Emerging AHP Strategies for Recruitment

1. Emerging AHP Strategies for Recruitment Maria E. Alvarez, MPA CDC/NCHSTP/DHAP/PPB Public Health Advisor Duty Point: NYC mma8@cdc.gov 212-268-6221

2. Recruitment • An activity or set of activities intended to bring persons at high risk for being exposed to or for transmitting HIV into interventions to promote the adoption and maintenance of risk-reduction behaviors • A critical element to the success of any intervention

3. Recruitment • Strategies to engage members of a target audience/population into HIV prevention interventions, care, and services • Promotion of awareness of HIV programs • Outreach, referral network, social marketing, community-level interventions and individual-level interventions

4. Fundamental Strategies for Recruitment • Outreach • Intensive/Enhanced/Targeted • In-reach • Referral Network • Social Marketing • Community Level Interventions (CLI) • Individual Level Interventions (ILI)

5. Outreach • Working in the community rather than waiting for the community to come to the agency or organization • A set of activities conducted in the community to • provide HIV prevention information • communicate the benefits of early knowledge of one's serostatus • conduct risk-reduction interventions • promote agency programs • refer or link persons at high risk to prevention interventions and services

6. Outreach • Conducted by peers, health educators, or outreach workers on the streets and face-to-face • Conducted in specific venues where persons at high risk congregate, such as neighborhood streets, parks, bars, bathhouses, adult book stores, shooting galleries, or crack houses

7. Outreach (Intensive or Enhanced ) • Implements a “higher threshold outreach” with specific objectives and methods for engaging high-risk populations and or sub-populations into care and treatment • Uses non-traditional venues and hours • Provides a direct connection to needed and or wanted services as well as consistent support • Encourages recruitment into prevention interventions, care, and services (using highly trained and experienced peers)

8. Outreach(Targeted) • Designed to reach a specific population or sub-population of persons, as opposed to “general outreach,” which may involve mass mailings and tabling of information (e.g., health fairs) and is not targeted to any particular audience

9. In-reach • Educational activity that provides HIV prevention information and promotes HIV program services to its own staff and to persons participating in services and programs • Conducted in the waiting areas or during an intake process for programs serving high-risk persons

10. Referral Networks • Are an important strategy for recruiting persons at high risk into HIV intervention activities • Identifies other providers of services to the same population • Develops reciprocal agreements between service providers

11. Referral Networks • Bi-directional (most often) • Formal mechanism for client referrals and service provision, delineating responsibilities • Broader HIV prevention services, including • Clinics • Substance abuse treatment facilities • Homeless shelters • Domestic violence programs • Health department based STD, TB, or hepatitis related services

12. Social Marketing • Planning and implementation of programs designed to bring about social change using concepts from commercial marketing • Social Marketing includes the use of • advertising, billboards • media campaigns, public service announcements • Web site development • brochures, palm cards

13. Community Level Interventions (CLI) • Seek to improve the risk conditions and behaviors in a community through a focus on the community as a whole • Work to alter social norms, policies, or characteristics of the social environment • Implement community-wide events, policy interventions, and structural interventions

14. CLI and Activities • Outreach to promote awareness of program services (e.g., agency meetings, conferences, health fairs) • Health communication/public information (e.g., presentations at community forums, use of print/electronic media, telephone hotline, information clearinghouse, resource library) • Social marketing campaigns • Community mobilization

15. Individual Level Interventions(ILI) • Assist clients make plans for individual behavior change and ongoing behavioral appraisals • Facilitate linkages to services in both clinic and community settings in support of behaviors and practices that prevent transmission of HIV • Help clients make plans to obtain needed services • Provide health education/risk reduction counseling to one person at a time

16. ILI Activities • Client intake • Assessment of clients’ strengths and developmental assets as well as risks for HIV infection or transmission • Comprehensive HIV prevention education and counseling, e.g., abstinence, risk reduction, interpersonal/ negotiation skills development • Prevention Case Management (PCM)

17. ILI Activities • HIV Counseling and Testing (on-site or through a direct referral agreement) • Partner notification assistance counseling and communication skills-building for HIV positive clients • Referral and follow-up to needed services (e.g., primary health care, STD screening/tx, pregnancy testing, substance use, mental health, housing, education, employment, legal services)

18. ILI Activities • Crisis interventions • Outreach to provide HIV prevention/risk- reduction education • Distribution of HIV prevention/risk- reduction supplies and materials (e.g., male and female condoms, dental dams, bleach kits, print/video/audio educational materials)

19. In Conclusion…. Emerging AHP Strategies • Depends gravely on RECRUITMENT • And remains key in effectively working with the three primary areas of HIV prevention that CDC is emphasizing: • Early detection of persons who are HIV positive and referral to care services • Prevention interventions with persons living with HIV • Prevention with persons who are at high risk for HIV infection

20. Recruitment Is Critical to Successful HIV Prevention