1. 1 Community Based HIV Prevention Research: Lessons Learned KENNETH VOGTSBERGER, M.D. STAFF PSYCHIATRIST ATCMHMR DAVID DESMOND, M.S.W. ASSISTANT PROFESSOR, RET. UTHSC, SAN ANTONIO

2. 2 OVERVIEW OF PRESENTATION HOW A NIDA GRANT INFLUENCED THE SUBSTANCE ABUSE DIVISION, DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER OVER A 10 YEAR PERIOD

3. 3 BACKGROUND OF MULTI- SITE STUDY NIDA OBJECTIVES: PREVENT DRUG ABUSE AND REDUCE TRANSMISSION OF HIV NIDA GOALS: TEST AND EVALUATE DIFFERENT MODELS /INTERVENTIONS TO REDUCE HIGH RISK DRUG ABUSE AND SEXUAL BEHAVIORS AMONG IDUS AND THEIR SEX PARTNERS

4. 4 BACKGROUND SEPT. 1987-SIX NADR, 5 ATOM PROGRAMS FUNDED SEPT. 1988-TOTAL OF 54 CITIES AND 63 SITES FUNDED

5. 5 LOCAL COMPETING APPLICATIONS SAN ANTONIO METROPOLITAN HEALTH DISTRICT UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER, SAN ANTONIO

6. 6 SHOTGUN WEDDING: OFFSPRING NAMED FRIO STREET PROJECT (FSP) $2,500,000 FOR PROJECT,1988-1991 (PIs second grant appl, first funded project) HEALTH DISTRICT: OUTREACH AND RECRUITMENT MEDICAL SCHOOL: DATA COLLECTION, INTERVENTION (Health Belief Model), AND DATA ANALYSIS

7. 7

8. 8 WHY DID WE GET FUNDED???? LOW SEROPREVALENCE COMMUNITY LARGE HISPANIC IDU POPULATION MADDUX/DESMOND TRACK RECORD WITH NIDA PI WITH EXPERIENCE AS TEACHER AND DIRECT PATIENT CARE PROVIDER HEALTH DISTRICT TRACK RECORD IN HIV TESTING/COUNSELING THE L------- WORD

9. 9 A FAMOUS SAYING THAT APPLIES TO GETTING FUNDED: THE ONLY THING WORSE THAN NOT GETTING WHAT YOU WANT, IS GETTING WHAT YOU WANT.

10. 10 FSP AS BASIS FOR 10 YEARS OF GRANT FUNDING $400,000/ 1991-1992 EXTENSION AND FORMATION OF THE SW RESEARCH CONSORTIUM (NIDA) $3,064,000/ 1989-1994 IMPROVING RETENTION ON METHADONE MAINTENANCE (NIDA) $972,000/ 1992-1995 STEPS PROJECT (CSAT) $2,300,000/ 1994-1999 COPA PROJECT (NIDA)

11. 11 ADDITIONAL GRANTS $150,000/ 1996-1999 SUPPLEMENT FOR NEW MINORITY RESEARCHERS (NIDA) $36,000/ 1997-1998 FEMALE CONDOM MULTI-SITE STUDY (NIDA)

12. 12 DOING THE WORK ESTABLISH FIELD OFFICE HIRE STAFF/ISSUES WITH OUTREACH WORKERS TRAIN STAFF/TEAMBUILDING MULTI-TASKING FOR ALL STAFF RECRUIT SUBJECTS-THE INFAMOUS AIA QUESTIONAIRE/ REFINE PROCESS IMPLEMENT/REFINE THE INTERVENTION

13. 13 DOING THE WORK DO FOLLOW-UP ASSESSMENTS 6 MONTHS POST-ENROLLMENT (A POPULATION OF HEROIN ADDICTS RECRUITED FROM THE STREETS!!) STAFF ATTRITION

14. 14 MEETINGS, BLOODY MEETINGS!! WEEKLY ALL STAFF MEETING OUTREACH WORKERS MEETING FOLLOWUP STRATEGY MEETING RESEARCH STAFF MEETING

15. 15 LOCATOR FORM DESCRIPTION OF SUBJECT HANGOUTS SIGNIFICANT OTHERS FOR CONTACT CONSENT FORM TO CONTACT IN 6 MONTHS

16. 16 FOLLOW-UP FLOW SHEET LETTER (EMPHASIZE $) PHONE CALL BE ON THE LOOKOUT INTENSE SEARCH

17. 17 RESULTS 2,292 IDUS AND 349 SEX PARTNERS RECRUITED IN 2 ½ YEARS 20,000 BOTTLES OF BLEACH DISTRIBUTED 72,000 CONDOMS DISTRIBUTED 2,300 BLOOD SAMPLES TESTED, 33 HIV+ (1%)

18. 18 RESULTS HIGH RATES OF UNSAFE NEEDLE USE AT INITIAL ASSESSMENT HIGH RATES OF UNSAFE SEX AT INITIAL ASSESSMENT

19. 19 RESULTS 80 % SIX MONTH FOLLOW UP RATE 1,673 BLOOD SAMPLES TESTED AT FOLLOW UP, ONLY 1 CONVERSION 60 % OF IDUS HAD AT LEAST ONE TREATMENT EXPERIENCE(reported at initial assessment) 90 % OF IDUS HAD AT LEAST ONE JAIL/PRISON EXPERIENCE(reported at initial assessment)

20. 20 OUTCOME OF THE INTERVENTIONS AT 6 MONTH FOLLOWUP, BOTH STANDARD AND ENHANCED INTERVENTION LEAD TO REDUCTION IN NEEDLE RISK INDEX AT 6 MONTH FOLLOWUP, NO SIGNIFICANT CHANGE IS SEX RISK LOW SEROPREVALENCE MAINTAINED IN SAN ANTONIO THROUGH 1998

21. 21 ESTIMATED TOTAL NUMBER OF SUBJECTS RECRUITED FOR ALL STUDIES: 1988-1999 5,575

22. 22 BENEFITS TO P.I. LETTER FROM THE PRESIDENT, UTHSCSA PROMOTION: FROM ASST. TO ASSOC. TO PROFESSOR PUBLICATIONS: 19 ARTICLES, 1 BOOK CHAPTER, 1 ABSTRACT THE ACADEMIC EXPERIENCE

23. 23 CHALLENGES FOR THE P.I. BALANCING TEACHING, SERVICE, AND RESEARCH DEALING WITH MULTIPLE, SEEMINGLY UNSOLVABLE PROBLEMS MULTIPLE RESPONSIBILITIES DEALING WITH MULTIPLE UNCERTAINTIES

24. 24

25. 25 CHALLENGES FOR THE P.I. HIRING COMPETENT EMPLOYEES TERMINATING PROBLEMATIC EMPLOYEES TERMINATING GOOD EMPLOYEES DUE TO REDUCTIONS IN FUNDING MONTHLY REPORTS, QUARTERLY REPORTS, ANNUAL REPORTS, RENEWAL APPLICATIONS, AD INFINITUM

26. 26 P.I. SURVIVAL DEVELOP RELATIONSHIPS WITH MENTORS MAINTAIN HIGH VISIBILITY WITH STAFF MAINTAIN A CLINICAL CONNECTION USE TEAM APPROACH USE TEAM PROBLEM SOLVING DELEGATE EVERYTHING POSSIBLE, WITH APPROPRIATE POWER, AND HOLD STAFF ACCOUNTABLE SET DEADLINES ACCEPT THE IMPERFECTIONS OF SELF, FACULTY, STAFF, AND NIDA

27. 27 RECOMMENDED TEXTS STARLING, GROVER. MANAGING THE PUBLIC SECTOR, 5 TH ED, WADSWORTH, 1997 WHITMAN, NEAL ET AL. EXECUTIVE SKILLS FOR MEDICAL FACULTY, 2 ND ED, UNIVERSITY OF UTAH SCHOOL OF MEDICINE, 1993 (801-581-7234)

28. 28 P.I. SURVIVAL MANAGE YOURSELF MANAGE YOUR REACTION TO STRESS MANAGE THE AMOUNT OF STRESS