CBA. Center of Excellence. Integration of Biomedical and Behavioral Interventions for HIV Prevention

Transcription

1 CB Capacity Building ssistance Integration of Biomedical and Behavioral Interventions for HIV Prevention The integration of biomedical and behavioral interventions in HIV prevention can be defined as addressing the medical component of treatment in addition to addressing knowledge, attitudes and behavior regarding the virus. Some sources of innovation for the next generation of HIV prevention may include: Effective HIV prevention requires a combination of behavioral, biomedical, and structural intervention strategies. 2 Evidence-Based Interventions (EBIs) and Diffusion of Evidence-Based Interventions (DEBIs) play an important role in reducing the incidence of the acquisition and transmission of HIV. Biomedical strategies represent the cornerstone for the CDC s High-Impact Prevention approach, which aims to minimize the number of new HIV infections. However, the availability of biomedical prevention tools is only one part of the equation toward ending the epidemic. These tools need to be understood, effectively used, and sustained by those who utilize them. With new bio-medical prevention tools we can even interrupt acquisition of the virus as well. Surveillance tools have improved as well with geo-mapping increasingly used to identify areas with high HIV/IDS infection rates. lthough there have been many biomedical breakthroughs, health literacy among providers and consumers is lacking. In order for the plethora of advances in the prevention and treatment of HIV to be effective, providers and patients must understand and acknowledge their own personal and organizational deficiencies. Next they must move forward with strong efforts to increase their capacity to effectively serve their communities. In order for the biomedical prevention tools to be implemented successfully, providers and patients must understand them, believe in them, and know how to use them. 3 Evidence-based intervention (EBI) development and adaptation Use of a continuous quality improvement paradigm in the creation, design, and dissemination of EBIs Utilization of business principles from marketers and entrepreneurs to facilitate design and diffusion of EBIs Reframing prevention from a diseasemanagement to a wellness perspective framework that reinforces HIV as a chronic disease Moving prevention from healthcare settings to community sites 1 In collaboration with Evidence-Based Interventions and Diffusion of Evidence-Based Interventions One way of reducing the number of new HIV infections is through the use of Evidence-Based Interventions (EBIs) and Diffusion of Evidence-Based Interventions (DEBIs). Rotheram-Borus et al. (2009) writes the strategies supporting the efficacy of EBIs are remarkably common across theories and include provision of information; shaping of attitudes, norms, self-efficacy, and motivation; and building behavioral skills 4. n increased focus on evidence-based public health strategies has numerous direct and indirect benefits, including access to more and higher-quality public health information, a higher likelihood of successful programs and better implementation of policies. Often EBIs are more effective when implementers and clients are similar in terms of ethnicity, gender, age, and behavioral and background characteristics 5. EBIs promote treatments meant to change a health behavior. Cicatelli ssociates Inc. Funded by the CDC Grant #8754

2 CB Capacity Building ssistance The validation process for EBIs involves multiple trials with groups or individuals. To achieve state and national objectives for population health, more widespread adaptation of evidencebased strategies is implemented. There are a number of confounders that can make an EBI unsuccessful in certain environments. For example, confounders such as transportation, attendance, incentives for participants, interest, subject matter, even the day of the week can all sway a very effective EBI into an unsuccessful venture and cause the intervention to lose integrity. Discussing the participants preferences and needs can help to make the intervention more effective for both the facilitator and the attendees. EBIs and DEBIs allow for a multifarious way of communicating and training lay individuals or groups to reduce risk behaviors. One goal of an EBI or DEBI is to acknowledge an individual or group s current behaviors and equip them to move forward with healthier life practices. Each intervention is tailored towards specific groups varying from high-risk negatives to those who are newly diagnosed with HIV. Individual, small-group, and community interventions for people at high risk of HIV infection can reduce risk behavior and can play an important part in comprehensive HIV prevention strategies 7. nother goal of EBIs and DEBIs is to ensure that they are realistic and sustainable for your population of interest. DEBIs began in 1999 when the Centers for Disease Control and Prevention (CDC) published a Compendium of HIV Prevention Interventions with Evidence of Effectiveness in response to prevention service providers who requested effective evidence-based interventions 6. Disseminating EBIs is essential in order to build capacity of HIV prevention programs. For example, if your goal is to increase physical activity by forming neighborhood walking groups in an area that doesn t have street lights, sidewalks, and has a high crime rate, the intervention will not be successful or sustainable. Equipping your population of interest with the necessary tools will make the interventions both successful and sustainable. nother way to look at sustainability is to build in a check-in or follow-up component of the project after the intervention is complete. For example, one might host an event for those who have completed an intervention to meet three months after the intervention to follow-up on their current behavior. This would allow for feedback and also opportunities to collect data to inform improvements of the interventions. Behavior change is the crux of an intervention. Increasing knowledge and attempting to identify and become more aware of one s personal attitudes towards a behavior can indeed lead a participant closer to change. High-Impact Prevention High-Impact Prevention (HIP), as described by the CDC, is an approach that uses combinations of scientifically proven, cost-effective, and scalable interventions targeted to the right populations in the right geographic areas in order to increase the impact of HIV prevention efforts 8. To advance the prevention of goals of National HIV/IDS Strategy (NHS) and maximize the effectiveness of current HIV prevention methods, the CDC pursues a High-Impact Prevention approach. By using combinations of scientifically proven, cost-effective, and scalable interventions targeted to the right populations in the right geographic areas, this approach promises to greatly increase the impact of HIV prevention efforts Cicatelli ssociates Inc. Funded by the CDC Grant #8754

3 CB Capacity Building ssistance - an essential step in achieving the goals of NHS9. When using the High-Impact Prevention approach, there are five major components to consider: Effectiveness and cost Feasibility of full-scale implementation Coverage in the target populations Interaction and targeting Prioritization Infusing these components into the EBIs provide for effective dissemination of information that combats stigma, myths, and fears while raising awareness that can provide for a great platform to reach the goals of NHS. Some proven HIP Interventions include: HIV and linkage to care, antiretroviral therapy, access to condoms and sterile syringes, prevention programs for people living with HIV and their partners, preventions programs for people at high risk of infection, substance abuse treatment, and screening and treatment for other sexually transmitted diseases. Train-the-Trainer Below you will learn about the benefits and lessons of using the train-the-trainer method when implementing an EBI. The advantage of local trainers who are more familiar with contextual issues to allow for tailoring of the training Enhanced collaboration among practice and academic partners to create a forum for networking and new partnership opportunities Benefits and lessons of the train-the-trainer model Specific examples of how to improve the course in the future more convenient and less costly method of training that eliminates the need to bring in external trainers or for participants to travel out of state to attend trainings Cicatelli ssociates Inc. Funded by the CDC Grant #8754

4 CB Capacity Building ssistance This evaluation suggests that the train-the-trainer method has increased the capacity of practitioners trained in evidence-based public health while maintaining the original objectives and framework of the course. The train-the-trainer method also addresses medical mistrust among communities. Training members of a community to share medical knowledge with other members of the same community may assist in breaking down the barrier of mistrust. Cost Effectiveness of EBIs and DEBIs Cost-effectiveness analysis is a type of economic analysis where both the cost and the outcome (e.g. impact, result, effect, benefit, health gain) of an intervention are evaluated and then expressed in the form of a cost-effectiveness ratio. The cost effectiveness of interventions can vary based on your population of interest, resources available, and other confounders. Farnham et al. (2010) measured the value of HIV prevention efforts in the United States by comparing the difference between the number of infections that occurred with the number that might have occurred in the absence of prevention programs. Combined with estimates of lifetime treatment costs 10, the study estimated the medical savings from infections averted by US prevention programs from to be $129.9 billion with 361,878 HIV infections averted 11. From both a financial and health standpoint, the prevention efforts are well worth the cost. 1 Mary Jane Rotheram-Borus et al; (2009) The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention, nnual Review Clinical 2 Mary Jane Rotheram-Borus et al; (2009) The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention, nnual Review Clinical 3 The Black IDS Institute. When We Know Better, We Do Better :The State of HIV/IDS Science and Treatment Literacy.in the HIV/IDS Workforce. 4 Mary Jane Rotheram-Borus et al; (2009) The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention, nnual Review Clinical 5 Mary Jane Rotheram-Borus et al; (2009) The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention, nnual Review Clinical 6 CDC. Effective Interventions: HIV Prevention That Works. 7 CDC. Evolution of HIV/IDS prevention programs United States, MMWR 2006; 55: Levine S, Brett B, Robinson BE, Stratos G, Lascher SM, Granville L, et al. Practicing physician education in geriatrics: lessons learned from a train-the-trainer model. J m Geriatr Soc. 2007;55(8): doi: /j x. [PubMed] [Cross Ref] 9 CDC Levine S, Brett B, Robinson BE, Stratos G, Lascher SM, Granville L, et al. Practicing physician education in geriatrics: lessons learned from a train-the-trainer model. J m Geriatr Soc. 2007;55(8): doi: /j x. [PubMed] [Cross Ref] 11 Farnham PG, Holtgrave DR, Sansom SL, Hall HI. Medical costs averted by HIV prevention efforts in the United States, JIDS 2010; 54(5): Cicatelli ssociates Inc. Funded by the CDC Grant #8754

5 CB Capacity Building ssistance Resources for Health Care Providers IDS.gov. Pre-Exposure Prophylaxis (PrEP). May Centers for Disease Control and Prevention, US Public Health Service. Pre-exposure Prophylaxis for the Prevention of HIV Infection in the United States-2014 Clinical Practice Guideline. Centers for Disease Control and Prevention, US Public Health Service. Pre-exposure Prophylaxis for the Prevention of HIV Infection in the United States-2014 Clinical Providers; Supplement. Centers for Disease Control and Prevention, Division of HIV/IDS Prevention, National Center for HIV/IDS, Viral Hepatitis, STD, and TB Prevention. Pre-Exposure Prophylaxis (PrEP) for HIV Prevention. May Centers for Disease Control and Prevention, Division of HIV/IDS Prevention, National Center for HIV/IDS, Viral Hepatitis, STD, and TB Prevention. PrEP Infographic: Talk to your Doctor about PrEP. Gilead Sciences, Educational Materials for Providers and Patients National lliance of State & Territorial IDS Directors. Fact sheet: Pharmaceutical Company Patient ssistance Programs and Co- Payment ssistance Programs for Pre-exposure Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP). PrEP%20and%20PEP%20PP%20fact%20sheet.pdf New York State Department of Health, IDS Institute, HIV, HCV & STD Clinical Education Initiative. Learning Modules: HIV Prevention with Pre-Exposure Prophylaxis Video Presentation. ugust cfm?mediaid=320#.vic9lsgaig PrEP Support Hotline for Clinicians. PrEPline, (1-855 HIV-PREP). The CCC Pre-Exposure Prophylaxis Service Project Inform. PrEP (Pre-Exposure Prophylaxis) Project Inform. Talking to patients about Pre-Exposure Prophylaxis. San Francisco IDS Foundation (February 2014). PrEP Facts Brochure. mech_finl.pdf Cicatelli ssociates Inc. Funded by the CDC Grant #8754