AEGiS-NHIVPC: Prevention Case Management: Lessons Learned from a Multi-Site Prevention with Positives Demonstration Project

National HIV Prevention Conference

Atlanta, Georgia, USA — July 27 - 30, 2003

Prevention Case Management: Lessons Learned from a Multi-Site Prevention with Positives Demonstration Project

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-F0701
Bonhomme JJ, Cardona G, Crump C, LLanas MR, Richardson DA, Stately AL, Kaplan M
Rollins School of Public Health, Emory University, Atlanta, GA

ISSUE: The Prevention with HIV-Infected Persons Project (PHIPP) has been able to glean valuable lessons learned from Prevention Case Management (PCM) interventions for purposes of informing similar projects and future Prevention with Positives (PWP) interventions.

SETTING: In conjunction with several PWP interventions under PHIPP, PCM is being implemented in HIV/AIDS service agencies, HIV early intervention clinics, correctional facilities, and mobile vans.

PROJECT: PHIPP is a five-year national demonstration project funding Health Departments providing PCM in Maryland, Wisconsin, Los Angeles, and the State of California. Cross-site commonalities in PCM include focus on behavior change to reduce HIV transmission, linkage and coordination with other services, client-centered approaches, and rapport building.

RESULTS: Nearly 500 HIV-positive clients have participated in PCM through the PHIPP demonstration project, almost half of which have completed multiple risk assessments. Demographic and HIV risk behavior characteristics of PCM clients vary according to site. Data collected from baseline and follow-up surveys in some sites reveal declines in clients' HIV risk behavior attributed to their participation in local PCM programs. These results include increased condom use during vaginal and anal intercourse, decreased diagnosis of a sexually transmitted disease, decreased unprotected sex with persons of unknown or negative HIV serostatus, decreased sex with injection drug users, decreased injection drug use, and decreased use of other illicit substances.

LESSONS LEARNED: The PCM approach may fill a gap in HIV transmission reduction efforts, as a hybrid intervention combining active case management targeting basic life needs with education promoting HIV transmission risk and harm reduction. PCM design, implementation, and recruitment strategies vary widely according to each site's structural setting, target groups, local resources, and client needs. Whereas client retention in PCM interventions is strengthened through rapport building with providers, gaining participants' trust during recruitment needs considerable attention when developing programs. PCM may conceptually and structurally be hard to integrate into existing case management and other programs. Strategies can be employed to maintain the risk-reduction and HIV prevention aspects of PCM when attempting to meet the HIV-positive client's basic life needs. Incremental PCM client progress may be captured utilizing specialized follow-up data collection survey tools. However, measurement of small incremental change in behavior presents a challenge. Qualitative methodologies may be useful in assessing and understanding PCM clients' progress and clarifying the underlying meaning of conclusions derived from quantitative data.

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