From Needs Assessment to Curriculum Development: HIV Intervention Program for Providers 3TC meeting October 17, 2002 Mary Schroeder, MPH (Project Director) Carol Dawson-Rose, PhD, RN (UCSF, PI) Kelly Knight, MEd (UCSF, Co-I) Grant Colfax, MD (SFDPH, Co-PI) Cynthia Gomez, PhD (UCSF, CO-PI)
The HIP Study: Acknowledgements The Centers for Disease Control Grant # R18/CCR920974-1 • Dogan Eroglu, PhD (CDC, Project Officer) • Cari Courtenay-Quirk, MA (CDC, Project Coordinator) • Vel McKleroy (CDC, Project Coordinator)
Needs Assessment components • AETC • Formative Research with HIV+ patients • Key Informant Interviews with HIV medical providers
AETC • Providers want consultation on Prevention with Positives • Training priority • Skills building on transmission risks
Formative work with HIV+ persons • Prevention Needs - Contextual • Commonalties • Desire to speak to providers about transmission risks
7 Medical Providers: 2 Infectious Disease 1 Internal Medicine 1 Family Practice 2 HIV Specialist GP 1 RN, HIV Health 2045 HIV+ patients: MSM, MSM/IDU, heterosexual men and women, IDU Key Informants: Interviews with HIV Medical Providers
Barriers Time Billing Legal concerns Communication skills Pt. Competing priorities Don’t regard patients as sexually active Facilitators Practical prevention & harm reduction skills Normalize risk assessment of sex and drug use Relationship building; pts like provider better when they can talk about sex Short, direct statements Prevention… over time Perceptions of Prevention in HIV Care
Barriers Time Too many sessions Incentives Preaching Providers will resist Facilitators Medical approach Emphasize positive results on patients’ health Peer facilitation Keep it real Support belief that Providers make difference Perceptions of HIP Training
Why HIP Study? • Importance of provider in prevention • Need for a provider intervention • Collaboration with SFDPH • CDC request to place intervention programs in the clinical setting
HIP Theories and Flow Adult Learning Harm Reduction Training Providers Prevention Messages IMB Motivational Interviewing Risk from HIV+ to HIV- & HIV status unknown HIV+ Patient Harm Reduction Outcome
HIP Curriculum Design • # 4 – 1 hour sessions • # 1 – 1 hour booster session • CAPRA method throughout • Case Studies • CME
CAPRA • Conversation opening • Assess risk • Prevention message • Referrals focus on prevention for positives • Agree to follow-up
Vignette • James HIV+ several years • Recently released from state prison • Current female sex partner, HIV status unknown • Has not disclosed to female partner • First visit since release, signs of STD
Conversation • How can we open a conversation with James about his sexual behavior. • Eric, the sore that you have is from a STD, I will talk to you about treatment of that and I want to talk to you about your sexual partners.
Assess Risk • Can you tell me a little about who you are having sex with? • Sex with current partner(s) • Sex while incarcerated • Use of barriers/condoms • I want to ask you some questions about your drug use
Prevention Message • What do we want the patient to take away from this visit? • If you are not using condoms with current partner, what would it take for you to use condoms? • Do you want to talk to your partner about your status? • Disclose/test partner?
Referrals: Provide name & number • There is a program that could advise your current partner of exposure to HIV and facilitate testing • We can set up a session for you and your partner to talk to the SW to discuss HIV • I can bring your partner in and talk to her now and you can disclose
Agree to follow-up • Whatever the plan….. • I want to talk to you again at our next appointment to see how this is going for you, to see how it worked out ...
Interactive components of training • Risk Assessment Videos (good, medium, bad) • Providers play the “Movie critic” • Video scenarios: Stop & Apply CAPRA • Apply CAPRA in practice & share case studies • Interactive CD-Rom