SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 1, Issue 1 (April 20, 1996)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

HRSA/HAB's SPNS Cooperative Agreements

27 cooperative agreement projects were funded by HRSA on September 30, 1994, for periods of two to five years. The five broad categories of these projects are listed below. Future issues of SPNS/Fax will present the experiences of these projects.

Capitated Care. Five of the projects share, as a central theme, the study of health care provided to individuals with HIV disease under models where the health care is capitated, or paid on a "flat fee" basis per patient per month. The Capitated Care projects differ in the ways that they provide health care, ranging from a small community-based clinic (East Boston Neighborhood Health Center) to a large "chain" of community-based clinics (AIDS Healthcare Foundation) to a home-based hospice (Visiting Nurse Association) to an university-based clinic (Johns Hopkins University School of Medicine) to a state wide system (New York State Department of Health/Health Research). These projects share the goals of determining costs for providing health care services to AIDS patients under a capitated care system and of ensuring that high quality care is provided under the capitated system.

Infrastructure-Advocacy. Projects in this group aim to increase the capacity of local service systems to provide appropriate services for individuals with HIV. The Center for Women Policy Studies through the MetroDC Collaborative is increasing the ability of service providers through leadership development with women with HIV, policy change, needs assessment, and targeted training. The Michigan Protection and Advocacy Service and Indiana Community AIDS Action Network provide training on the legal rights of individuals with HIV. The Hektoen Institute for Medical Research at the Cook County Hospital's HIV Primary Care Center/Women and Children HIV Program and the State University of New York – Health Science Center at Brooklyn are increasing the infrastructure's ability to provide services to women with HIV – especially pregnant women with HIV. The University of Texas Health Science Center at San Antonio is developing a model for comprehensive models of care for women with HIV and their children, while the Missouri Department of Health is systematically developing the capacity of its AIDS service providers to provide mental health (and possibly substance abuse) services for individuals with HIV.

Community-Based Organization (CBO) Models. Six of the projects share, as a central theme, the goal of providing high quality care for individuals with HIV who belong to groups that are traditionally underserved because of linguistic, cultural, racial, and economic barriers that prevent their full integration into the traditional hospital-based service system. Outreach, Inc., has a program for substance abusers, many of whom are African Americans living in public housing projects. PROTOTYPES has implemented a "Settlement House model" for women with HIV and their children. The Well-Being Institute has developed a two-tier program wherein substance abusing women with HIV are offered the opportunity to receive social and support services well before such time as they decide to stop using drugs, and are later offered the opportunity to participate in a 60-day drug treatment program combined with housing in a drug-free environment. The Haitian Community AIDS Outreach Project/Center for Community Health, Education, and Research provides culturally appropriate social services to the Haitian community. The Fortune Society targets incarcerated Latinos with HIV and offers services both while the client is in prison and after release. Larkin Street Services has developed a comprehensive continuum of services for homeless youth with HIV.

Training. While training is integral to almost all of these projects, six have identified training among their most key elements. The University of Mississippi Medical Center is developing a training program for health care providers in rural and urban settings in Mississippi. The University of Colorado Health Sciences Center has developed an eight state program to compare different ways of providing medical information to health care providers. The Interamerican College of Physicians and Surgeons has developed a culturally appropriate training program for Hispanic physicians so that they can be trained in the management of patients with HIV disease. The University of Washington has developed a training program in neuropsychiatric illness associated with HIV disease. Emory University has instituted a training program for health care providers who provide HIV-related medical services to inmates in the Georgia prison system. Health Initiatives for Youth has developed a training program on appropriate and sensitive services for youth and adolescents with HIV.

Comprehensive Healthcare. Three projects are developing specialized medical care models within the context of a continuum of services in a medical clinic. The University of Vermont & State Agricultural College has developed community clinics throughout rural Vermont. The University of Nevada School of Medicine has added a nutrition component to its comprehensive AIDS care clinic. Washington University is providing a continuum of care to women with HIV and their children within a traditional medical clinic model combined with aggressive community outreach and case management.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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