Evaluating AIDS Prevention Programs Expanded Edition (1991) / Chapter Skim
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5 Evaluating HIV Testing and Counseling Projects
5 Evaluating HIV Testing and Counseling Projects
Pages 102-123
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From page 102... ...
channels funds for such programs through 62 cooperative agreements with states, territories, and a handful of major cities to support this widescale program. Grantees provide HIV testing and counseling services free of charge in a variety of health care settings.
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From page 103... ...
~ establishing new HIV testing and counseling sites, priority has been given to projects that serve those segments of the population Hat are most likely to be infected or that engage In behaviors that risk HIV transmission (CDC, 1987:510~. Halfway through 1989, there were more than 1,600 counseling and testing sites nationwide, and that number is expected to grow to 2,000 by the end of the year.
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From page 104... ...
The pane' recommends that data be gathered from multiple sources including testing sites, clients, groups at increased risk of HIV infection, and independent observer~to evaluate five aspects of service delivery: the adequacy of the counseling and testing protocol, the adequacy of the coun seling that is actually provided, the proportion of clients that complete the full protocol, the accessibility of services, and the nature of the barriers, if any, to clients seeking and completing counseling and testing. The rate of completion of the program and the identification of banders to participation in the program are subsumed under "adequacy" and "accessibility.
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From page 105... ...
Thus, the sexing in which testing and counseling services are delivered may be a significant factor to be taken into account in analyzing data collected from project sites. As a first step, the panel believes CDC should prepare an inventory of the venous services that are delivered by HIV testing and counseling sites.
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From page 106... ...
These data can then be used in four ways: to link test data with type of service site; to identify the demographic distribution of clients and determine trends ~ client utilization of the site; to link test data with risk behavior and demographic data to assess trends in seropositivity; and to link test results with pastiest information to determine trends in return rates for results, counseling, and partner notification and referral. The data gathered with this form would also allow analysis of variations among project sites and geographic regions.
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From page 107... ...
(O (O ~) (O C~ CD i~ ~ D ( (O FIGURE 5-1 HIV Testing and Counseling Report Form
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From page 108... ...
~ HIV COUNSELING AND TESTING REPORT FORM POSTTEST COUNSELING & PARTNER NOTIFICATION POSTTEST REFERRED COUNSELED FOR TB TEST o (ID NO (GINO ~ YES O G) YES PARTNER NOTIFICATION (Positives Only)
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From page 109... ...
While the reliability and validity from such surveys must always be considered, information from such surveys might also be helpful in designing more inviting and accessible settings for testing and counseling (e.g., "attractive" physical surroundings, "convenient" locations for services) , understanding what aspects of the pretest counseling session encourage clients to return to learn tests results, assessing the optimal content and timing of a pastiest counseling session and the provision of referral services, and specifying He profiles of the more effective counselors for different circumstances.
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From page 110... ...
Indeed, the approaches suggested are complementary to one another, and all might be undertaken to yield He most 5As noted in chapter 1, the panel believes that project administrators should be given advance notification that professional customers will be visiting their sites for counseling and testing services, and prior consent should be solicited before this method of data collection is used. fits document on process perfollllance standards covers a series of steps its counselors are to talce in providing counseling and partner notification, and it provides a skills inventory to be used by managers in evaluating counselors performance (see CDC, n.d.)
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From page 111... ...
Although a services inventory could show who is using testing and counseling services and could monitor trends in this use over time, some caution is warranted in interpreting inventory data. The main methodological problem will be the accuracy of the project site's reporting.
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From page 112... ...
The pane! recommends that the NHIS be periodically augmented with several questions about accessibility and barriers to HIV testing and counseling services.
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From page 113... ...
If the alternative of using professional customers to gather information is considered, it may be desirable to ask for a site's informed consent before that site is funded for HIV testing and counseling services. Resources and Aspirations An inventory system requires record-keeping by personnel at the counseling and testing sites.
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From page 114... ...
Case studies call provide a rich and ~n-depth look at some aspects of service delivery for a subset of testing and counseling sites, which will in turn be important for developing studies Hat evaluate comparative effectiveness. OPTIONS FOR EVALUATING WHETHER HIV TESTING AND COUNSELING SERVICES MAKE A D1FIERENCE The panel weighed several options for addressing the question, "Does He policy of providing free HIV testing and counseling services make a difference?
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From page 115... ...
The panel also considered a variation of a randomized experiment that would capitalize on delays in the implementation of projects, but concluded that such an experiment would not usually be feasible. This design variation assumes that lags occur in the deployment of counseling and testing projects because of scarce resources; as funding becomes available for some projects, sites can be randomly assigned to receive the intervention or to continue waiting.
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From page 116... ...
Because the groups are composed randomly, the comparison of outcomes such as client return rates for clients receiving regimen A or regimen B is Hen a fair one. In some circumstances, REV seroconversion may be a helpful outcome measure for evaluating He effectiveness of different counseling and testing projects.
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From page 117... ...
suggests consideration of three types of assignment: it · random assignment of individual testing and counseling sites to alternative regimens; · random assignment of project staff members at a given site to the use of alternative regimens, and · random assignment of individual clients to alternative regimens at a site. In cases of random assignment of sites, we recognize that some facilities, such as those whose primary mission is not HIV-related, may not be amenable to being randomly assigned to provide different interventions.
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From page 118... ...
The number of sessions as well as the content of counseling may have an effect on cognition and behavior. Other process variables Hat may influence return rates involve the adequacy of services In teas of emotional support and medical service referral.
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From page 119... ...
Increased relapse prevention services for IV drug users In treatment who become seropositive are a good example. A common reaction to stress by IV drug users is to seek and use drugs for stress reduction.
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From page 120... ...
Although these uncertainties are troubling, the pane} points out that some important crucial outcome measures e.g., the proportion of clients that return for HIV test results and subsequent stages of the protocol—can be known with certainty even in an anonymous testing program. Although the pane} recommends that a skilled evaluation team carefully design and conduct randomized studies, the evaluation team and the sponsoring agencies should be prepared for a certain number of failures in carrying out experiments.
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From page 121... ...
Finally, evaluation studies that are cattier out as randomized trials by outside experts will require appropriately trained CDC staff to interact win the investigators and to interpret study results. In addition, CDC's personnel expertise and workload should also permit staff to conduct evaluation studies themselves.
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From page 122... ...
Thus, there may be a substantial increase in the demand for HIV testing—as well as for medical monitoring of seropositive persons. ~ a rapidly changing environment, an ongoing program of evaluations will be essential to assess progress toward both the goal of adequate service delivery and He goal of reduced HIV transmission.
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From page 123... ...
Presidential Commission on the Human Immunodeficiency Virus Epidemic (1988) Final Report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic.
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