1 / 28

Community Based HIV Prevention Research: Lessons Learned

Community Based HIV Prevention Research: Lessons Learned. KENNETH VOGTSBERGER, M.D. STAFF PSYCHIATRIST ATCMHMR DAVID DESMOND, M.S.W. ASSISTANT PROFESSOR, RET. UTHSC, SAN ANTONIO. OVERVIEW OF PRESENTATION.

kita
Télécharger la présentation

Community Based HIV Prevention Research: Lessons Learned

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Community Based HIV Prevention Research: Lessons Learned KENNETH VOGTSBERGER, M.D. STAFF PSYCHIATRIST ATCMHMR DAVID DESMOND, M.S.W. ASSISTANT PROFESSOR, RET. UTHSC, SAN ANTONIO

  2. OVERVIEW OF PRESENTATION HOW A NIDA GRANT INFLUENCED THE SUBSTANCE ABUSE DIVISION, DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER OVER A 10 YEAR PERIOD

  3. BACKGROUND OF MULTI-SITE STUDY • NIDA OBJECTIVES: PREVENT DRUG ABUSE AND REDUCE TRANSMISSION OF HIV • NIDA GOALS: TEST AND EVALUATE DIFFERENT MODELS /INTERVENTIONS TO REDUCE HIGH RISK DRUG ABUSE AND SEXUAL BEHAVIORS AMONG IDUS AND THEIR SEX PARTNERS

  4. BACKGROUND • SEPT. 1987-SIX NADR, 5 ATOM PROGRAMS FUNDED • SEPT. 1988-TOTAL OF 54 CITIES AND 63 SITES FUNDED

  5. LOCAL COMPETING APPLICATIONS • SAN ANTONIO METROPOLITAN HEALTH DISTRICT • UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER, SAN ANTONIO

  6. SHOTGUN WEDDING:OFFSPRING NAMED FRIO STREET PROJECT (FSP) • $2,500,000 FOR PROJECT,1988-1991 (PI’s second grant appl, first funded project) • HEALTH DISTRICT: OUTREACH AND RECRUITMENT • MEDICAL SCHOOL: DATA COLLECTION, INTERVENTION (Health Belief Model), AND DATA ANALYSIS

  7. WHY DID WE GET FUNDED???? • LOW SEROPREVALENCE COMMUNITY • LARGE HISPANIC IDU POPULATION • MADDUX/DESMOND TRACK RECORD WITH NIDA • PI WITH EXPERIENCE AS TEACHER AND DIRECT PATIENT CARE PROVIDER • HEALTH DISTRICT TRACK RECORD IN HIV TESTING/COUNSELING • THE L------- WORD

  8. A FAMOUS SAYING THAT APPLIES TO GETTING FUNDED: THE ONLY THING WORSE THAN NOT GETTING WHAT YOU WANT, IS GETTING WHAT YOU WANT.

  9. FSP AS BASIS FOR 10 YEARS OF GRANT FUNDING • $400,000/ 1991-1992 EXTENSION AND FORMATION OF THE SW RESEARCH CONSORTIUM (NIDA) • $3,064,000/ 1989-1994 IMPROVING RETENTION ON METHADONE MAINTENANCE (NIDA) • $972,000/ 1992-1995 STEPS PROJECT (CSAT) • $2,300,000/ 1994-1999 COPA PROJECT (NIDA)

  10. ADDITIONAL GRANTS • $150,000/ 1996-1999 SUPPLEMENT FOR NEW MINORITY RESEARCHERS (NIDA) • $36,000/ 1997-1998 FEMALE CONDOM MULTI-SITE STUDY (NIDA)

  11. DOING THE WORK • ESTABLISH FIELD OFFICE • HIRE STAFF/ISSUES WITH OUTREACH WORKERS • TRAIN STAFF/TEAMBUILDING • MULTI-TASKING FOR ALL STAFF • RECRUIT SUBJECTS-THE INFAMOUS AIA QUESTIONAIRE/ REFINE PROCESS • IMPLEMENT/REFINE THE INTERVENTION

  12. DOING THE WORK • DO FOLLOW-UP ASSESSMENTS 6 MONTHS POST-ENROLLMENT (A POPULATION OF HEROIN ADDICTS RECRUITED FROM THE STREETS!!) • STAFF ATTRITION

  13. MEETINGS, BLOODY MEETINGS!! • WEEKLY ALL STAFF MEETING • OUTREACH WORKERS MEETING • FOLLOWUP STRATEGY MEETING • RESEARCH STAFF MEETING

  14. LOCATOR FORM DESCRIPTION OF SUBJECT HANGOUTS SIGNIFICANT OTHERS FOR CONTACT CONSENT FORM TO CONTACT IN 6 MONTHS

  15. FOLLOW-UP FLOW SHEET • LETTER (EMPHASIZE $) • PHONE CALL • “BE ON THE LOOKOUT” • INTENSE SEARCH

  16. RESULTS • 2,292 IDUS AND 349 SEX PARTNERS RECRUITED IN 2 ½ YEARS • 20,000 BOTTLES OF BLEACH DISTRIBUTED • 72,000 CONDOMS DISTRIBUTED • 2,300 BLOOD SAMPLES TESTED, 33 HIV+ (1%)

  17. RESULTS • HIGH RATES OF UNSAFE NEEDLE USE AT INITIAL ASSESSMENT • HIGH RATES OF UNSAFE SEX AT INITIAL ASSESSMENT

  18. RESULTS • 80 % SIX MONTH FOLLOW UP RATE • 1,673 BLOOD SAMPLES TESTED AT FOLLOW UP, ONLY 1 CONVERSION • 60 % OF IDUS HAD AT LEAST ONE TREATMENT EXPERIENCE(reported at initial assessment) • 90 % OF IDUS HAD AT LEAST ONE JAIL/PRISON EXPERIENCE(reported at initial assessment)

  19. OUTCOME OF THE INTERVENTIONS • AT 6 MONTH FOLLOWUP, BOTH STANDARD AND ENHANCED INTERVENTION LEAD TO REDUCTION IN NEEDLE RISK INDEX • AT 6 MONTH FOLLOWUP, NO SIGNIFICANT CHANGE IS SEX RISK • LOW SEROPREVALENCE MAINTAINED IN SAN ANTONIO THROUGH 1998

  20. ESTIMATED TOTAL NUMBER OF SUBJECTS RECRUITED FOR ALL STUDIES: 1988-1999 5,575

  21. BENEFITS TO P.I. • LETTER FROM THE PRESIDENT, UTHSCSA • PROMOTION: FROM ASST. TO ASSOC. TO PROFESSOR • PUBLICATIONS: 19 ARTICLES, 1 BOOK CHAPTER, 1 ABSTRACT • THE ACADEMIC EXPERIENCE

  22. CHALLENGES FOR THE P.I. • BALANCING TEACHING, SERVICE, AND RESEARCH • DEALING WITH MULTIPLE, SEEMINGLY UNSOLVABLE PROBLEMS • MULTIPLE RESPONSIBILITIES • DEALING WITH MULTIPLE UNCERTAINTIES

  23. CHALLENGES FOR THE P.I. • HIRING COMPETENT EMPLOYEES • TERMINATING PROBLEMATIC EMPLOYEES • TERMINATING GOOD EMPLOYEES DUE TO REDUCTIONS IN FUNDING • MONTHLY REPORTS, QUARTERLY REPORTS, ANNUAL REPORTS, RENEWAL APPLICATIONS, AD INFINITUM

  24. P.I. SURVIVAL • DEVELOP RELATIONSHIPS WITH MENTORS • MAINTAIN HIGH VISIBILITY WITH STAFF • MAINTAIN A “CLINICAL CONNECTION” • USE TEAM APPROACH • USE TEAM PROBLEM SOLVING • DELEGATE EVERYTHING POSSIBLE, WITH APPROPRIATE POWER, AND HOLD STAFF ACCOUNTABLE • SET DEADLINES • ACCEPT THE IMPERFECTIONS OF SELF, FACULTY, STAFF, AND NIDA

  25. RECOMMENDED TEXTS • STARLING, GROVER. MANAGING THE PUBLIC SECTOR, 5TH ED, WADSWORTH, 1997 • WHITMAN, NEAL ET AL. EXECUTIVESKILLS FOR MEDICAL FACULTY, 2ND ED, UNIVERSITY OF UTAH SCHOOL OF MEDICINE, 1993 (801-581-7234)

  26. P.I. SURVIVAL • MANAGE YOURSELF • MANAGE YOUR REACTION TO STRESS • MANAGE THE AMOUNT OF STRESS

More Related