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| Practice Type: |
Promising |
| Program Name: |
The Interdiction Project |
| Organization: |
Florida Department of Health |
| Web site: |
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| Overview: |
HIV is spread primarily through unprotected sex. Though people with known HIV infection tend to be more careful about infecting others, a significant fraction of this population does not. A new sexually transmitted disease (STD) is good evidence of unsafe sexual behavior that may also transmit HIV. This project works to identify HIV-positive clients with a new STD and history of unprotected sex and link them to services that will promote safer sexual behavior. The goal of the Interdiction Project is to reduce the sexual transmission of HIV by people with established HIV. The project's objectives are accomplished through individualized health education/risk reduction counseling and prevention intervention. These objectives are: (1) to increase knowledge of STDs and the negative consequences of noncompliance with safer-sex practices, (2) to increase self-efficacy of condom negotiation, condom use, condom skills, and to disclose HIV status to sex partners, and (3) decrease new STDs. Initial findings indicate significant improvement in enrolled clients’ knowledge of HIV transmission prevention (61.5% to 96.5%), condom use (36.8% to 92.9%), negative consequences of HIV and STD co-infections (54.4% to 92.9%) and HIV treatment monitoring (42.1% to 82.5%) and the intend to use condoms (96%). Plans are in place to verify new STD after initial visit by review of patients records at the HIV clinic and the state STD database and have attending physicians order STD screenings for all clients at least 12 months after initial prevention intervention and program completion; this will serve as an additional measure of program effectiveness. |
| Year Submitted: |
2010 |
| Responsiveness and Innovation: |
This project addresses the spread of HIV through unprotected sex. HIV is 100% preventable and by working with those who are already infected gives us the best chance to eliminate this disease. By identifying clients with long-term HIV infection and a recent STD allows us to bring prevention education services to those in highest need.Florida Department of Health HIV and STD surveillance data are compiled and reviewed monthly by program staff. In 2008, these data showed an increase in syphilis and HIV co-infection. Further investigation revealed that many of these clients had long-standing HIV. Many of these clients were receiving medical care and case management, but not formal health education.AIDS Program Office staff work with providers at an STD clinic, an HIV specialty care clinic, and with STD field investigation personnel to identify HIV-positive individuals presenting with a new Syphilis, Gonorrhea, or and/or Chlamydia infection, and history of unprotected sex. A meeting with the counselor is held at the time of the initial clinic visit. Minimally, this meeting includes a client needs assessment and preliminary counseling and condom use skills. Additionally, the clients are encouraged to help a process of confidential sex partner notification and involve their sex-partners in future meetings. Sex partners are provided HIV pre-test counseling, confidential OraQuick Rapid HIV-1/HIV-2 test, and post-test counseling, condom use skills and early linkage to HIV care. The prevention activity is individual or couple-based counseling, condom demonstrations, condom practices, and role-play. The activity is customized to meet the needs of the client. In most cases, HIV transmission knowledge, condom use and negotiation skills are the focus of this activity, but issues of disclosure can also be addressed.Project staff performed a brief literature review looking for evidence of HIV prevention programs that seek to use STD diagnoses as objective indicators of clients with high need. Numerous conversations with Florida Department of Health officials suggested no similar program exists.This project varies from typical practice in couple key ways. Most HIV health education is passive, relying of clients to self identify and enroll in interventions. The Interdiction Project is more immediate; it is introduced to the client by the medical provider or the STD field staff at time of STD diagnosis. This occurs in the clinic or shortly after field contacts. Another key difference is the emphasis placed on soliciting and involving sex partners in the HIV prevention activity. The Duval County Health Department hosts the First Coast Community AIDS Prevention Partnership (FCCAPP), part of the Florida HIV Community Planning Group. This body serves as the primary venue for HIV prevention dialogue in Northeast Florida.First Coast Community AIDS Prevention Partnership members, many of whom are clients and/or HIV prevention professionals, have offer ongoing suggestions and encouragement for the project. Project staff have been able to make more effective referrals for non-HIV education needs (housing, drug assistance, etc.) as a result of the inter-agency knowledge and familiarity build through FCCAPP. |
| Agency and Community Roles: |
The LHD provides office space immediately adjacent to the HIV clinic and in close proximity to the STD clinic. It also provides administrative and IT support. Both STD and HIV specifically care providers (physicians and nurses) were consulted in developing the project. The initial drive for the project was greatly influenced by STD field staff and AIDS Program Office health educators. A workshop was held during a regular monthly meeting of a client/consumer group to discuss the need for this project. |
| Costs and Expenditures: |
This project was fully implemented in January, 2009. Current staff includes a fulltime counselor (Samuel Frimpong, M.D., M.P.H.), an evaluator/coordinator at (M. Maximillion Wilson, Ph.D.) and one data entry volunteer. The project housed in a large public health complex which includes a 2,400 patient HIV specialty care clinic and a STD clinic. There are five programmatic elements of the project: identification and referral, assessment, prevention activity, follow-up, and evaluation. Medical staff at the STD and HIV specialty care clinics and disease intervention specialists from STD field investigation unit link HIV+ individuals presenting with a new Syphilis, Gonorrhea, or and/or Chlamydia infection and history of unprotected sex to project staff. A meeting with the counselor is held at the time of the initial clinic visit. Minimally, this meeting includes a client needs assessment and preliminary counseling and condom use skills. Additionally, the clients are encouraged to help a process of confidential sex partner notification and involve their sex-partners in future meetings. Sex partners are provided HIV pre-test counseling, confidential OraQuick Rapid HIV-1/HIV-2 test, and post-test counseling, condom use skills and early linkage to HIV care. Funding for staff and supplies are a combination of state categorical dollars (match for Ryan White Care Act funding) and CDC prevention grant funds. |
| Implementation: |
This project addresses the spread of HIV through unprotected sex. HIV is 100% preventable and by working with those who are already infected gives us the best chance to eliminate this disease. By identifying clients with long-term HIV infection and a recent STD allows us to bring prevention education services to those in highest need.Florida Department of Health HIV and STD surveillance data are compiled and reviewed monthly by program staff. In 2008, these data showed an increase in syphilis and HIV co-infection. Further investigation revealed that many of these clients had long-standing HIV. Many of these clients were receiving medical care and case management, but not formal health education.AIDS Program Office staff work with providers at an STD clinic, an HIV specialty care clinic, and with STD field investigation personnel to identify HIV-positive individuals presenting with a new Syphilis, Gonorrhea, or and/or Chlamydia infection, and history of unprotected sex. A meeting with the counselor is held at the time of the initial clinic visit. Minimally, this meeting includes a client needs assessment and preliminary counseling and condom use skills. Additionally, the clients are encouraged to help a process of confidential sex partner notification and involve their sex-partners in future meetings. Sex partners are provided HIV pre-test counseling, confidential OraQuick Rapid HIV-1/HIV-2 test, and post-test counseling, condom use skills and early linkage to HIV care. The prevention activity is individual or couple-based counseling, condom demonstrations, condom practices, and role-play. The activity is customized to meet the needs of the client. In most cases, HIV transmission knowledge, condom use and negotiation skills are the focus of this activity, but issues of disclosure can also be addressed.Project staff performed a brief literature review looking for evidence of HIV prevention programs that seek to use STD diagnoses as objective indicators of clients with high need. Numerous conversations with Florida Department of Health officials suggested no similar program exists.This project varies from typical practice in couple key ways. Most HIV health education is passive, relying of clients to self identify and enroll in interventions. The Interdiction Project is more immediate; it is introduced to the client by the medical provider or the STD field staff at time of STD diagnosis. This occurs in the clinic or shortly after field contacts. Another key difference is the emphasis placed on soliciting and involving sex partners in the HIV prevention activity. The Duval County Health Department hosts the First Coast Community AIDS Prevention Partnership (FCCAPP), part of the Florida HIV Community Planning Group. This body serves as the primary venue for HIV prevention dialogue in Northeast Florida.First Coast Community AIDS Prevention Partnership members, many of whom are clients and/or HIV prevention professionals, have offer ongoing suggestions and encouragement for the project. Project staff have been able to make more effective referrals for non-HIV education needs (housing, drug assistance, etc.) as a result of the inter-agency knowledge and familiarity build through FCCAPP. |
| Sustainability: |
The natural course of this project works to develop and enrich the relationships between project staff, medical providers, and patients. With respect to the medical providers, this project provides them with a ready resource for help patients with recurring patterns of STD infection. They acknowledge that over time the project should work to reduce morbidity among their patients with highest need. Patient feedback and participation, also a critical factor in the sustainability of the project, has been good. The educational activity is very client-centered and not time limited; patients can receive more than an hour of personalize health education and counseling. Our hope is that this practice will be recognized as the best possible use of HIV health education resources. Existing Ryan White funding will provide an additional three years of project activity. We hope that with further opportunities to share this model, we will be able to continue funding under the AIDS Program Office’s prevention-for-positives program. |
| Lessons Learned: |
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