Trudy A. Larson

A National Program of AIDS Care Projects and Their Cross-Cutting Evaluation: The HRSA SPNS Cooperative Agreements

SUMMARY As more people in the U.S. seek HIV care, the need has grown for demonstrated service models that address comprehensive needs. The Special Projects of National Significance (SPNS) Innovative Models of HIV Care Initiative funded by the Health Resources and Services Administration (HRSA) is an effort of 27 projects to jointly establish goals, develop common evaluation methods, and produce comparable and measurable outcomes. The projects have different service models, but share the goals of reducing barriers and improving access to quality HIV care. To evaluate the pooled effects of these models, a modular evaluation design (Huba & Melchior, 1995) was adopted. The use of shared evaluation protocols permits evaluation of the entire initiative, as well as the evaluation of project clusters with similar service delivery models.

Finding the underserved: directions for HIV care in the future.

SUMMARY The demographic, behavior, and background characteristics of 4,804 participants in 17 national demonstration projects for HIV medical and/or psychosocial support services were coded for an index of “service need” or possible under-representation in the traditional healthcare system. Fifteen items were coded including status as a person of color, lack of private insurance, unemployment/disability, problem drinking, crack cocaine use, heroin use, other illicit drug use, less than 12 years of education, criminal justice system involvement, children requiring care while the patient receives services, sex work, being the sex partner of an injection drug user, unstable housing, primary language not English, and age less than 21 or over 55 years. Most (87.7%) of the program participants had four or more of these factors present. Through CHAID modeling, those groups with the highest levels of service need and vulnerability were identified. These data suggest that these projects, designed to attract and serve individuals potentially underrepresented in the health services system, had in fact achieved that goal. Implications of the changing demographics of the HIV epidemic for the health service delivery system are discussed.

Key Elements for Implementing Comprehensive Health Care Models for Persons with HIV A Stakeholder Analysis

A semistructured interview was conducted with 69 stakeholders in three university-based health care projects that were funded to provide an integrated continuum of care for persons living with HIV/AIDS. Data from the key informant interviews yielded composite indicators of familiarity with the service model, the importance of the elements in the service model, and the perceived quality of services provided by these innovative HIV service demonstration projects. Ratings of service quality were related to ratings of the respondent’s knowledge of the service demonstration project, the importance of the various elements in the service continuum, and several indicators of stakeholder characteristics using the data modeling method titled Exhaustive CHAID (Chi-squared Automatic Interaction Detector). The groups of stakeholders most likely to give the highest quality or success ratings for these projects are identified. The implications of these findings for developing collaborative and comprehensive service models for persons with HIV/AIDS are discussed.

Service needs and factors related to quality of life at time of service enrollment among persons living with HIV.

ABSTRACT This article explores the relationships of HIV risk factors, service needs, and vulnerabilities to health-related quality of life in a sample of 1,371 participants newly enrolled into 13 innovative HIV/AIDS treatment model service demonstration projects. These projects targeted services to traditionally underserved populations. Eight distinct quality of life clusters of HIV patients were used in this analysis along with patient self-identified risk factors. The quality of life clusters were based on patient self-reported quality of life dimensions. The eight clusters were differentiated based on relative strengths and weaknesses in physical functioning, energy levels, and social functioning. Data on patient need-vulnerability factors and demographic characteristics were related to these eight clusters using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Through this method, the characteristics most likely to be associated with higher and lower levels of quality of life at the time of enrollment into services were identified. The results provide further support that quality of life assessment is a useful clinical tool for monitoring patient progress.

Typology of quality of life experiences among persons living with HIV.

ABSTRACT This article develops a typology of 2,038 participants in 13 innovative HIV/AIDS treatment model service demonstration projects targeted to traditionally underserved populations. The typology is based on self-reported health-related quality of life levels. Eight clusters were identified that classify HIV/AIDS patients based on their reported health-related quality of life. Participants were clustered based on their overall levels of quality of life, as well as by deficits in specific areas of functioning such as energy level, physical impairment, and role impairment. However, factor analysis suggests that health-related quality of life as perceived by the HIV-positive participants is best represented as a single underlying dimension and an ordering of the types shows that they are consistently related, in the same order, to several criterion measures of impairment. The results suggest that a general categorization of patients with HIV in terms of quality of life is more meaningful than an assessment of the relative areas of impairment. Since the impairment ratings were also self-reported, analyses relating quality of life clusters to actual symptom levels and healthcare utilization are needed. Implications for the assessment of health-related quality of life and the evaluation of service delivery programs for persons living with HIV are discussed.

Evaluation of Status and Progression of HIV Disease: Use of a Computerized Medical Module

SUMMARY The Northern Nevada HOPES (HIV Outpatient Program, Education, and Services) Clinic provides comprehensive and consultative care to persons living with HIV/AIDS in Reno, Nevada. As a method of tracking clinical data for evaluation purposes, a computer database was designed and implemented in the clinic setting. Analysis of these data permitted an exploration of the relations among client behaviors such as substance abuse and clinical markers of HIV disease progression. Substance abuse was found to be related to a number of indicators of impaired health. The computerized medical data module was found to be a useful tool for evaluation and quality assurance purposes and permitted the quantification of substance abuse behaviors in the clinic population.

Integrating and Utilizing Evaluation in Comprehensive HIV Care Programs

SUMMARY In healthcare programs for people with HIV/AIDS, the use of evaluation data is often considered to be non-essential to the healthcare delivery system. Three innovative healthcare programs have developed specialized evaluation models within a comprehensive continuum of care. This article describes methodologies for implementing evaluation and uses of evaluation data to improve clinic programs. Data were used to ensure quality of care and that patient needs were being met, patient management, evaluation of program priorities, resource allocation and availability of future funding. It is recommended that programs that wish to implement and utilize program evaluation in clinical settings not only track health outcomes, but obtain patient feedback, monitor program operations and request appropriate resources for this process.

A Comparison of Results From Two Bioimpedance Analyzers: HIV Infected V.S. Non-infected Adults

Abstract LEARNING OUTCOME: To determine whether there would be greater variability in body composition (BC) results obtained from two different bioimpedance analyzers (BIA) used at the same time and under the same conditions with HIV infected (HIV+) v.s. non-infected (HIV-) adults. The accurate determination of BC in HIV+ individuals is a critical adjunct to the provision of timely and appropriate nutrition intervention. Yet its measurement may be complicated by the somewhat unexpected BC changes that are experienced by individuals with this disease. Subjects (Ss) included 24 relatively healthy HIV+ adults (5♂,♀19; Xage=42.7; XBMI= 24.9) and 29 healthy HIV- volunteers (22♂,7♀ Xage=40.5; XBMI=26.5 ). All Ss met four hour pre-test conditions (fasting, no vigorous exercise, no alcohol, no caffeine) and were measured either on the floor or on an exam table without any parts of the body touching each other. Height and weight were measured on all Ss, and age and activity level were determined from interview. Sites were cleaned with alcohol, electrodes were placed on hand and foot as specified by manufacturers instructions, and BC was measured consecutively using two BIAs (BodyStat 1500 [BS] and Maltron [M]). The difference in % body fat (%BF) as measured by the two analyzers was calculated for each subject (DIF = % BF-M minus % BF-BS). Data were analyzed using SPSS for Windows. Percent body fat results were: 1) BS-HIV+: 23.4%; 2) BS-HIV-: 30.3%; 3) M-HIV+: 23.8%; and 4) M-HIV-: 31.2%). Mean DIF was slightly less for the HIV+ group (0.4±4.9 v.s. 1.0±4.7; ns) and slightly greater for men (2.1 vs. -0.7; p 30 were more likely to be HIV- and have positive differences (value from Maltron > Body Stat). From these data it appears that the variability in measures between the two BIA methods is within acceptable limits in an HIV+ group indicating that the simple BIA technology may be adequate to monitor this important parameter of body composition in relatively healthy clients.