Appendix F-1

• I think that we all feel that the care conferences make us more prepared to say, "I saw this" and actually talk about "what's going on". There's discussion of topics. Other people notice things others aren't aware of. 10
• People are more open to HIV now than before. I think there can be more improvements as far as providers go. 16
• We have at least one person who is well-informed about HIV and HIV-positive individuals. This has helped increase awareness. 21
• There is Increased recognition of groups affected by the epidemic. The greater proportion of minorities is still a problem. 26
• There is a definite system set up regarding how they are going to move people into administration. They are struggling with mothers and infants who are exposed. They took a look at all patients who are HIV-positive other than the mothers, and they are not ordering their medications. About more than one third are not getting what they are supposed to. The basic knowledge about the disease has not reached the everyday doctor. They identified this as a real problem. There are problems with residents coming in and out and there are a lot of bad attitudes still about HIV-positive patients. They still have a long way to go. For example, they need to know how effective the medications are. They don't know that yet. 34
• The rounds haven't changed. People are more focused on the overall picture, which includes the dementia and the practitioner part of the input. 35
• I have gotten an increased recognition of all groups affected by this epidemic; therefore, I evaluate risky behavior of all patients regardless of their HIV status. That is, I don't assume that all HIV-positive patients will be gay, white males. 39
• It had the biggest impact on my ancillary staff in terms of better understanding of the disease, which results in not being afraid to treat those with the disease, and using relative precautions, such as wearing rubber gloves, etc. Because of their increased understanding, the amount of fear surrounding the disease has greatly decreased. It is now a "matter of fact" part of our daily patient routine. 48
• It has given us somewhere to go in working with patients with HIV/AIDS. 70
• The hospital clinic was specifically testing patients without telling them. Now, they don't do that. The clinic is more aware and there is greater continuity. 84
• Everyone (my co-workers) was sent to the training and got something out of it. Everyone was deeply touched emotionally and that has had an impact on our jobs. 85
• There is less confusion because we have more people that are a little more knowledgeable about HIV. 95
• The training emphasized the need to get tested to rule out any possibility of being HIV-positive. 108
• Now, people don't assume that everything is dementia. We're able to make distinctions between the different psychiatric illnesses. 111
• The training made it run a little better in terms of pre- and post-testing and the patients' rights. 130
• The physicians and dentists had not been extensively trained in the past. The training gave them more information regarding medical treatment and medications. 134
• The training gave more information, but the way they do things hasn't changed. 139
• We got better patient education from the training. 145
• It provided us with information to have more pre- and post-test counseling staff here. 147
• The people involved with the service organization that I came from had different experiences and backgrounds. The training helped bring us together with new information on treating youth and adolescents. 160
• It helped inmates understand why it’s so important to take their medications. 161
• I am able to help educate the other nurses who weren't able to go to the training and make them aware, and share the information. 165
• It provided more queer youth-sensitive issues that we can present to administration here and to other staff. 168
• There is better documentation and better assurance that people were given the option of testing. 176
• I am documenting counseling care more thoroughly. Frankly, an AIDS discussion rarely comes up. 177
• There was an increased recognition of all groups affected by the epidemic. In our community people feel that we're in a pretty safe place. It helped me better understand that there's more of it than I thought and, because of this, know that we can provide better care. 181
• There is better documentation of sexual practices, drug use, and any exposure. 186
• There is better documentation. There is more of an emphasis on counseling, which has been stressed by the department ever since the session. 190
• Standardized approaches for improving care were developed and I observed a change in how care is documented. Before when delivering care, I was always anxious. I rushed everything. Now I take my time. I am less careless. I try to prevent unnecessary things, such as needle sticking. I am more aware. I treat everybody. 192
• I brought up the need to have all staff participate in this training because it would be beneficial to helping our clients. 202
• It improved the quality of the care given in that it is more likely to give medical regimens to prevent opportunistic infections and to expedite treatment programs more quickly after diagnosis. 203
• The staff is more aware of how the disease occurs, so I’m more confident referring HIV-positive individuals to the proper agencies. 204
• I was the only person who attended the training from my care provider team. I can say that I personally document care in greater detail, that is what patients tell me about their illness and the signs and symptoms. 210
• People have a lot more information, especially about the mental illness part of HIV. 220
  
  
  

• The window period, for example, and personal things like that. The project put those ideas in my head. The project planted the seed in me to be engaged with that person and to befriend him/her. To be the clients’ friend, to build some kind of rapport with them is important. 6
• At the care conferences, with the types of medicine being administered now, the pharmaceutical suppliers are there in conjunction with the trainer and everyone else. You have people there who can question the drugs people are being given and their side effects. They know when you should contact the doctor. They can suggest other ideas. The doctor doesn't have the day-to-day contact or the most up-to-date knowledge about the combination of drugs and what they are doing. We can make intelligent and sympathetic decisions about drug regimens and changes for the better. 15
• Patients with inappropriate behavior would have been referred out or staff would avoid them. Now, because of the training, staff understands what's really going on with the patients and how best to deal with them. 37
• It improved this a lot because we don't have psychiatrists on site, so having the trainer as a resource has been great! It has improved the staff's confidence about speaking up regarding observations and opinions we have about patients to the providers. 42
• There is an adult section, but I deal with pediatrics. We did update procedures/policies about counseling. These things were done keeping the trainings in mind. They have only have been put in place about a year. We were just keeping in mind the rising population of teenagers who are very likely to end up with HIV. They're the highest rising percent group exposed. This was all done before the training. The training, though, affected documentation. 47
• I have a primary obstetrics practice, and during women's prenatal visits, we now talk about HIV. 56
• It hasn't changed any actual protocols, but it has increased staff sensitivity and awareness. It has helped us in getting patients into care earlier. 61
• There haven't been any changes in the doctors. They've always provided good care, even before the training. Since I am the nursing director, when the nursing staff sees that my attitudes have changed, their attitudes change as well. 62
• I'm a little bit more likely to bring the subject up with patients now than I was before the training. 64
• There has been an increase in staff sensitivity toward client needs. The medical information helped us know that we can actually provide the care without having to automatically refer them to the University medical center anymore. 65
• Our agency is now more open to relating the information to our clients. It is now easier to discuss HIV/AIDS issues among staff at our agency. 73
• The training has allowed case managers to provide direct services to clients and establish a therapeutic relationship with them. 99
• Patients are treated in a better way regarding testing and counseling. I know more about psychological factors. I know not to make patients feels any different than anyone else with another disease. 124
• In my impression, there was change because many who went were in OB/GYN and I think it was useful for them in their daily practice regarding how to pick up and how to cope with those issues. Secondly, they must raise those issues when they encounter those HIV-positive individuals. Thirdly, the residents had a good vignette to make them aware and to use the route that is already there. It is useful outside of the hospital, with groups, HMOs, and private practice settings. 132
• It improved. We have more sessions with the patients. The more knowledge, the better. 157
• There was increased recognition of all groups affected by the epidemic. I was able to observe a change in how clinical care is documented. I don't think my co-workers have had much training concerning HIV. They probably learned a lot. I learned tools to provide sensitive and appropriate services. 191
• The main thing I can think of is that we were taught how to provide help to clientele. That is, when dealing with HIV-positive patients, there are certain precautions you have to take, which aren't necessarily going to be detrimental to your relationship with your client. Instead of it being a prudish, hands-off approach, there are certain ways we can handle certain situations, such as the diaper-changing technique. This might be more relevant for long-term case workers or maybe I will encounter this situation. You need to help change the diaper. We learned the way to keep from being exposed, but not make it seem like you don't want to be near the child. This might affect your relationship with your client. 193
• The program had to do with if you supposedly had HIV-positive patients and how you would treat them. It took away the stigma of the HIV-positive patient. It showed me that they're just like you. 219
  
  
  

• The trainer’s perspective allows for people to have insight they might not otherwise have. She gives alternative explanations for situations others would not have thought of. The combination of medications causes issues and psychological problems. Before, it was not considered a possibility. Now, there are other alternatives to treatment and other approaches. 13
• It has given us more insight into things, and we use those tools to give care to patients. 18
• Coordinators have gotten more community feedback and new approaches. Trainers need more roll-playing activities and need more people in the field. The trainings keep evolving. We need to get down to the base of HIV, but there are other things other than HIV. In State and County trainings, there's still the old guard: going to training to become a counselor. Some people are in for the hell of it. Some need attitude training and sensitivity training. I have been vocal and there have been some changes. I'm in contact with coordinators. 36
• It helped to give the staff more knowledge, but it hasn't changed any specific policies. It only changed staff attitudes and knowledge of dementia and delirium. 38
• We have assisted clients in getting linked to resources. I can't really say how the training impacted this, but I don't believe it had any influence on it. 52
• We now have nursing staff available to all of our workers to use as a resource to continue to educate the clients and ourselves. The nursing staff available makes home visits to give our case workers direct feedback on what to look for and about specific resulting individual care plans. 67
• It showed us additional tools that we could use to fine tune our existing processes that are already in place for educating service providers. 114
• Now, we treat more patients, evaluate them better, and give them more information. 150
• The manual the trainers worked out of was very good. I refer back to that manual. It gave me different group process ideas. It had a good format and outline for when I refer to it when presenting my new curriculum. It also gave good referrals. 153
• If the patients need counseling, we make referrals. I know who exactly to send them to, who they can relate to. I will send them to a doctor they can feel more comfortable with. I try to have a good rapport with the patients. It is nice to know there is someone who cares, and it gives them the strength to carry on. You have to develop a relationship with the patient. 167
• It improved because more staff were trained by the project, and therefore, were more able to do HIV testing, so our service delivery has improved and is more effective now. 170
• It gave the tools, recommendations, information, and background information for the clinical areas and offices that provide services to patients to develop and establish standards. That is, we didn't have any AZT before and now we do, so we developed a standardized procedure on how to dispense it. Also, before, it was our prenatal care admission policy to test any woman for HIV who had not had any previous history of prenatal care. Now, patients must be informed and they must sign a consent form before they are tested. Teaching also must take place before the testing. 175
  
  
  

• The training improved the way I do the HIV counseling. All of the staff at my organization attended the same training and we are now working from the same baseline, and we are able to work better together in terms of providing counseling to the clients. 2
• The rounds improved the way care is delivered a lot. The staff work together more as a group. The staff looks at things differently and talks about behavioral situations that arise. I learned how to speak to another staff member when a behavioral situation arises. 3
• It has improved. Teammates and I problem solve/brainstorm together about the appropriateness of particular prescriptions. 20
• It improved our care. We work also with the project. We are affiliated with the hospital. We are really in touch with observation. We meet on a monthly basis. We're working together more. There is more teamwork because of the training and because we're involved. My clinic is associated with a hospital in the area. 30
• The information helped with groups and collaboration. 86
• It is always useful to meet other people from different agencies. 133
  
  
  

• My organization is doing more needs assessments and focus groups to make the programs a better "fit" to the communities being targeted. 1
• In the process of identifying how things are carried out, glitches were streamlined. We modified some practices, for example, recording patient Information. Before, different formats were used at different institutions. This led to inconsistency in getting information back before delivery. 9
• On the whole, care is changing. People are living longer. There is probably a lot of work to do, that is admission/discharge, and obtaining consults while a person is still here, since a person may be here for short time. We look at the multi-disciplinary approach. 11
• We have AZT protocols for pregnant women now. 17
• We developed a standardized, systematic way to contact HIV-positive people and follow up with their CD4 counts. Also, now when patients arrive, we know that we should get the blood test first. We know how to better approach them. Also, we know how to deal with post-exposure prophylaxis, for example, if blood is spilled or if the person was pricked by a needle, we now have a protocol to deal with it. 32
• The care is different. There are many more cases being diagnosed by my colleagues. We do a lot more screening for HIV. 45
• We have a certain form that patients sign, that shows that they were offered the HIV-test. 57
• My organization didn't have a program before. It is a great improvement in the quality of care because there was never a program for HIV in place before. In terms of HIV, there was 100 percent no testing of the patients before. Now we screen all of our patients. 59
• We are now testing the kids when we first take them out of a home to go to foster care, especially if the parents practiced risky behaviors. We used to do that even before the training, but it's been done more now since the training. 63
• Our post-test counseling has improved because we used to have long, drawn out counseling for negative test results. But, in the training, we learned how to give negative test results in a quicker and more concise manner. 81
• A lot of different agencies attended the trainings, which was beneficial because they could share information and ideas about what works in an organization. I have used ideas from the workshop to develop my organization's policies around servicing youth. 89
• It was helpful in developing a street-based, peer-led program for asymptomatic sexually transmitted disease screening. The course reinforced the concepts of addressing the needs of the community, and how to effectively provide services to clients. 94
• The presence of a psychologist during the care conferences has been the most positive outcome. It has allowed for a multi-disciplinary approach to determining care needs. Having a bigger picture of mental health issues has had a very positive effect. 102
• Level two hospitals now have examples of policies and procedures that the training gave them. At Evanston especially, there was no AZT syrup. Once it was identified that some babies needed it as a part of their treatment, they changed their policy and they keep it on stock now. 104
• We have increased screening and pre-test counseling. We now have all patients complete a consent form for HIV testing first. 107
• We created a protocol for lab work and care plans that are needed after a positive diagnosis. We've tried to make lab work more accessible to our patients in terms of the costs of labs and medications, so we negotiated terms with local labs and pharmacies. We've developed protocols for care in different stages of disease progression. 109
• It led to the creation of HIV task forces. It had a direct impact on pre- and post-test counseling done in the obstetric units in the hospital. The same changes were made in the obstetrics treatment plan and directly led to the development of a pediatric plan. 112
• We do HIV counseling and testing now on a routine basis. 113
• Our referral system is now more organized. We do more follow-ups than before the training. The nurses are more aware of how to handle patients’ issues of confidentiality. 115
• We document everything now. We were extremely poor at that before. 119
• We altered data collection for people who come in with high-risk behaviors. We revamped the form and expanded the base questions to include disease-type information rather than just behaviors. 120
• I think it improved the way care is done because it directly allows us to privately focus on women of childbearing age. It allows for pre- and post-test counseling. It automatically improves care in a way that is patient and compassionate, and in a way that encourages the women and does not scare them off. 129
• When an inmate is asked to take an HIV test or given an HIV test, pre- and post-test counseling is documented. That was not done before as much as it is now. 140
• It made our care more open so that we're not so one-on-one anymore. Now, we don’t have to refer to the manual because we have specific guidelines. 149
• We now get viral loads and then call the state hospital for consultations, so that they can tell us what medications the inmate needs to be on. 162
• We've started new support groups. 171
• A few more HIV tests are being done now. If doctors had been involved in the training, we would be doing more testing, since the nurses can't order HIV tests. 172
• We had representatives from other prisons at the training. We document very well at our institution. We send medical records from one institution to another (it follows the inmate). We can standardize it to ensure continual treatment for the patient. Out in the free world, this is not true. We have better control over the patients (in prison) where we can call on guys every day or week if we need to. 179
• We've standardized care, especially with pregnant patients. There were documentation issues that were stressed in the training sessions, that is documentation of counseling. If we know that a patient is pregnant, the Department of Public Health requires that all pregnant women be counseled 100 percent about the disease and the importance of maternal/fetal health, and offer them the opportunity to get screened. Also, after attending the training sessions, I feel that the providers are more comfortable with the issue of confidentiality. 180
• There are more standardized approaches. They wanted to make it clear what our position was in terms of what we were allowed to tell/ask. That is, to have children tested they must meet certain criteria and we must get ad lidum attorney permission. 185
• We have recently received new updated procedures for care. These procedures are more in line with what the community is doing. 195
• The pediatric AIDS portion of the hospital was always subject to specialty. The area was always adult oriented, so they weren't used to babies and kids. They were more used to adults and they were more isolated. I convinced the director to incorporate HIV care within the entire clinic. Now they have the whole nine yards. 209
• We have more focused documentation of care, medications, and the general status of the patients. We're able to see deviations from the norm. 212
• We now have a protocol that we can follow regarding the importance of counseling and blood tests. 213
• In terms of documentation, the staff looks at different areas that they didn't look at before. They document different pieces of information, such as signs and symptoms. 218
  
  
  

• I've started to carry gloves on field assignments, just in case. 49
• More care is provided. There is more use of gloves and hand washing. Staff made themselves more aware of the possibility of contamination. 55
• Care delivery is better in terms of our workers, line staff and ancillary staff, and accidental exposures to HIV (for example, needle sticks). The training reinforced our safety guidelines and what to do when accidents occur. 78
• The care is the same. There is more protection for myself and for the clients. 128
  
  
  

• There has been no change. 8
• Not at all. 19
• It didn't change. There is some strong patient advocacy in some cases. We have second and third party observations. This variation is not very helpful; it’s theoretical. 22
• The VA hospital [where I work] has community based outpatient clinics in rural areas. The study reaffirmed my belief that patients need to be triaged into the medical care center rather than cared for in a rural atmosphere. 23
• No. 25
• No. 33
• I don't know what to say about that. 40
• The training hasn't changed the way we deliver care. 41
• In our network, based on the individuals who attended, we didn't get enough physicians at the training. We had more nursing personnel attend. They're more sensitive and informed now, but not in the role for changes. 46
• It hasn't changed because of the training. 50
• This is the same. 51
• It is hard to say. It is not something you can pinpoint. There is limited knowledge of other organizations. I really don't know based on my limited experience. 58
• We already had a policy regarding confidentiality in place, so nothing has changed because of the training. 60
• There have been no changes. 68
• It hasn't changed delivery of care. 71
• The training hasn't changed this. 72
• It hasn't changed the general delivery of care. 76
• It hasn't changed our general delivery of care. 77
• There have been no changes. 80
• There has been increased insistence that practicing physicians offer pregnant women testing. I am frustrated that it hasn't been done with a lot of doctors. I will take the edict from the chairman of the hospital to get it done. 83
• It hasn't changed because we still follow some guidelines that have been in effect for four years. 96
• It hasn't changed much. We don't see many HIV-positive patients. 100
• The change hasn't happened yet. But one thing I did recommend to my office was that for every agency we fund, the program developer should participate in the training. The training should give people a sense of how their organization works, and how the money and the allocation of the money is affected. It would make the program developers think on a broader level. 105
• My work is with protocol and it hasn't changed in any way when we see HIV-positive clients because we really don't manage any. They are managed by another hospital. 106
• It hasn't changed. 110
• No formal policies that have changed that I am aware of. 118
• Nothing much has changed because of the training. 121
• There is a definite system set up for moving people into administration. We are struggling with mothers and infants who are exposed. We took a look at all patients who are HIV-positive other than the mothers, and we are not ordering their medications. About more than one third of the patients are not getting what they are supposed to. The basic knowledge about the disease has not reached the everyday doctor. We have identified this as a real problem. There are problems with residents coming in and out, and there is a lot of negative attitude still about HIV-positive patients. We still have a long way to go. For example, we need to know how effective the medications are. We don’t know that yet. 122
• There has been no impact on that. 123
• Beyond what I have already said, nothing really has changed. I work now on a more person-to-person level. I have noticed that in my own work. 126
• There were no changes. I need to emphasize that we have very highly sensitive policies already in place. We have a handbook that tells us what we have to do when we become aware of a child's diagnosis, or for high-risk people. 131
• I work in a small rural area. There is not much contact with HIV except in the clinic. I can't really see change on the system level. 141
• None. 144
• Some of the doctors that don't usually deal with HIV-positive patients have a lot to gain from this type of training. 146
• It hasn't changed. 148
• I haven't seen any change because of my position. Maybe in the investigation level, where they are working with children, you see more change. But I am not saying that it is not there. 151
• It has not changed. Things are running the same way. As a nurse, you should already know a lot. This training put everyone on the same level playing field. 158
• None of that has changed so far. 159
• Changes were made on an individual basis, but there are not any new policies or guidelines. We've always adhered to patient confidentiality and guidelines. 163
• There is no change or effect at this point. 164
• No changes have been made. 173
• No difference has been made. 182
• No. 189
• I don't think it did because our standards of care are in line with what the training intended. We need to make sure that this level remains. 194
• The training did not effect this because we've always had guidelines and procedures that we abide by in the prison system. 197
• It didn't change, in general. 198
• We have guidelines that we have to follow. So I decline on this question. 199
• There are basic guidelines/procedures about protecting the anonymity of patients when charts go from clinic to clinic, such as referrals to dentistry. We have to use some kind of code. 200
• There has been no change. 205
• It really didn't have an effect. We are mandated by the Department of Corrections. It gives us a specific focus and we cannot override that. We do what we are told to do. 206
• I can't really say that it has changed. We are already following protocol. 208
• There was no effect at all. 222

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