Enhancing Prevention with Positives Evaluation Center (EPPEC)
NOTE: This study has ended. The Enhancing Prevention with Positives Evaluation Center (EPPEC) is a technical assistance and evaluation center for 15 demonstration sites funded by the Special Projects of National Significance (SPNS) program of the Health Resources and Services Administration (HRSA). The 15 demonstration sites work with EPPEC and the SPNS program at HRSA to implement and evaluate HIV prevention interventions with HIV-infected patients in primary health care settings. A multidisciplinary team led by the UCSF AIDS Policy Research Center is carrying out the project. Each of the participating sites reports client, provider, organizational setting and intervention characteristics, as well as the results of behavior change surveys and other core measures. What is unique about this project is that each of the 15 sites is implementing a different intervention specifically tailored to the local client population and environment. Interventions range from brief counseling delivered by primary care providers during regular visits to individual risk reduction counseling delivered by prevention specialists, and to peer-led group sessions. Some sites are using a combination of models and several sites are delivering intervention services in more than one clinical setting. The specific aims for EPPEC are:
- Evaluation: To facilitate and conduct evaluation research that will have maximum impact on practice and policy of HIV prevention across 15 demonstration sites.
- Technical Assistance: To provide methodological (both quantitative and qualitative) research design and technical assistance on the development of behaviorally based interventions, assist sites in design of data collection and management systems, and provide a central database for measurement of outcomes.
- Dissemination: To synthesize and disseminate findings from demonstration projects to maximize their impact on further prevention research, practices and policies.
- Capacity: To stimulate innovative projects, scientific excellence, and organizational capacity to ensure integrity of research and sound fiscal operations.
EPPEC is working to analyze, synthesize and disseminate findings from demonstration projects so that they have optimum impact on further prevention research, practices and policies.
Nearing the end of the interventions at the demonstration sites, analysis of quantitative baseline data indicates that providers of primary care and support services in HIV clinical settings have a potential role in HIV prevention. Providers are more likely to deliver PwP if they feel responsible for doing so; providers are less likely to deliver PwP if they express prevention fatalism, the belief that no matter how much counseling is delivered, some HIV+ patients will still infect others. Among all HIV+ patients enrolled in the study–MSM, MSW and women–stimulant use is associated with risk. Through analysis of pre-implementation qualitative data collected through interviews with project staff and interventionists at the demonstration sites we identified the following common elements to successfully implement complex behavioral interventions in clinical settings:
- Internal leadership and authority to overcome resistance and foster interest and motivation on the part of clinical providers and clinic staff,
- Shared belief in importance, need, viability, and appropriateness of PwP in clinical setting,
- Adequate attention to creating flow between clinic practice and intervention,
- Ongoing training within the clinic that can address clinician and staff needs as prevention programs become a regular part of the care.
Successful implementation depends on the complementary fit between the intervention model and the clinical setting. Assessing the feasibility of whether or not a clinic has the support of providers, staff and patients–as well as the financial resources–is the first step in determining the potential success of implementing an intervention. Developing interventions that resonate with the patient population and the clinical environment will lead to great willingness from and meaningful experience for participants. Please see the following articles for more detail:
- Implementation of HIV Prevention Interventions with People Living with HIV/AIDS in Clinical Settings: Challenges and Lessons Learned. AIDS and Behavior, 2007
- Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings. AIDS and Behavior, 2006
HRSA-SPNS funding for EPPEC began in October 2002 and will continue until September 2007. The funding for the 15 demonstration project sites began in October 2003 and will continue until September 2007. For more information, please contact: Jennifer Bie, Project Assistant Center for AIDS Prevention Studies 50 Beale Street, Suite 1300 San Francisco, CA 94105 415/597-9213 - fax 415/597-9285 - phone jennifer.bie at ucsf.edu