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Early intervention demonstration projects (EIDPs) in the US: linking HIV care and prevention services at the local level.


Unique Identifier : AIDSLINE ICA12/98390369

BACKGROUND: To gain experience in managing the incorporation of early intervention (EI) services into publicly-funded HIV programs at the local level and identify primary care organizational strategies for linking new EI services with existing counseling and testing programs. DESIGN: From 1991-95, the Health Services and Resources Administration (HRSA)/Centers for Disease Control and Prevention (CDC) funded local health departments (LHDs) to establish EIDPs, among the first HIV early intervention service programs developed in the US Projects were evaluated using a case study design based on interviews with key staff members and review of project documents. METHODS: LHDs carried out four major activities: 1.) design a network of publicly-supported counseling and testing sites; 2.) El diagnostic and clinical services; 3.) case management to coordinate other needs; and 4.) HIV prevention services. Five service objectives were used in evaluation: 1.) outreach and recruitment; 2.) case finding and identification of clients; 3.) development of referral linkages; 4.) prevention programs; and 5.) primary medical care programs. LHD strategies differed in the scope of services provided, number and type of network agencies, allocation of funds between services and networking activities, and the creation of specialized HIV clinics or use of exiting primary care services. RESULTS: LHDs developed four major program types: contracting to a major medical care provider; enhancement of existing programs; emphasis on referral and tracking; and use of existing system of care. Implementation timelines were longer than anticipated. Challenges included: oversight; forging linkages; and gaining agency staff support. CONCLUSION: Implementation experiences from these EIDPs provide valuable insights on the design of future EI programs. In the development of EI services, program design should address: 1.) developing trust between patient and providers and between network providers; 2.) tracking HIV-infected persons from counseling sites to care providers; and 3.) strong linkages to drug treatment programs, mental health services and inpatient care.


Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.