Co mmunity Ba se d Pa rtic ipa to ry Appro a c he s to Unde rsta - - PowerPoint PPT Presentation

Co mmunity Ba se d Pa rtic ipa to ry Appro a c he s to Unde rsta nding a nd Addre ssing L a te HI V Dia g no sis in Oa kla nd

A Co lla b o ra tive Ca se Study

Aminatu R. Yusuf1, Christina Grijalva 2, Sandi Mc Co y3, PhD, MPH, Carla Dillard Smith1, MPA, Alisun Cho pe l

3, MPH, I

fe o ma C. Udo h4, PhD, Me re dith Minkle r

3, PhD

1Califo rnia Pro stitute s E

duc atio n Pro je c t, Oakland, CA, 2 L a Clinic a de la Raza, Oakland, CA, 3 Unive rsity o f Califo rnia-Be rke le y, Sc ho o l o f Pub lic He alth, Be rke le y, CA, 4 Pang ae a Glo b al AI DS F

• undatio n, Oakland, CA

Ba c kg ro und



Na tio na lly a nd lo c a lly, la te dia g no sis o f HI V (initia l dua l dia g no sis o f HI V a nd AI DS, o r pro g re sse s to AI DS within o ne ye a r) re ma ins a sub sta ntia l pub lic he a lth pro b le m with a la rming ra c ia l dispa ritie s



T he ma jo rity o f la te dia g no se s in Ala me da Co unty a re a mo ng Afric a n Ame ric a ns, ho we ve r, whe n c o mpa ring within g ro ups, L a tino s we re 1.2 time s mo re like ly to te st la te tha n Afric a n Ame ric a ns



68% o f Oa kla nd L a tino s living with HI V/ AI DS a re dia g no se d la te



50% o f a ll individua ls who re c e ive d a la te HI V dia g no sis in Oa kla nd a re Afric a n Ame ric a n



L a te dia g no sis o f HI V is INCRE

ASING in Ala me da Co unty; up fro m

39% in 1998 to 57% in 2010

T he c o lla b o ra tive e ffo rts o f the Pa ng a e a Glo b a l AI DS F

• unda tio n, CAL
• PE

P, L a Clinic a de la Ra za , Ala me da Co unty Pub lic He a lth De pa rtme nt, a nd UC Be rke le y a re wo rking to de ve lo p c o mmunity drive n so lutio ns to this impo rta nt pub lic he a lth pro b le m.

Study Ob je c tive s

 T

• e luc idate individual and str

uc tur al bar r ie rs to e a r lie r de te c tion of HIV

 T

• ma ke e xisting (b ut no t re a dily a c c e ssib le )

c o unty a nd sta te -wide HI V te sting a nd AI DS c a se da ta a va ila b le to lo c a l c o mmunitie s fo r impro ve d pro g ra mming .

 T

• e ng a g e c o mmunity a nd o the r HI

V/ AI DS sta ke ho lde rs to ide ntify a nd de ve lo p c o mmunity- drive n re spo nse s to inc re a se e a rly HI V de te c tio n a nd dia g no sis.

 T

• pilo t te st the mo st pro mising o f the se

c o mmunity-drive n re spo nse s in Oa kla nd .

Me tho ds

 Pe e r re c ruitme nt a da pte d fro m RDS stra te g ie s wa s

use d to ide ntify fo c us g ro up pa rtic ipa nts

 E

lig ib ility: pa rtic ipa nts who ha d no t re c e ive d HI V te sting o r HI V pre ve ntio n a nd e duc a tio n se rvic e s within the pa st 12 mo nths

 Co nduc te d13 fo c us g ro ups with Afric a n Ame ric a n

(n=48) a nd L a tino / a (n=61) pa rtic ipa nts*:

Afr ic an Ame r ic an L atino/ a

Me n re le a se d fro m inc a rc e ra tio n within the la st 12 mo nths Me n c urre ntly e mplo ye d a s da y la b o re rs Wo me n o ve r 30 ye a rs o ld Wo me n unde r 40 ye a rs o ld T

• ta l 48 Pa rtic ipa nts

T

• ta l 61 Pa rtic ipa nts

*Additio na l pilo t fo c us g ro ups we re c o nduc te d with HI V+/ - L a tino MSM, HI V+ L a tina s a nd HI V+ Afric a n Ame ric a n me n a nd wo me n.

Additio na l CBPR Me tho ds

 T

• inte g ra te CBPR a ppro a c he s a s a ve nue s fo r

c o mmunity e ng a g e me nt a nd dia lo g ue , we ro utinize d two ke y pra c tic e s:

 Co mmunity fo rums: F

• ur c o mmunity fo rums we re

he ld to info rm c o mmunity me mb e rs a b o ut the pro g re ss a nd finding s o f the study a nd to re c e ive fe e db a c k o n the study de sig n a nd finding s.

 Co mmunity Adviso ry Bo ard-Data I

nte rpre tatio n: A six- pa rtic ipa nt (HI V+/ -)CAB ha s b e e n tra ine d in da ta a na lysis a nd inte rpre ta tio n c o ntrib uting to the ide ntific a tio n o f the me s a nd re c o mme nda tio ns fo r pilo t pro je c ts b a se d o n the study’ s finding s.

Re sults

Pr e liminar y Community and Data Dr ive n Inte r ve ntion Possibilitie s

Be havio ral Struc tural

• I

mpro mptu stre e t the a tre in no n-tra ditio na l se tting s (la undro ma ts, b a rb e rsho ps, WI C

• ffic e s, e tc .)
• Gro up-le ve l info rma tio na l se ssio ns
• Me dia c a mpa ig ns ta rg e ting no n-tra ditio na l

HI V ta rg e t g ro ups

• I

nvo lve re lig io us c o mmunitie s in te sting a nd e duc a tio na l se rvic e s

• I

nc re a se pre se nc e a nd invo lve me nt fro m c o mmunity me mb e rs (b o tto m-up)

• I

nte g ra te d he a lth se rvic e de live ry a ppro a c he s

• Ma sking o f HI

V te sting a nd tre a tme nt se rvic e s

• Se rvic e pro vide rs o ffe ring te sting during

ro utine visits (o pt-o ut te sting )

• E

xpa nding te sting a va ila b ility in hig h-risk ne ig hb o rho o ds (i.e . 94601, 94621, e tc .)

• Offe r e xte nde d se rvic e ho urs
• E

xpa nding mo b ile te sting pro g ra ms to no n- tra ditio na l HI V ta rg e t g ro ups

• E

xpa nding inc e ntive -b a se d te sting

BRIDGE S BE HAVIORAL AND ST RUCT URAL

• I

nc re a se a wa re ne ss o f a nd sta ffing o f tra nsla tio n se rvic e s

• I

nc re a se sa fe ty a nd c o nfide ntia lity o f HI V te sting a mo ng undo c ume nte d c o mmunitie s

• I

nc re a se invo lve me nt a nd po litic a l a dvo c a c y a ddre ssing the inte rse c tio na lity o f ra c e , c la ss, g e nde r, a nd immig ra tio n sta tus whic h e xa c e rb a te HI V re la te d he a lth dispa ritie s

Disc ussio n



Da ta sho w c o mmo na litie s a nd dive rg e nc e s a c ro ss ra c ia l/ e thnic g ro ups a nd g e nde r; ho we ve r e a c h po ints to a ne e d fo r ne w a nd diffe re nt a ppro a c he s to pro mo ting HI V te sting a mo ng the se g ro ups



Additio na lly, finding s hig hlig hte d c ultura l b e ha vio rs/ pra c tic e s whic h c a n b e b e tte r utilize d in the de ve lo pme nt a nd imple me nta tio n o f inte rve ntio ns to re duc e HI V-re la te d he a lth dispa ritie s



Pilo t inte rve ntio ns b a se d o n the se da ta a re like ly to fo c us o n re a c hing ne w ta rg e t g ro ups suc h a s da y la b o re rs a nd yo ung he te ro se xua ls a t risk -- wo rking to inc re a se risk a wa re ne ss, a nd pro mo te te sting



Also implic it in the da ta , is the ne e d fo r inside r pa rtic ipa tio n a nd stra te g ie s invo lving me mb e rs o f the ta rg e t po pula tio n



L e ve ra g ing re so urc e s fro m the a c a de mic c o mmunity a s we ll a s e xpe rie ntia l kno wle dg e fro m c o mmunity pa rtne rs (thro ug h CBPR), a llo we d fo r mo re b re a dth in the da ta c o lle c tio n pro c e ss, c o mmunity e ng a g e me nt pro c e ss a nd da ta a na lysis