essential to HIV prevention.

Recent studies of syphilis in Detroit by MDCH indicate that those who are infected with HIV are still engaging in unprotected sex. And the Southeastern Michigan HIV/ AIDS Council (SEMHAC) needs assessment identified a large number of extremely high-risk young men who have sex with men who were homeless and/or recently incarcerated as well as other individuals, who in spite of their risky behavior had no knowledge of appropriate risk reduction strategies.

Seeking out these individuals at highest risk, providing a rapid test to find out if they are HIV positive and then assisting them on a one-on-one basis to help them reduce HIV transmission is a high priority for the CDC’s Advancing HIV Prevention Initiative and for CHAG.

Rapid Testing in Outreach Settings

The common component of the CDC grant, the grant from HAPIS and the BCBSMF grant, is the pilot testing of the OraQuick™ rapid test. Contrary to its name this test is not an oral test. It is the first blood test approved to give either a negative HIV test result or a preliminary positive test result within 20 minutes. CHAG is the only community-based organization in Michigan that has been approved to pilot the HIV Rapid Test in outreach settings.

This test allows CHAG to now go out into the ‘risk pockets’ that have been identified in the Detroit area, conduct the test on the outreach van, or inside a site with adequate facilities, provide counseling in one session and link clients up with services they are going to need whether the results are positive or not. For those with preliminary positive results, a confirmatory OraSure® test must be done and an appointment scheduled for the client to return for test results. At that time, a Ryan White Outreach Specialist arranges a primary care appointment for positive clients and the STARRS* mobile advocates screen them to determine whether they are eligible for prevention case management. The clients are also asked to complete a self-administered survey, which assesses willingness and ability to engage in the intensive process of risk reduction therapy.

The CDC grant provides for staff dedicated to the new programs and a new outreach van specifically for rapid testing. The HAPIS prevention grant is for staff training and technical assistance and monitoring, which the new test procedure requires. MDCH labs will continue to perform the confirmatory testing. The BCBSMF grant provided for Wayne State University (WSU) technical assistance to develop an effective protocol, and the monitoring and assessment required for a research model pilot study to find HIV testing and counseling methods that are more effective at reducing clients’ risk of infection.

Risk Reduction Strategies

The new CHAG prevention case management (PCM) program – called STARRS *(Sustained Training in Adopting Risk Reduction Strategies) – is a highly personalized program to help those HIV infected individuals who continue to engage in high risk behaviors develop a plan of action to reduce the likelihood that they will transmit the virus to others. STARRS then links them to sustained behavior change, such as substance abuse treatment and mental health services. STARRS also allows confidential tracking of clients, who all have multiple issues to contend within their lives, so they don’t fall through the cracks. Services could include those provided directly by existing CHAG programs as well as linkages with community services for substance abuse treatment, mental health and HIV medical care.

An important piece of the STARRS program is the initial contact with the client and the ability to provide a rapid test with immediate results. The STARRS mobile advocates work in tandem with all of CHAG’s counseling, testing and referral services, as well as all of CHAG’s Ryan White funded care programs, to identify HIV positive individuals appropriate for prevention case management.

STARRS is based on sound behavioral research with input from consumers and technical assistance from experts. CHAG has worked with its active Consumer Advisory Group to make sure the needs of consumers have been addressed in developing the new PCM program. CHAG staff also works closely with advisors from WSU. An important part of the new program is a tracking system developed by WSU using a unique identifier, a special formula of a client’s personal information that is known to them but that does not reveal their identity, to ensure that there is follow-up within CHAG’s various programs and also with collaborating agencies. It also involves obtaining consent for follow-up with newly diagnosed individuals who have been screened for STARRS but are not ready to accept services at the time of diagnosis, and allows for identifying clients in outreach settings who have dropped out of the system. Many fail-safes are built into the program for quality assurance and there are strict guidelines for measuring outcomes. There are many reasons why CHAG is well suited to provide optimal PCM services. One is that many of the individuals testing positive for HIV have substance abuse issues that need to be addressed. Not only is the Life Points syringe exchange van a resource for active injection drug users, CHAG’s Point of Change substance abuse program provides a full range of services including immediate access to substance abuse treatment.

After an eligibility screening for the STARRS program and a referral to CHAG’s Ryan White funded case management program to address the food, shelter, clothing and medical needs of the client, the STARRS client is ready to be assessed for risk behaviors and the development of a risk reduction plan. STARRS involves weekly face-to-face individual counseling as well as peer-led group work based on the client’s current level or readiness for behavior change. CHAG has cross-program collaboration and holds case conferences to assure a client’s needs are being met. Clients are reassessed at 3-month intervals. Once goals are met for STARRS, clients will remain in Ryan White case management as appropriate. Collaboration has always been a key to CHAG’s success in our mission to provide health care to African Americans in the City of Detroit. This synchronicity of funding and prevention programs now allows us to do that for those most in need of our services.


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