Elements of Effective Interventions
Update on Positive Prevention Interventions
HEI CONFERENCE
Jim Sacco, MSW
August 2012
Elements of Effective Interventions
Update on Positive Prevention Interventions
Overview
Positive Prevention/Adherence Interventions can be divided into four primary categories based
on the following types of strategies they employ:
1)
2)
3)
4)
HIV Adherence Strategies
Public Health Strategies
Behavioral Strategies
Structural Strategies
Suggestions from Charles Collins [CDC] on the role of outreach workers:
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Elements of Effective Interventions
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Recruiting clients into interventions is a critical function of outreach workers. Outreach
workers conducting condom distribution and rapid testing could recruit clients into
ARTAS, CRCS, CLEAR, and Health Relationships.
Rapid Testing is a critical intervention; outreach workers are in a pivotal role to identify
most at risk populations and conduct HIV testing. Linking newly identifies staff to case
management, medical services, and facilitating access to PwP interventions should be the
primary focus.
Outreach workers/positive peers are collaborating extensively with clinics to act as
patient navigators, to deliver adherence interventions, to assist with referrals, and to
identify individuals in need of additional secondary prevention support.
I. HIV Adherence Strategies
Elements of Effective Interventions
Strategy
Name
2
Target
Population
Description
Duration
Project Heart
(Helping Enhance
Adherence to
Antiretroviral
Therapy)
ART- naïve
Social support/problem-solving,
individual/dyadic intervention
delivered before and in the first 2
months after initiation of ART. A
patient-identified support partner is
required to attend at least 2 of the first 4
sessions
Five 1 1/2 to
2hr. sessions
and 5 phone
calls over 6
months
Partnership for
Health
ARTexperienced
Brief, clinic-based individual-level,
3 to 5 minute
provider-administered intervention
session at each
emphasizing the importance of the
clinic visit
patient-provider relationship to promote
patient’s healthful behavior. Adherence
messages are delivered to the patient
during routine medical visits and the
use of posters and brochures convey the
partnership theme and adherence
messages
Peer Support
ARTexperiencedor ART naïve
Individual-and group-level
intervention, where HIV-positive
individuals, currently adherent to ART
serve as peers, who provide
medication-related social support
through group and weekly telephone
calls to patients initiating or changing
their ART regimen.
Six twicemonthly 1-hour
group meetings
and weekly
phone calls over
3 months
Text Messaging
ARTexperiencedor ART naïve
Individual-level intervention, where
patients receive text message reminders
customized to their daily medication
regimen.
Daily
customized text
messages over 3
months
SMART Couples
Sharing Medical
Adherence
Responsibilities
Together
HIVserodiscordant
couples, with
poor
medication
adherence in
the HIVpositive
A couple-level intervention
administered to sero-discordant couples
that addresses adherence to ART and
safe sex behaviors within the couple
dyad, fostering active support of both
individuals.
Four 45-60
minute sessions
over 5 weeks
Elements of Effective Interventions
partner
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II. Public Health Strategies
Anti-Retroviral Treatment and Access to Services (ARTAS) - ARTAS is an individual-level,
multi-session, time-limited intervention with the goal of linking recently diagnosed persons with
HIV to medical care soon after receiving their positive test result. ARTAS is based on the
Strengths-based Case Management (SBCM) model, which is rooted in Social Cognitive Theory
(particularly self-efficacy) and Humanistic Psychology. SBCM is a model that encourages the
client to identify and use personal strengths; create goals for himself/herself; and establish an
effective, working relationship with the Linkage Coordinator (LC).
Counseling and Testing (CTR) - see CDC Procedural Guidance for CBOs [August 2009] If
more than 20% of individuals living with HIV are unaware of their status, this continues to
present huge challenges to linking these people to care and encouraging HIV prevention
activities. Rapid testing of highest risk individuals continues to be a key strategy to identify
those unaware or their status.
Elements of Effective Interventions
Comprehensive Risk Counseling Services (CRCS) - CRCS, formerly Prevention Case
Management (PCM), is a client-centered HIV prevention activity with the goal of adoption and
maintenance of HIV risk-reduction behaviors. Originally, CRCS was conceived as a
combination of HIV risk-reduction counseling and conventional case management for persons at
high risk of transmitting or acquiring HIV. As such, CRCS typically provided intensive,
ongoing, individualized prevention counseling, support, and service brokerage. However,
information from CRCS demonstration projects indicates that a more successful model for CRCS
for HIV-infected persons clearly defines the CRCS prevention counselor’s primary role as
working closely with existing case management systems to provide other services to clients.
Where such case management systems are not available, the prevention counselor is still
encouraged to support the client by providing traditional case management services such as
linkage to needed services.
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III. Behavioral Interventions
CLEAR: Choosing Life: Empowerment! Action! Result - CLEAR is an evidence-based, health
promotion intervention for males and females ages 16 and older living with HIV/AIDS or
at high-risk for HIV. CLEAR is a client-centered program delivered one-on-one using cognitive
behavioral techniques to change behavior. The intervention provides clients with the skills
necessary to be able to make healthy choices for their lives. The Centers for Disease Control and
Prevention's (CDC's) guidelines on Comprehensive Risk Counseling and Services (CRCS),
formerly known as Prevention Case Management (PCM), identify CLEAR as a structured
intervention that may be integrated into CRCS programs.
Healthy Relationships - Healthy Relationships is a five-session, small-group intervention for men
and women living with HIV/AIDS. It is based on Social Cognitive Theory and focuses on
developing skills and building self-efficacy and positive expectations about new behaviors
through modeling behaviors and practicing new skills.
Holistic Harm Reduction (HHRP) - HHRP is a 12-session, manual-guided, group-level program
for HIV-positive and HIV negative injection drug users. The primary goals of HHRP are health
promotion and improved quality of life. More specific goals are abstinence from illicit drug use
or from sexual risk behaviors; reduced drug use; reduced risk for HIV transmission; and
improved medical, psychological, and social functioning. HHRP is based on the InformationMotivation-Behavioral Skills (IMB) model of HIV prevention behavioral change. This
intervention is offered delivered by methadone counselors in methadone clinics.
Elements of Effective Interventions
Partnership for Health (PfH) – PfH is a brief, safer sex intervention in clinics. It uses message
framing, repetition, and reinforcement during patient visits to increase HIV positive patients'
knowledge, skills, and motivations to practice safer sex. The program is designed to improve
patient-provider communication about safer sex, disclosure of HIV serostatus, and HIV
prevention. All staff in the clinic are trained and support the physician-delivered interventions.
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IV. Structural Interventions
Condom Distribution
Those interested in designing and implementing a CD program should consider including these
elements:
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Provide condoms free of charge.
Conduct wide-scale distribution.
Implement a social marketing campaign to promote condom use (by increasing
awareness of condom benefits and normalizing condom use within communities).
Conduct both promotion and distribution activities at the individual, organizational, and
environmental levels.
Target: 1) individuals at high risk, 2) venues frequented by high-risk individuals, 3)
communities at greatest risk for HIV infection, especially those marginalized by social,
economic, or other structural conditions, or 4) the general population within jurisdictions
with high HIV incidence.
Supplement the CD program with more intense risk reduction interventions or other
prevention or health services for individuals at highest risk. Integrate CD program
activities within other community-level intervention approaches to promote condom use
and other risk reduction behaviors.
Establish organizational support for condom distribution and promotion activities in
traditional and non-traditional venues.
Conduct community-wide mobilization efforts to support and encourage condom use.
Elements of Effective Interventions
Recruitment and Retention
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Outreach workers are in a central role to recruit clients into care/prevention services.
Meeting most at risk individuals and forming relationships, explaining availability of services,
de-stigmatizing HIV testing, delivering condoms, and emphasizing value of screening/treatment
of HIV are critical public health activities. In clinic settings, outreach workers are increasing
used to orient new consumers, deliver adherence interventions, identify needs for PwP, and
deliver select PwP interventions.