RICHLAND COUNTY HIV/AIDS INTERVENTION
Statement of Substantive Initiative:
Human Immunodeficiency Virus (HIV) became a widespread epidemic in the United States in the 1980s. Since then, organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have been working to stop the spread of HIV and Acquired Immunodeficiency Syndrome (AIDS). With the involvement of these
organizations, researchers now understand this disease - allowing for healthcare workers to help raise awareness and educate populations on how to effectively prevent the spread of
HIV. Within the past couple of years, a shift regarding transmission rates has occurred as health care workers have seen the HIV rates in big cities start to drop, whereas rates in rural communities have remained relatively static (CDC). The rural communities referenced are generally referring to cities in the deep south, such as in South Carolina. According to the South Carolina Department of Health and Environmental Control (SCDHEC), in South Carolina, men who have sex with men (MSM) “accounted for 79% of recently diagnosed adult/adolescent cases.” It was reported that out of the MSM demographic, 60% of all new diagnoses and individuals living with HIV/AIDS are African American men. In addition, African American men had the highest proportion of new HIV cases for men below age 40. Among MSM between the ages of 20-40, 77% of those living with HIV/AIDS are African American, and 76% of new diagnoses are African American as well (SCDHEC, 2016a). Further data for this demographic provided by the South Carolina Department of Health and Environmental Control shows that between the years of 2014 and 2015, 56% of new diagnoses consisted of men aged 20-29 years old. Additionally, MSM living with HIV (PLWH) showed a similar pattern of higher rates in African American men: 60% African American, 36% white men, and 4% Hispanic men. My goal is to improve the lives of individuals at risk for HIV/AIDS in Richland County, South Carolina. I will promote health through increasing access to resources, empower African American MSM with community support, and advocate for these individuals with HIV/AIDS so they may be freed from social stigma. I will be narrowing the focus to providing HIV testing to African American MSM in the 25 to 35-year-old age range in Richland County for an HIV intervention. Providing HIV testing for the chosen demographic can reduce the prevalence and severity of the disease through early detection, immediate intervention, and increased awareness.
General Solution to Address the Problem:
My general solution to address the HIV/AIDS problem in Richland County is to create a testing site that is mobile, such as a testing bus. My team and I will secure specific locations in Richland County where our target population are located and can easily access our site. For those who test positive for HIV/AIDS, we will provide health education through community meetings that will address these 3 goals: (1) educate individuals about HIV prevention, (2) promote safer sex practices, and (3) reduce stigma. We will also encourage those who test negative for HIV to come to the community meetings as well.
All three of my key insights play a role in addressing this problem
Detailed Plan:
Intervention
This program is a multi-part intervention plan to reduce the rate of HIV and AIDS in African American MSM ages 25-35 years old in Richland County. The first section of the plan is a six-month pilot study, this is the section called “The Magic Testing Bus.” The team and I will secure an old school bus, retired status, then remodel the bus so that we can conduct rapid blood HIV mobile testing. Once the bus is fit for testing, we will then take the bus to locations where our committee member who is part of our target population has stated that other individuals of the target population tend to gather. By using our committee member, we will be sure to be at locations that our target population will be, increasing our chances of testing African American MSM ages 25-35 years old. We will drive our mobile testing center around Richland County to ensure that all areas of the county are reached. The county will be divided into 4 quadrants. The bus will stay in each quadrant for a week, and it will move around within the quadrant. After that week, the bus will move to another quadrant. This rotation will continue throughout the duration of the pilot study. The bus will revisit each quadrant six times over the course of the 6-month pilot study. We will have two phlebotomists on the bus to perform the rapid test and two phlebotomists at the main laboratory running the standard HIV test. On the bus, we will be performing rapid blood HIV test, which takes ten minutes for a result to appear. If the test comes back positive, then a standard HIV test is required. For the standard test, blood will be taken and then stored until the bus returns to the main laboratory where the test will be performed. After test results come in, we will then begin notifying patients of their results. For those who test HIV positive, we will then register them for the second part of RCHAP, which is the educational component.
The second part of my intervention plan is the educational component. If the participant is tested and results come back positive, they are registered for group meetings that are conducted by health educators. We will have four health educators, one stationed in each quadrant so that meetings will be held locally, making it easier for participants to attend sessions. Also, during our pre-testing survey, participants can indicate if they are interested in attending these group meetings. Meetings are only required if a participant is HIV positive, but all are welcome to attend. By opening this up to people who are not HIV positive, we hope that this will reduce the stigma and also reduce the rate new HIV infections occur if individuals are better educated on how the virus spreads.
Intervention
This program is a multi-part intervention plan to reduce the rate of HIV and AIDS in African American MSM ages 25-35 years old in Richland County. The first section of the plan is a six-month pilot study, this is the section called “The Magic Testing Bus.” The team and I will secure an old school bus, retired status, then remodel the bus so that we can conduct rapid blood HIV mobile testing. Once the bus is fit for testing, we will then take the bus to locations where our committee member who is part of our target population has stated that other individuals of the target population tend to gather. By using our committee member, we will be sure to be at locations that our target population will be, increasing our chances of testing African American MSM ages 25-35 years old. We will drive our mobile testing center around Richland County to ensure that all areas of the county are reached. The county will be divided into 4 quadrants. The bus will stay in each quadrant for a week, and it will move around within the quadrant. After that week, the bus will move to another quadrant. This rotation will continue throughout the duration of the pilot study. The bus will revisit each quadrant six times over the course of the 6-month pilot study. We will have two phlebotomists on the bus to perform the rapid test and two phlebotomists at the main laboratory running the standard HIV test. On the bus, we will be performing rapid blood HIV test, which takes ten minutes for a result to appear. If the test comes back positive, then a standard HIV test is required. For the standard test, blood will be taken and then stored until the bus returns to the main laboratory where the test will be performed. After test results come in, we will then begin notifying patients of their results. For those who test HIV positive, we will then register them for the second part of RCHAP, which is the educational component.
The second part of my intervention plan is the educational component. If the participant is tested and results come back positive, they are registered for group meetings that are conducted by health educators. We will have four health educators, one stationed in each quadrant so that meetings will be held locally, making it easier for participants to attend sessions. Also, during our pre-testing survey, participants can indicate if they are interested in attending these group meetings. Meetings are only required if a participant is HIV positive, but all are welcome to attend. By opening this up to people who are not HIV positive, we hope that this will reduce the stigma and also reduce the rate new HIV infections occur if individuals are better educated on how the virus spreads.
Evaluation:
Qualitative evaluations: Process and impact evaluation surveys and questionnaires to track program progress, successes, and failures.
Quantitative (outcome) evaluation: If the program is allowed to continue, data on HIV rates would have to be calculated to see if the program is effectively reducing the rate at which HIV spreads in Richland County.
Quality Assessment:
A needs assessment survey will be provided at the beginning of the program so that any necessary changes can be made to the program in a timely manner and the needs of the population can be met. The survey can be included in a self-report questionnaire that all program participants are required to take and will ask questions relevant to improving the overall quality of the program and the experience of each participant. The necessary changes will then be made to the program.
In order to determine if the implementation of the program was successful, an analysis of program results is necessary. Factors such as dose, reach, response, and fidelity determine the overall quality of the program. At the end of each month that the program is implemented, the evaluation coordinator and their team will conduct an internal evaluation to analyze the data for the factors previously listed. The team will check for the number of individuals receiving HIV tests and attending informational/educational sessions to determine if the dose is on track with program goals. They will also be responsible for monitoring the reach and response data in order to determine if members of the population were given a fair opportunity to participate in the program and track the actual number of population members that actually participated in the program. Lastly, the evaluation team will need to check the fidelity of the program to see if the services are being given according to protocol and if the program is following the proposed timeline. The evaluation team monitoring all of these factors will greatly enhance the overall success and effectiveness of the program by allowing the team to track the program’s successes and failures, and also make monthly data comparisons in order to make improvements to the program implementation.
Any sensitive information will remain confidential and be used solely for its intended purpose(s). All participants will be informed about the purpose(s) and potential risks of the evaluation(s) and program and be required to give written consent of their willingness to participate.
Effectiveness assessment:
An impact evaluation is necessary in order to assess the effectiveness of the of the program to monitor changes and improvements in participant HIV and safe sex knowledge, behaviors regarding safe sex, attitudes about negative stigmas surrounding HIV, and awareness. A survey and self-report questionnaire will be given to each program participant monthly in order to monitor each of the previously stated components. The questionnaire and survey results will be used to determine if the program has benefited participants and if the intended outcomes were reached.
If the program is allowed to continue past the 6-month mark, an outcome evaluation will be completed to determine if the program was successful in decreasing the rate of new HIV positive tests in the community. During a prolonged period of time (3-5 years or more), the rate at which the community members test positive for HIV will be recorded monthly. If the rate at which community members test positive for HIV decreases over time, then the program can be deemed a success. This is due to the fact that the program’s efforts to provide education, support, and free/affordable health care to community members would have worked and ultimately resulting in a decrease in the transmission of HIV in the target population.
Any sensitive information will remain confidential and be used solely for its intended purpose(s). All participants will be informed about the purpose(s) and potential risks of the evaluation(s) and program and be required to give written consent of their willingness to participate.
Qualitative evaluations: Process and impact evaluation surveys and questionnaires to track program progress, successes, and failures.
Quantitative (outcome) evaluation: If the program is allowed to continue, data on HIV rates would have to be calculated to see if the program is effectively reducing the rate at which HIV spreads in Richland County.
Quality Assessment:
A needs assessment survey will be provided at the beginning of the program so that any necessary changes can be made to the program in a timely manner and the needs of the population can be met. The survey can be included in a self-report questionnaire that all program participants are required to take and will ask questions relevant to improving the overall quality of the program and the experience of each participant. The necessary changes will then be made to the program.
In order to determine if the implementation of the program was successful, an analysis of program results is necessary. Factors such as dose, reach, response, and fidelity determine the overall quality of the program. At the end of each month that the program is implemented, the evaluation coordinator and their team will conduct an internal evaluation to analyze the data for the factors previously listed. The team will check for the number of individuals receiving HIV tests and attending informational/educational sessions to determine if the dose is on track with program goals. They will also be responsible for monitoring the reach and response data in order to determine if members of the population were given a fair opportunity to participate in the program and track the actual number of population members that actually participated in the program. Lastly, the evaluation team will need to check the fidelity of the program to see if the services are being given according to protocol and if the program is following the proposed timeline. The evaluation team monitoring all of these factors will greatly enhance the overall success and effectiveness of the program by allowing the team to track the program’s successes and failures, and also make monthly data comparisons in order to make improvements to the program implementation.
Any sensitive information will remain confidential and be used solely for its intended purpose(s). All participants will be informed about the purpose(s) and potential risks of the evaluation(s) and program and be required to give written consent of their willingness to participate.
Effectiveness assessment:
An impact evaluation is necessary in order to assess the effectiveness of the of the program to monitor changes and improvements in participant HIV and safe sex knowledge, behaviors regarding safe sex, attitudes about negative stigmas surrounding HIV, and awareness. A survey and self-report questionnaire will be given to each program participant monthly in order to monitor each of the previously stated components. The questionnaire and survey results will be used to determine if the program has benefited participants and if the intended outcomes were reached.
If the program is allowed to continue past the 6-month mark, an outcome evaluation will be completed to determine if the program was successful in decreasing the rate of new HIV positive tests in the community. During a prolonged period of time (3-5 years or more), the rate at which the community members test positive for HIV will be recorded monthly. If the rate at which community members test positive for HIV decreases over time, then the program can be deemed a success. This is due to the fact that the program’s efforts to provide education, support, and free/affordable health care to community members would have worked and ultimately resulting in a decrease in the transmission of HIV in the target population.
Any sensitive information will remain confidential and be used solely for its intended purpose(s). All participants will be informed about the purpose(s) and potential risks of the evaluation(s) and program and be required to give written consent of their willingness to participate.
References:
Centers for Disease Control and Prevention. (2016). Terms, definitions, and calculations used in
CDC HIV surveillance publication. Retrieved from https://www.cdc.gov/hiv/statistics/
surveillance/terms.html
South Carolina Department of Health and Environmental Control. (2016a). An epidemiologic
profile of HIV and AIDS in South Carolina 2016. Retrieved from
http://scdhec.gov/health/doc/stdhiv/pp_CH1-EpiProfile.pdf
South Carolina Department of Health and Environmental Control. (2016b). People tested for
HIV in South Carolina health department clinics, 2016, by gender, race/ethnicity, age, site type, risk exposure and region. Retrieved from www.scdhec.gov/Health/docs/stdhiv/data/labqr2016.pdf
Centers for Disease Control and Prevention. (2016). Terms, definitions, and calculations used in
CDC HIV surveillance publication. Retrieved from https://www.cdc.gov/hiv/statistics/
surveillance/terms.html
South Carolina Department of Health and Environmental Control. (2016a). An epidemiologic
profile of HIV and AIDS in South Carolina 2016. Retrieved from
http://scdhec.gov/health/doc/stdhiv/pp_CH1-EpiProfile.pdf
South Carolina Department of Health and Environmental Control. (2016b). People tested for
HIV in South Carolina health department clinics, 2016, by gender, race/ethnicity, age, site type, risk exposure and region. Retrieved from www.scdhec.gov/Health/docs/stdhiv/data/labqr2016.pdf