Los Angeles County PATH: PrEP and TLC+ for HIV Prevention PATH Community Advisory Board Member Application We would like to invite you to become a member of the PrEP and TLC+ for HIV Prevention (PATH) Community Advisory Board (CAB). The CAB will advise the Los Angeles County Division of HIV and STD Programs and the PATH Study Investigators on the delivery of services for HIV/AIDS prevention, care and treatment. PATH PrEP stands for pre-exposure prophylaxis. PrEP is an HIV prevention strategy of administering antiretroviral medications to uninfected, at-risk individuals. 1,2 TLC+ stands for Testing and Linkage to Care Plus Treatment. TLC+ is a framework for integrating HIV testing, care and treatment, social services and prevention-with-positives activities in provider settings or in health jurisdictions. 3 CAB MEMBER RESPONSIBILITIES Term Each member is asked to serve for two years; continued membership is dependent on individuals availability and fulfillment of responsibilities. Orientation CAB members will attend one orientation to learn about the PATH projects and strategies. Attendance CAB members will be expected to attend a minimum of 3 out of 4 meetings; meetings will be held on a quarterly basis. Preparation CAB members will be provided with meeting materials in advance of all meetings and will be expected to have reviewed the materials to be able to provide input on the PATH projects and information dissemination. Participation CAB members will be expected to actively participate in discussion. Engagement CAB members will provide information about the CAB and the PATH projects to community members, stakeholders and other relevant groups. CAB MEMBERSHIP We are seeking a diverse CAB membership and encourage applications from individuals who have life or professional experience relevant to HIV counseling and testing, linkage to HIV medical care, reengagement or retention in HIV/AIDS medical care, behavioral prevention, and biomedical prevention. Please use extra space, as needed, and include a current resume. Each CAB member will receive $20 per meeting attended. 1 Los Angeles County Office of AIDS Programs and Policy (2011). Research Brief: iprex Study. http://www.publichealth.lacounty.gov/aids/docs/researchbriefiprex1-11.pdf 2 Gorman, A. (2012, April 18). California to test HIV-prevention pill. http://www.latimes.com/news/local/la-mehivpill-20120418,0,3812415.story 3 Los Angeles County Office of AIDS Programs and Policy (2011). Program Brief: HIV Prevention Through Care and Treatment. 1
APPLICATION REVIEW All applicants will be reviewed by the PATH CAB Selection Committee composed of investigators and providers from the PATH grant. Affiliation or membership in the communities to be served by the PATH study, geographic representation of impacted communities in Los Angeles, race/ethnicity and experience with HIV/AIDS prevention, care and treatment or research will be considered in the selection of applicants. As needed, telephone or in-person interviews will be conducted to select CAB members. Ten individuals will be selected to serve on the PATH CAB. Newly selected members will be notified in early July in order to participate in the first CAB meeting. APPLICATIONS ARE DUE ON JUNE 1, 2012 Fax or e-mail your application to ATTN: Kiesha McCurtis, M.P.H. UCLA Department of Family Medicine (310) 794-2808 fax kmccurtis@mednet.ucla.edu e-mail Questions about the CAB application process are welcome at (310) 794-0619 x233. MEETING DATES 2012-2015 Meeting times will be determined by the CAB members in coordination with the PATH study investigators. Locations will be announced well in advance of meeting dates. Meetings will be held in the following months in 2012: August, October and December Meetings will be held on a quarterly basis in succeeding years. 2
PATH CAB MEMBER APPLICATION FORM Please use extra space as needed. First and Last Name: Street Address or Organization (Line 1): Street Address (Line 2): City: State: Zip Code: Phone number at which you can be reached: Email: Best way to send correspondence to you: Email U.S. Mail 3
1. Why do you want to become a member of the PATH Community Advisory Board? 2. What relevant life or work experiences in HIV research, prevention, or care/treatment do you bring to the PATH CAB? 3. Please discuss the relevant communities and networks to which you have access. 4. CAB members contribute to research feedback sessions. Applicants need not have research backgrounds, but should feel comfortable discussing research. Please briefly discuss your comfort discussing research. 5. Are you able to fulfill the following CAB responsibilities? Responsibility Yes No Term Orientation Attendance Preparation Participation Engagement 4
What is your age (optional)? Race/Ethnicity (check all that apply) (optional) (1) American Indian/Alaska Native (2) Asian American/Pacific Islander (3) Black/African American (non-hispanic) (4) Hispanic/Latino/a (5) White/Caucasian (non-hispanic) (6) Other (7) Decline to state Do you consider yourself to be: (1) Heterosexual or straight (2) Gay, lesbian or same gender loving (3) Bisexual? (4) Decline to state What is your sex or gender? (Check ALL that apply) (1) Male (2) Female (3) Transgender Male/Transman (4) Transgender Female/Transwoman (5) Genderqueer (6) Additional Sex or Gender: Please specify: (7) Unknown or Question Not Asked (8) Decline to State What sex were you assigned at birth? (Check one) (1) Male (2) Female (3) Unknown or Question Not Asked (4) Decline to State 5