Discussion: Innovative HIV Interventions

Evidence-Based Programs and Practice and

The Future of the HIV/AIDS Epidemic

Evidence-Based Programs

•  What is ‘evidence-based’ and how does evidence influence public health practice?

•  Life cycle of evidence-based programs •  Key concepts and terminology •  Using evidence-based programs in practice

Life-Cycle of Evidence-Based Programs

Terminate

Maintenance

Initial Implementation of EBI

Clinical Trials: Evidence Based Interventions

Research

National Efforts to Disseminate EBIs

Centers for Disease Control

–  Identified efficacious programs –  Created a replication package (for general use; involved the developers and CDC)

–  Identified core elements and key characteristics (more on this) –  Directly funded agencies to deliver/provided indirect funding through states

–  Built on existing CDC funded training centers to develop and deliver training and TA

–  Adjust programs to reflect policy priorities

Diffusion and Implementation of EBIs

•  How do programs move out into practice? •  Slowly….. – Select – Adopt – Adapt – Implement – Sustain/Terminate

EBIs: Core Elements and Key Features

•  Core Elements – Aspects of the program that ‘make the program work’

– Are essential/foundational and cannot be eliminated

•  Key Features (Characteristics) – Elements of a program that can be adapted to meet needs of a new population/setting/changing environment

Example 1: RESPECT

•  Developed by behavioral scientists and physicians in mid-1990’s to address HIV/STI risks

•  Testing and Treatment for HIV –  Blood test/2 week interval between test and results –  Although AZT had been available since 1987, the ‘culture’ was still one of ‘HIV kills’

–  Behavior change was viewed as the best form of prevention •  Large scale Randomized Controlled Trial (RCT)

–  Showed a two session brief counseling program, with a two week interval was an efficacious approach to reducing STDs and behavior

Example 1: RESPECT (cont) •  Session 1

–  Rapport building and risk assessment •  Discuss health goals and risk behavior •  Discuss sex and drug risks

–  Risk Prevention Analyses •  Discuss reasons for engaging in risk •  Barriers to reducing risk behavior

–  Negotiated Risk Reduction •  Develop behavior change plan •  Set achievable goals

Example 1: RESPECT (cont)

•  Session 2 (two weeks later) –  Evaluation risk reduction plan –  Identify problems and solutions –  Negotiate new risk reduction plan

Example 1: RESPECT (cont) •  Advances changed the landscape

–  Rapid Testing (20 minute lag time/no blood draw) –  Medications improved

•  Translation Research –  RESPECT can be delivered to high risk clients in CBOs and DPHs with good

fidelity –  Financial factors heavily impact program delivery –  Organizational-level decisions impact program fidelity

•  Further tests of RESPECT raised questions –  One session (Pre-test, wait 20 min, Post-test) –  Two RCT showed minimal effects of one session program on behavior in

studies of MSM and of drug users •  2014 CDC stopped actively supporting the program

Example 2: Helping Enhance Adherence to Antiretroviral Therapy (HEART)

•  e-Learning training information •  Social support and problem-solving intervention •  5 sessions: patient and a patient-identified support partner.

–  Patient-identified support partner can attend all 5 sessions –  Partner required to attend at least 2 of the first 4 sessions, one of

which needs to be a pre-medication session –  2 sessions are delivered just before initiating antiretroviral therapy –  3 sessions occur during the first two months after initiation of

antiretroviral therapy

•  Patients and support partners work through a series of problem-solving activities to identify and address adherence barriers.

Example 2: HEART (cont) •  Describe the key components of the HEART strategy •  Describe the role of the support partner in promoting adherence

•  Describe the use of an individualized adherence plan in HEART Sessions

•  Describe the role of the provider during HEART sessions and phone calls

•  Identify and describe social and behavioral factors associated with medication non-adherence, and identify strategies to improve adherence.

HIV in the Media

When did you first learn about

HIV/AIDS?

Stories from around the world

•  CDC: Theresa's Story, Let's Stop HIV Together

– https://www.youtube.com/watch?v=z1u8PpbQnPE •  CDC: Shana’s Story, Let's Stop HIV Together

– https://www.cdc.gov/actagainstaids/campaigns/lsht/ stories.html

•  Youth Voices - Cleopas’ story on living with HIV in Zambia

– https://vimeo.com/175205002 •  Yvette’s Story – South Africa National AIDS Council – https://www.youtube.com/watch?v=WSClAtQJ73w

Celebrities

•  Rock Hudson •  Princess Diana •  Magic Johnson •  Freddie Mercury •  Salt-N-Pepa •  Charlie Sheen

Movies and Television

•  An Early Frost (1985) •  The Ryan White Story (1989) •  Something to Live For: The Alison Gertz Story (1992) •  Philadelphia (1993) •  ER (1997) •  Rent (2005) •  Holding the Man (2015)

HIV in the Media around the world

•  Gilead TV ad: https://www.youtube.com/watch?v=yROagCIt5VQ

•  Testing commercial: https://www.youtube.com/watch?v=sh1QzNLM5_w

•  HIV/AIDS alliance: https://www.youtube.com/watch?v=XNMRqCwN3Qg

•  Safer Sex ad: https://www.youtube.com/watch?v=-ZXc_VQG0PA

•  Transmission ad: https://www.youtube.com/watch?v=q3JrdzJXDqs

•  Condom ad: https://www.youtube.com/watch?v=yCa6XBKwMjM

•  Atlanta News clip:https://www.youtube.com/watch?v=CQ0Y0wRstFs