SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 2, Issue 17 (August 22, 1997)

This document has been superceded by our Online Knowledge Base on Innovative Models of HIV/AIDS Care. Click here to access the Knowledge Base. Click here to access descriptions of 27 Innovative Models of HIV/AIDS Care and the lessons learned from these projects. SPNS/Fax was written, published, and distributed by fax by The Measurement Group between 1995 and 1998.

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.

Comprehensive Healthcare Work Group Shares Valuable Lessons Learned

As part of its involvement in the overall Cooperative Agreement Steering Committee, the Comprehensive Healthcare Work Group has developed an evaluation report to educate people about these projects, their experiences, and the valuable lessons they have learned.

The three Comprehensive Healthcare projects — the University of Nevada School of Medicine’s Early Nutrition Intervention in HIV and AIDS project, the University of Vermont & State Agricultural College’s Rural HIV Service Delivery project, and Washington University School of Medicine’s Helena Hatch Special Care Center for Women — have developed specialized medical care models within the context of a continuum of services in a medical clinic. The University of Vermont (located in Burlington) has developed community clinics in rural areas of Vermont, and is determining whether patients receive appropriate and consistent care at the satellite clinics, as opposed to not receiving care at all or having to travel great distances to a central site. The University of Nevada (located in Reno) has added a nutrition component to its comprehensive AIDS care clinic, and is studying the effects of adding nutrition assessment, objective measures, counseling, and supplements to the treatment of wasting in AIDS patients. Washington University (located in St. Louis, Missouri) is providing a continuum of care to women with HIV and their children within a traditional medical clinic model, combining aggressive community outreach and case management.

Project Strategies and Accomplishments

The Comprehensive Healthcare projects have undertaken diverse activities and have utilized numerous effective strategies to increase their ability to provide a continuum of care and services for people living with HIV/AIDS. These strategies include early provision of nutrition and metabolic assessments, psychosocial case management, home visits, support groups, and interventions. Consequently, the projects have made significant progress in offering a continuum of culturally sensitive and culturally appropriate medical care and social services to their target populations.

University of Nevada

University of Vermont

Washington University
  • Developed and implemented comprehensive nutritional assessment (diet, metabolic behavior)
  • Provided individualized nutritional counseling for the first time
  • Continued to produce newsletters and provided lectures for patient education
  • 3 state-of-the-art specialty clinics were established
  • Client referral increased 30 – 35 percent
  • Program staff created HIV "mini-residency" trainings for professional healthcare providers
  • Staff held quarterly HIV/AIDS educational sessions
    •
  • A clinic was established at Washington University Medical School
  • Enrollment increased from 25 to 215 clients
  • Personalized care was provided, including pre-clinic home visits
  • Adult and pediatric primary clinics were combined

    • Barriers Encountered

    During the first 2 years, the projects have identified a number of barriers to developing and implementing their models, including (1) lack of funding/resources; (2) agreements with agencies in the projects’ service network; (3) staff-related problems; (4) enrollment and maintenance of high retention rates; and (5) competing agendas within and among institutions and communities. The projects suggested solutions to counteract each of these barriers, some of which are indicated in the box to the right. All of the programs have found that flexibility and perseverance are key attributes in building the referral networks needed to achieve their goals. It is expected that these suggestions will prove extremely useful to other programs offering comprehensive care services to people living with HIV/AIDS.

    Solutions to Barriers:

    1. Work with Medicaid and CARE Act systems to negotiate rates to cover non-medical and supportive services

    2. Form collaborative initiatives to unify existing outreach activities

    3. Develop clear job descriptions and provide ongoing professional development and support for staff

    4. Develop retention strategies based on client feedback

    5. Provide technical assistance on evaluation

    For a complete copy of the "Comprehensive Healthcare Work Group Evaluation Report" please contact The Measurement Group at 310.216.1051 or visit their web site at www.TheMeasurementGroup.com where the full report is posted.

    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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