1. Lessons from the CDC/RTC HIV Integration Project Marianne Zotti, DrPH, MS, FAAN Team Leader Services Management, Research & Translation Team NCCDPHP/DRH/ASB

2. Content  History of the HIV Integration Project  Current Project Overview  Logic Model  Regional Training Center (RTC) Role  HIV Integration Toolkit  Monitoring & Evaluation

3. History  Since 1993 CDC & OPA have collaborated re HIV prevention  1993-1996 Operations research  1996-1999 Focus on counseling about risks, Title X  1999-2004 Client centered counseling, Title X, non Title X, also focus on teen pregnancy prevention and prenatal smoking cessation  2004-2009 HIV prevention integration

4. Current HIV Integration Project  Objective  To increase the number of reproductive health clinics/settings that integrate HIV prevention services at an appropriate level into routine care  Future supplement  To increase the number of reproductive health clinics serving American Indian/Alaska Natives that integrate HIV prevention services at an appropriate level into routine care

5. Levels of HIV Prevention  HIV Prevention Education  HIV Prevention Counseling  HIV Testing Services  Health Care for HIV + Women

6. Strategies of the Project  Build clinic capacities through training & technical assistance by RTCs  Establishment & use of model clinics

7. Logic Model  CDC Role  RTC Role  Capacity Building Outcomes  Short-term & Intermediate Outcomes  Long-term Outcomes

8. 1. Discuss desired integration level with clinic 2. Determine current level of HIV Services 3. Determine clinic proficiency at current level 4. Assess clinic capacities 5. Develop training and technical assistance plan 6. Conduct training and technical assistance 7. Evaluate training and technical assistance activities HIV Integration Program RTC Role in Integration

9. Essential Capacities  Management awareness & motivation to integrate  Staff awareness & motivation  Clinical staff skills  Adequate referral systems

10. Short-Term & Intermediate Goals  Increased number of clinics integrating HIV counseling & testing  Increased proficiency in HIV counseling  Increased proficiency in HIV testing  Increased number of HIV tests at clinics  More referrals for HIV testing  Increased number of HIV+ individuals served

11. Long-term Goals  Reduced risky sexual behavior among people served in RH clinic/settings  Increased number of HIV+ individuals seeking & adhering to treatment  Reduced incidence of HIV among people in the service area

12. Essential Capacities  Management awareness & motivation to integrate  Staff awareness & motivation  Clinical staff skills  Adequate referral systems

13. Management Awareness & Motivation  Established policies and procedures for HIV prevention integration  Motivated management staff  Adequate resources for services  Established clinic flow procedures  Established commitment to quality assurance

14. Staff Awareness & Motivation  HIV-related knowledge of most staff  Staff motivation to provide HIV prevention services  Staff comfort in delivering HIV prevention services

15. Clinical Staff Skills  Knowledge & skills for HIV prevention education  Skills in client-centered HIV prevention counseling  Skills in HIV testing (traditional and/or rapid)

16. Adequate Referral Systems  Referral lists continually documented and updated  Established mechanisms to monitor success of referrals

17. HIV Integration Toolkit  RTC product  Definition of integration  Supporting literature  Description of levels of HIV prevention  Common barriers to integration  Description of needed capacities  Tools for assessment of levels & training needs  Examples of training tools  Technical assistance tools  Monitoring & evaluation  Experiences of different types of providers

18. Monitoring & Evaluation  Process monitoring (all clinics)  # of clinics served (Title X & non Title X)  Needs assessment for technical assistance (TA) performed  # & type of training sessions & TA events  # & demographics of people trained  # of clinics with > 1 PFA

19. Monitoring & Evaluation (continued)  Outcome monitoring (clinics with Intensive TA)  Short-term = Capacities  Intermediate  Other factors  Case studies

20. Capacity Building Outcomes (Levels 1-4)  How well the clinic protocols & policies outline HIV requirements for each level  Level of motivation, knowledge and skills & comfort level of staff to deliver HIV prevention activities for each level

21. Monitoring & Evaluation (continued)  Outcome monitoring (clinics with Intensive TA)  Intermediate outcomes  # of clinics integrating counseling & testing  Proficiency in HIV prevention counseling  Proficiency in HIV testing  # of HIV tests across clinics  # of referrals for HIV testing across clinics  # of HIV + women served

22. Other Factors  Training plan  OPA funding  Use of HIV integration champions  HIV Integration champions are staff members who not only actively advocate but boldly lead in integrating HIV prevention services into routine care at reproductive health clinics/settings.

23. Qualitative Case Studies  Potential topics  Special populations  State family planning systems  Non Title X providers  Unique TA methodologies  Unique clinics  Potential factors  Critical capacities  Biggest barriers & how they were overcome  Role of RTCs & other partners  Success institutionally or personality driven  Next steps for sustainability  Needed additional resources

24. Questions and Discussions