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