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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.

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Community Based HIV Prevention Research: Lessons Learned

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  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

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