Integrating Prevention in Residential and Community Care Settings: A Multidimensional Program Evaluation

Abstract

As people with HIV live longer and healthier lives, ongoing prevention with positive individuals has become a new focus of care. Effective prevention with positives interventions are emerging and new interventions continue to be developed. This article discusses the development and evaluation of the prevention for positives intervention developed for a large AIDS service organization in Chicago. The intervention consists of case manager based HIV prevention education and support within residential and community settings. The article describes the intervention and presents the methods and findings of the program evaluation. The multidimensional evaluation includes formative and process evaluation elements as well as qualitative and quantitative measures (N = 94). The article concludes with a discussion of the challenges and opportunities associated with integrating prevention into care.

Diagnostic Value of Model-Based Iterative Algorithm in Tuberculous Pleural Effusion

“…Model adaptive and interactive learning control of unknown nonlinear systems have been reported [ 6 – 8 ]. In the diagnostic application of tuberculous pleural effusion, due to the limited processing speed, memory capacity, and communication bandwidth of the IPC, an event-triggered control mechanism was proposed [ 11 ]. In this mechanism, only the trigger moment is used for computing and information transfer, which effectively reduces the number of controls and communication burden.…”

HIV Care Providers' Implementation of Routine Alcohol Reduction Support for Their Patients

“…20 However, other providers and their patients have come to expect that the provider will facilitate access to services and respond to the patient's expressed needs, rather than focus on the patient's alcohol use practices. 21 Some providers may therefore resist implementing alcohol reduction counseling. This may especially be the case if they feel that it will shift priorities away from providing more traditional care and support, and if it threatens to harm their good relationships with patients.…”

“…2,19,[22][23][24] Less experienced providers (who constitute a substantial proportion of the HIV care workforce as a result of high provider turnover rates 25,26 ) may find it especially challenging to incorporate addiction counseling into their interactions with patients if they lack the skills, confidence, experience, and organizational support to do so. 21,27,28 Regardless of their experience with HIV patients, providers' personal alcohol use may be an additional unspoken barrier. The importance of alcohol reduction among HIV patients, however, argues for the need for its support by HIV care providers.…”

Barriers and Facilitators in Implementing “Prevention for Positives” Alcohol-Reduction Support: The Perspectives of Directors and Providers in Hospital-Based HIV Care Centers

“…Importantly, because hundreds of thousands of HIV-infected patients receive regular primary care in clinical care settings, HIV care providers in these settings are in a strategic position to reach many patients and offer risk reduction support. Notably, however, patients and HIV care providers have come to expect that the provider will facilitate access to services and respond to the patient’s expressed needs, rather than focus on the patient’s potentially problematic alcohol use practices (Mitchell et al, 2005). In addition, providers often have limited education and training to address alcohol abuse issues, and limited skills, confidence, experience, and organizational support to incorporate addiction counseling into their interactions with patients (Bluespruce et al, 2001; Mitchell & Linsk, 2001; Mitchell et al, 2005).…”