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Appendix I
Brief Abstracts of Projects
AIDS Healthcare Foundation (Los Angeles, California)
Grant Title: Test the Feasibility of Providing Comprehensive HIV Services under a Capitated Reimbursement System
Project Period: 10/94-09/99
Category: 1B
Description: The objective of this project is to test the feasibility of providing comprehensive HIV services under a capitated reimbursement system. This pilot project offers a comprehensive managed health care program to Medi-Cal-eligible AIDS patients in Los Angeles County and was established through the State of California's Department of Health Services. The AHF Clinic patients will have access to a full continuum of medical and social services. An intended outcome of this project is to demonstrate that an enhanced, capitated, managed health care approach to providing HIV/AIDS care will produce fewer opportunistic infections, fewer and shorter hospitalizations, better compliance with medical treatment, and an overall longer lifespan including a better quality of life for HIV/AIDS diagnosed populations.
Center for Community Health, Education, and Research/Haitian Community AIDS Outreach Project (Dorchester, Massachusetts)
Grant Title: Enhanced Innovative Community and Hospital-based Case Management Program
Project Period: 10/94-09/97
Category: 3B
Description: The Center for Community Health, Education and Research/Haitian AIDS Project (CCHER/HAP) of Dorchester, Massachusetts is seeking to enhance its current community and hospital-based case management system. The enhancement will add one-on-one intensive counseling sessions and educational training. The grantee will develop a Haitian culturally competent risk reduction curriculum. Clients will be selected from the Haitian population residing in the Greater Boston Area who are HIV-positive or have AIDS. The participants will sign a consent form and receive a stipend for complying with the guidelines and completing the program.
Center for Women Policy Studies (Washington, District of Columbia)
Grant Title: Metro DC Collaborative for Women with HIV
Project Period: 10/94-09/99
Category: 3A
Description: The Center for Women Policy Studies’ project – the Metro DC Collaborative for Women with HIV – is designed to ameliorate organizational barriers to care for women with HIV through organizational collaboration and inclusion of women with HIV, their providers, and advocates in policy development. The project is conducted in collaboration with PROTOTYPES. The components of the model are: 1) nurturing leadership among women with HIV in the policy arena and building a cadre of women with HIV who are policy advocates and influencers; 2) educating policy makers about the needs of women with HIV; 3) capacity building through training, technical assistance, and organizational development; and 4) process and outcome evaluation consisting of a needs assessment instrument of service barriers, a longitudinal client-participation instrument, a training and technical assistance evaluation form, and fax-in data system maintained by TMG, as well as qualitative data gathering.
East Boston Neighborhood Health Center (East Boston, Massachusetts)
Grant Title: Development of an HIV/AIDS Service Delivery Model
Project Period: 10/94-09/99
Category: 1B
Description: This project will develop an expanded, capitated reimbursement system for providing a cost-efficient, community-based HIV/AIDS care plan. We will explore the feasibility of developing three separate, capitated reimbursement rates for patients who will be appropriately grouped according to clinical diagnosis – HIV-positive asymptomatic, HIV-positive symptomatic, and CDC AIDS. This system of care will provide appropriate and comprehensive services from the time of seroconversion through terminal care.
Emory University (Atlanta, Georgia)
Grant Title: HIV Training for Georgia Correctional Providers
Project Period: 10/94-09/97
Category: 4
Description: The grantee will develop, test, and evaluate educational models for increasing, improving, and updating knowledge about HIV infection and treatment for Georgia's correctional health care providers. Using a quasi-experimental design, Emory will compare the impact of three different levels/intensities of training and three different training strategies. The project will utilize interviews and chart audits to examine the following variables: knowledge and attitudinal changes, trainees' assessments, and observed change over time.
Fortune Society (New York, New York)
Grant Title: Discharge Planning and Case Management for Latino and Latina Prisoners Who are HIV-Positive and Symptomatic
Project Period: 10/94-09/99
Category: 3B
Description: The Fortune Society proposes to deliver culturally and linguistically appropriate services to Hispanic women and men prisoners and releasees who are HIV-positive and symptomatic in New York City jails and New York state prisons. This project will focus on discharge planning for prisoners, case management referrals with follow-up, and intensive case management post release. This innovative approach entails identification and consistent contact with clients prior to release.
Health Initiatives for Youth (San Francisco, California)
Grant Title: Youth AIDS/HIV Community Training Project (YouthACT)
Project Period: 10/94-09/99
Category: 3A
Description: This project helps health and human service providers offer developmentally and culturally appropriate care for HIV-affected youth and young adults ages 12-25. The project offers a variety of experiential trainings on health and psychosocial topics related to youth; informational resources including a quarterly newsletter, a directory of providers, and information packets; and technical assistance through in-person, written and telephone consultation. In addition, the project encourages networking and collaboration among providers so that youth receive better-coordinated care for HIV- and health-related concerns.
Hektoen Institute for Medical Research/Cook County HIV Primary Care Center (Chicago, Illinois)
Grant Title: Illinois Maternal and Child Health Integrated Project
Project Period: 10/94-09/99
Category: 1F
Description: Cook County Hospital HIV Primary Care Center, Women and Children’s HIV Program will develop the MCH/HIV Integration Project. This purpose of the project is to insure HIV education, counseling and testing by consent in all family planning and perinatal sites in Cook County. Additionally, the Project will link the MCH service delivery sites and the Ryan White funded primary care agencies to guarantee on-going care for identified women living with HIV and their families. The project has also received additional funding through the MCHB to follow HIV-positive pregnant women and their infants. The evaluation will assess the change in practice of MCH providers in providing HIV education counseling and testing by consent as a routine part of MCH care and the offering of zidovudine to pregnant women.
Indiana Community AIDS Action Network (Indianapolis, Indiana)
Grant Title: Indiana HIV Advocacy Program
Project Period: 10/94-09/96
Category: 3D
Description: Program will target African Americans and men who have sex with men to increase their utilization of advocacy services and, therefore, reduce barriers to health care access and discriminatory practices encountered in health care settings, employment, housing, public accommodations, governmental services, criminal justice, social/domestic relations, and insurance. The model will provide education to reduce HIV discrimination by employers and health care providers, coupled with skills building to increase the capacity of consumers and consumer advocates to redress HIV-related bias. Primary objectives of the project are assistance in enforcing state and federal anti-discrimination laws and development of a grass roots coalition through which to influence public policy decision-making. Increased utilization of these advocacy services will reduce barriers to health care access and financing.
Interamerican College of Physicians and Surgeons (New York, New York)
Grant Title: Expanding Access to Health Care Services for Hispanic HIV-Infected /STD Patients by Promoting Early Intervention, Screening, and Counseling Among Hispanic Physicians
Project Period: 10/94-09/97
Category: 3A
Description: The project is a collaborative effort between the Interamerican College of Physicians and Surgeons (ICPS), Bellevue Hospital Medical Center and the Department of Dermatology at NYU School of Medicine. ICPS proposes to expand access to health care services for HIV-positive Hispanic populations by increasing, through training, the number of Hispanic health care providers active in screening, testing, counseling and managing their patients at risk or already HIV infected. Individualized training will be provided to each of the 90 physician trainees in their private offices and an in-hospital training session will be held at Bellevue Hospital Medical Center. Physicians will be assigned to intervention and control groups in randomized research trial with a post-test intervention and a case study design involving 5% of randomly selected subjects.
Johns Hopkins University School of Medicine (Baltimore, Maryland)
Grant Title: Johns Hopkins – Medicaid AIDS Capitated Care Program
Project Period: 10/94-09/99
Category: 1B
Description: This activity will involve three major entities – Johns Hopkins Health Systems, the Hopkins HIV Care Program, and the Maryland Medicaid Program. The goal of this project is to reduce the financial barriers to adequate care for AIDS patients and to improve the comprehensiveness of their care while containing costs to the insurer and reducing uncompensated costs to the provider. The evaluation analysis will include: 1) cost-effectiveness, 2) rate of clinical progression, and 3) quality of life assessment.
Larkin Street Services (San Francisco, California)
Grant Title: HIV Service Delivery Model for Homeless Youth and Young Adults, 16 to 26 Years of Age, with CDC Defined Stage III and IV AIDS
Project Period: 10/94-09/99
Category: 1E
Description: There are two primary objectives for this project. First, the Larkin Street Youth Center (LSYC) will expand their existing "Aftercare" program services which provide emergency housing, comprehensive primary medical care and psychosocial support services for homeless youth living with HIV to serve CDC-defined HIV symptomatic disease or AIDS diagnosed youth. Secondly, they will establish an "Assisted Care Facility"; this will consist of a twelve-unit assisted living and long-term care facility. The permanent housing program will be a focal point for providing a coordinated service delivery model which manages medical, substance abuse, and mental health treatment needs of these young people. The cadre of services to be provided include: 1) Social Services – case management, mental health and psychiatric care, counseling, advocacy; 2) Health Services – linkage to HIV primary health care, TB screening, nutrition counseling; 3) Personal Care Services – nutrition, food vouchers, clothing, transportation; and 4) Recreation and Social Activities. This facility will be open and supervised 24 hours a day. A full evaluation will also be conducted.
Michigan Protection and Advocacy Service (Lansing, Michigan)
Grant Title: HIV/AIDS Advocacy Program – Community Advocate Training Program
Project Period: 10/94-09/96
Category: 3D
Description: Michigan Protection and Advocacy will expand its HIV/AIDS Advocacy Program by providing training to consumers and service providers in African American, gay and lesbian, and rural communities regarding HIV legal issues. The trainings will increase identification of HIV legal issues and access to legal advocacy services through the HIV/AIDS Advocacy Program. The program will also train attorneys, expand its attorney referral network, and pursue impact litigation.
Missouri Department of Health (Jefferson City, Missouri)
Grant Title: Integrated Care for Individuals with HIV/AIDS, Mental Illness, and/or Substance Abuse Problems
Project Period: 10/94-09/97
Category: 1A
Description: This project will develop and implement an "Integrated Model of Care" for individuals with HIV/AIDS that are diagnosed with a mental illness and/or substance abuse problems. An enhanced case management system (through collaborative efforts with the Department of Mental Health) will be developed, simplifying the referral system for mental health and substance abuse treatment services.
New York State Department of Health/Health Research (Albany, New York)
Grant Title: New York State Managed Care Demonstration Project for HIV-Infected Persons
Project Period: 10/94-09/98
Category: 1B
Description: This project will involve a dynamic data collection effort to generate information related to cost, utilization and access to care as persons with HIV/AIDS transition from fee-for-service to a managed care environment. Cost and utilization data collected will be used to validate risk-adjusted payment rates for HIV/AIDS and to develop accurate cost estimates that will be used in structuring HIV Special Needs Plans. Access to care will be evaluated through a representative survey of the experiences of persons with HIV and AIDS as they seek and use services during the period of transition to Medicaid managed care. Financial, administrative and organizational information necessary to develop managed care Special Needs Plans that ensure appropriate access to and quality of care will be collected from organizations awarded HIV Special Needs Plans planning grants.
Outreach, Inc. (Atlanta, Georgia)
Grant Title: Safe Place
Project Period: 10/94-09/99
Category: 3C
Description: Outreach's project, SAFE PLACE, will use a peer counselor and street team model for service delivery using indigenous staff. Outreach, Inc. will expand enrollment and enhance retention of substance abusers with HIV in primary care by opening a satellite facility within an African American neighborhood near downtown Atlanta. Activities will include assisting 75 substance abusing, HIV-positive adults in obtaining medical and substance abuse treatments. The project will also address barriers to care by developing a training program for primary care and other service providers.
PROTOTYPES (Culver City, California)
Grant Title: PROTOTYPES WomensLink: Reduction of Barriers to HIV/AIDS Care
Project Period: 10/94-09/99
Category: 3C
Description: PROTOTYPES will head a consortium of Los Angeles County agencies designed to be a community-based, outpatient model for delivering a comprehensive continuum of services for women with HIV/AIDS. Women will be recruited throughout Los Angeles County in order to: 1) provide a range of quality services to substance abusing women with HIV designed to increase their use of health care services and treatment compliance; 2) change risk behaviors with an array of services; 3) increase compliance with medical treatment and enhance access to existing services outreach to high need women; 4) improve the quality of life for women living with HIV through comprehensive case management; 5) increase provider's knowledge, receptiveness and skill in treatment of women substance abusers living with HIV; 6) to develop and evaluate models for replication and integration into HIV/AIDS delivery systems for women; and 8) disseminate information about successful service models.
SUNY Health Science Center at Brooklyn (Brooklyn, New York)
(The Research Foundation of the State University of New York)
Grant Title: The Brooklyn Service Model
Project Period: 10/94-09/99
Category: 1F
Description: The major objectives of this initiative are to develop systems which: 1) reduce the frequency of perinatal transmission of HIV through increased counseling and testing of pregnant women and increased use of perinatal AZT protocols, 2) enhance access to care for women with HIV through provision of combined HIV primary and gynecologic care, and 3) disseminate successful models of early identification and care to the greater community of providers. Models will be developed at three sites – SUNY Health Science Center at Brooklyn, a tertiary care center; Kings County Hospital Center, a municipal hospital; and Lutheran Medical Center, a community hospital.
University of Colorado Health Sciences Center (Denver, Colorado)
Grant Title: Educating Rural Providers to Improve HIV Services
Project Period: 10/94-09/97
Category: 4
Description: The grantee will evaluate the impact and cost effectiveness of three educational methodologies designed to increase service delivery to individuals in rural areas. The methodologies are self-study modules, two-way interactive audio/visual teleconferencing, and experiential programs delivered by rural outreach teams. The project will focus on physicians, physician assistants, and nurses to examine whether improvements in knowledge, attitudes, and willingness translate into increased services for at-risk and seropositive individuals.
University of Mississippi Medical Center (Jackson, Mississippi)
Grant Title: HIV Early Intervention for Mississippi Community Health Centers
Project Period: 10/94-09/99
Category: 4
Description: University of Mississippi Medical Center (UMC) proposes to enhance the capacity of health care providers in rural clinics to diagnose and treat asymptomatic HIV disease. This will occur by expanding the Delta AIDS Education and Training Center's (DAETC) ability to provide clinical training for those providers with a computer-based distance learning system and building on the existing preceptorship provided by DAETC. Physicians, nurse practitioners, and dentists at targeted clinics will be provided updated medical references, access to sources of additional HIV funding, and a means for interactive training supervised by HIV specialists at UMC. Providers and community health centers in areas of highest HIV prevalence will be targeted.
University of Nevada School of Medicine (Reno, Nevada)
Grant Title: Early Nutrition Intervention in HIV and AIDS
Project Period: 10/94-09/98
Category: 1A
Description: The goal of this service delivery model is to provide comprehensive nutrition assessment and intervention services to relatively healthy HIV-infected individuals. Patients are from the Early Intervention Clinic of the Washoe County District Health Department and from private practitioners in the medical service area of Reno, Nevada. The program will: 1) demonstrate the efficacy of nutritional services in preventing or delaying the onset of weight loss and wasting syndrome in HIV-infected individuals, 2) determine the most practical and cost effective system of incorporating nutrition screening and counseling in a clinic setting, and 3) develop an automated FAX-IN based system for recording, managing, and tracking data from physician and nursing interventions.
University of Texas Health Science Center at San Antonio (San Antonio, Texas)
Grant Title: SPNS Family Unit Project for South Texas (Project SALUD)
Project Period: 10/94-09/97
Category: 3A
Description: The "Salud y Unidad en la Familia/Health and Unity in the Family" ("SALUD") Project targets the health and human services delivery system for women, children, and their families with HIV in South Texas. Project "SALUD" is a collaborative effort involving the Texas Department of Protective and Regulatory Services (TDPRS) and four Ryan White service providers who have been seminal organizations in the development and delivery of HIV/AIDS services in San Antonio, Corpus Christi and the Lower Rio Grande Valley. This project is designed to provide a mechanism for urban and rural communities to build upon existing strengths and capacities for continued development of a comprehensive, family-centered continuum of care for HIV/AIDS women, children and their families. Project "SALUD’S" goal is to bring about system assessment and system change. System assessment objectives include: child and family-focused needs assessment and organizational and systems resource assessment. System change objectives include: dissemination activities at the local and state levels, cross-training of staff, caregiver training and curricula development.
University of Vermont & State Agricultural College (Burlington, Vermont)
Grant Title: Health Care Delivery for People with HIV/AIDS in Rural Vermont
Project Period: 10/94-09/98
Category: 1D
Description: This activity involves the development of three rural community HIV satellite clinics in Vermont to supplement services currently being provided by the state's only comprehensive HIV clinic located in Burlington. These satellite clinics will be housed in regional hospitals. The clinics will provide state-of-the-art medical care for people with all stages of HIV/AIDS, psychosocial case management, and education for rural primary care providers in diagnosis and treatment of people with HIV/AIDS. Psychosocial education and a resource directory will be developed. A computerized database will be developed.
University of Washington (Seattle, Washington)
Grant Title: Psychiatric Management of HIV/AIDS Patients with Delirium
Project Period: 10/94-09/97
Category: 4
Description: The University of Washington Center for AIDS and STDs will work with the School of Medicine, Department of Psychiatry and Behavioral Science to train primary care providers, mental health staff, and volunteers at four sites: Harborview Medical Center, Swedish Medical Center AIDS Unit, Bailey Boushay House and Rosehedge. The training and education model will develop, test, and evaluate strategies for increasing, improving, and updating knowledge about HIV neuropsychiatric illness with specific emphasis on delirium and its treatment. Program goals include enhancing current service delivery and standardizing assessment and treatment across providers in the project.
Visiting Nurse Association of Los Angeles (Los Angeles, California)
Grant Title: AIDS Special Care Program: A Capitation Baseline Demonstration Project
Project Period: 10/94-09/97
Category: 1B
Description: This project will focus on AIDS patients. A database program will be developed which will test the feasibility of providing a comprehensive, capitated reimbursement system. This system will compare service utilization, costs of care, quality of life, and patient outcomes of approximately 1,000 AIDS-infected clients under a fee-for-service Medicare/Medicaid reimbursement system and a condition-based Medicare/Medicaid capitated hospice. The project will also provide a fuller continuum of care and test the model on a broader population base. To accomplish this, an effort will be made to remove barriers to hospice utilization by AIDS patients through patient and physician education as well as broadening AIDS hospice eligibility requirements.
Washington University (St. Louis, Missouri)
Grant Title: Special Care Center for Women with HIV
Project Period: 10/94-09/99
Category: 1F
Description: Washington University School of Medicine will develop a special care unit for women with HIV to integrate services for women in a 12 county area around St. Louis. Early intervention and treatment would be promoted to involve women in the area who are not presently seeking services. The integrated services will include pediatric services. Case management will be used to coordinate all services and appointments while attempting to assure compliance with medication and medical regimens. The intended results are to identify women with HIV at an earlier stage, increase access to service and clinical trials, provide support services, decrease preventable opportunistic infections and vertical HIV transmission and improve quality of life.
Well-Being Institute (Detroit, Michigan)
Grant Title: Well-Being Institute Women's Intervention Program
Project Period: 10/94-09/99
Category: 3C
Description: The Well-Being Institute Women's Intervention Program is a comprehensive, nursing-based intervention program designed for women HIV-positive substance abusers who are not accessing existing health delivery systems. The program is three-tiered and provides services to 32 women each month. Tier one services assist women in overcoming access barriers to primary health care services. Tier two services focus on assisting women to become drug free and provide housing for the women and their children. Tier three women, who are actively involved in primary care for their HIV disease and are drug free, work together in a revenue-generating, entrepreneurial activity, making and selling crafts.
The Measurement Group-PROTOTYPES (Culver City, California)
Grant Title: Evaluation and Dissemination Center: SPNS HIV Service Delivery Grants
Project Period: 10/94-09/99
Category: Evaluation and Dissemination Center
Description: The Measurement Group-PROTOTYPES consortium will provide consultation and technical support services to grantees which include components of centralized data entry/management, statistical and management information reports, and information dissemination functions. Some specific activities that the Center will provide to HRSA as well as grantees include review and assess evaluation plans; provide technical assistance to refine and implement evaluations; conduct an evaluation workshop; provide on-going support for data collection and analysis of site-specific data; monitor the quality of data and provide feedback; establish and maintain a computerized data repository; provide writing and editing support; provide logistical support for meetings; and work with HRSA and grantees to produce journal articles and policy program reports. The EDC is a consortium headed by The Measurement Group and also includes PROTOTYPES. The Measurement Group provides overall management for the EDC and is responsible for evaluation and some dissemination activities. PROTOTYPES is responsible for logistical support of the Steering Committee meetings and dissemination activities.
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