Achievements & Lessons Learned-X: Washington University School of Medicine

Knowledge Item: CA-Initiative Impact-99X
Major Achievements and Lessons Learned: 1994-1999

Washington University School of Medicine

The Helena Hatch Special Care Center (HHSCC) – in the Washington University School of Medicine – is a specialized medical care clinic that has provided coordinated, comprehensive care to women with HIV/AIDS.

In 1999, the Evaluation and Dissemination Center asked each project to state its major achievements and the lessons it had learned from conducting the project. Those stated achievements and lessons learned are reproduced here (with minor editing) as reported to the Evaluation and Dissemination Center. The summary statements given here are those aspects of the program's experiences that the Project Director wished to emphasize.

Achievement 1: Surpassed our five-year goal to enroll women in comprehensive HIV care. (January 1995: 25 women, goal 75 women; current number enrolled 352 women.)
Key Elements for Success: Strategic planning and collaboration.	Factors that Limited Success: None listed.	Factors that Ensured Success: a) Adequate resources for HIV primary and sub-specialty care and for data collection and assessment. b) Strong referral networks.

*Achievement 2:* Reduction in HIV vertical transmission (Pre-program vertical transmission rate of 44% in 1994 for St. Louis; 9% in 1995; 0% in 1996-98.)
Key Elements for Success: Coordinated perinatal program and implementation of ACTU 076 protocol.	Factors that Limited Success: None listed.	Factors that Ensured Success: a) Onsite OB/GYN Nurse Practitioner. b) Coordination with Obstetrics and Pediatric HIV services. c) Adequate data base management.

*Achievement 3:* Identification of gender differences in Nevirapine Rash (risk of grade III–IV rash seven-fold higher in women than men).
Key Elements for Success: Collaboration with two non-SPNS sites.	Factors that Limited Success: None. Data presented at 1999 RV-01 Annual Meeting.	Factors that Ensured Success: Astute clinical observation in program focused on comprehensive, state-of-the-art initiation of HAART.

*Achievement 4:* Retention in care for primary and sub-specialty comprehensive HIV care.
Key Elements for Success: Comprehensive tailored HIV care.	Factors that Limited Success: None listed.	Factors that Ensured Success: a) Staff commitment, program reputation, state-of-the-art care. b) SPNS funding. c) One-step services. d) Holistic approaches.

*Achievement 5:* Enhanced prescription and acceptance of HAART in guideline-eligible women living with HIV.
Key Elements for Success: Behavioral and educational interventions.	Factors that Limited Success: a) Limited standardization of educational intervention and evaluation. b) Patient psychological and environmental barriers.	Factors that Ensured Success: a) Readiness assessment. b) National guidelines c) External cues (beepers, pamphlets), and incorporation into lifestyle. d) Development of trusting relationships. e) Close monitoring by nursing staff.

1. Lesson Learned: Gender differences in provision of HIV comprehensive care exist.

How related to achievements: Success in design, implementation, and evaluation of a comprehensive HIV program for women. This Midwest program cares for a predominantly underserved, African-American adolescent females and women who are single, unemployed, and living complex lives.

2. Lesson Learned: Gender differences in costs exist for the provision for comprehensive HIV care.

How related to achievements: Beyond routine medical care (history, physical exam, laboratory data, HAART education, OI prophylaxis), women need OB/GYN care and Ryan White costs and "CAPS" need to address contraception, family planning, pap smears, and cervical histology evaluations.

3. Lesson Learned: Provision of HIV care at academic centers requires "buy-in" commitment of Deans, Medical Executive Councils, and others in leadership positions.

How related to achievements: Procurement of funding after 5-year project requires University commitment for programs located in academic centers.

4. Lesson Learned: Substance abuse is an integral issue for women living with HIV.

How related to achievements: Publication in special edition of "Drugs & Society."

5. Lesson Learned: Dual diagnosis of HIV and mental illness is an integral issue for a subset of women living with HIV.

How related to achievements: Collaboration with mental health providers is underway to enhance treatment services.

Completed by: Linda Mundy, M.D.; Karen Meredith, R.N., M.P.H.
Last Updated: July 1999

Project Resource Page

Washington University School of Medicine

Evaluation Data

Service Population Demographics

Last Updated: August 02, 2001; data through June 15, 1999; analyses conducted January 2000.

Knowledge Base Citation: The Knowledge Base and this Knowledge Item were designed and authored by G. J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L. A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On the World Wide Web: http://www.TheMeasurementGroup.com."

Questions or Comments: Contact The Measurement Group.

Use of Knowledge Base Information: Acceptable Uses and Limitations.

Collaborators from Participating Projects: Cooperative Agreement Steering Committee 1999.

Participating Projects: This Knowledge Base is based on the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center which produced this Knowledge Base were funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) between 1994 and 1999.

Why This Evaluation was Conducted: Editorial.

More Information: Design of this Knowledge Base.

Recommended Citation Format for Web Materials: American Psychological Association Publication Manual Section, Revised 2001.

Work on the Knowledge Base and the cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance (SPNS). The contents of this Knowledge Base are solely the responsibility of The Measurement Group and do not necessarily represent the official views of HRSA or HRSA/HAB's Special Projects of National Significance nor may they represent the positions of the individual grantees whose projects are included in the cross-cutting evaluation.