Evaluation and Program Support Center: Innovative Programs for HIV Positive Substance Users

The Evaluation and Program Support Center (EPSC), funded as a Special Project of National Significance (SPNS) grant through the Health Resources and Services Administration (HRSA), is based at the Health and Disability Working Group (HDWG) at the Boston University School of Public Health. Over a 4 year period, the Center has conducted a series of activities to identify guiding principles of performance standards; develop program typologies; and identify innovative and successful practices in serving HIV-positive substance users. A national Training of Trainers curriculum was developed and a cross-disciplinary training program conducted in January, 2003.

Center activities to date and resultant products can be found on this website include the following:

Guiding Principles for Programs Serving HIV Positive Substance Users, plus a cover letter of support from Deborah L. Parham, Ph.D., R.N., Associate Administrator at the Health Resources and Services Administration. Working with multiple experts and the national advisory committee and based on the body of knowledge gained from previous activities, the Center developed a set of guiding principles for primary HIV care, substance abuse services, outreach services and care coordination. The principles were developed to assist HRSA and other purchasers of services to establish standards of care for the delivery of services to HIV-infected substance users.

A comprehensive literature review and annotated bibliography of publications that address the epidemiology of substance use and HIV; the relationship between substance use and HIV treatment delivery systems; the status of performance standards for the care of people with HIV who are substance users; barriers to care for demographic groups of people with HIV who are substance users; and innovative programs and interventions that have been developed for HIV-infected substance users.

Key informant interviews and surveys of more than 400 CARE Act-funded grantees (Title I and Title II), over 100 other funded providers, 40 HIV-positive substance users, and more than 50 key informants. The results and an analysis of these interviews and surveys have been reported and contain sections on successful program models and strategies, barriers to care for people with HIV who are substance users, and program evaluations.

Identification of innovative program models. Based on the results of the survey work, the Center developed a set of criteria for defining innovative models of care and identified over 50 program models that met the criteria. An in-depth telephone survey was developed and conducted with these programs. Twelve of the programs surveyed were selected as representative of the range of innovative models. Site visits were conducted with these sites to further examine interventions used with different populations, specialized case management systems, and linkages between primary medical care, substance use treatment and other support services. A summary of common themes and individual case studies of the findings were written up.

The national training program – A Kaleidoscope of Care: Responding to the Challenges of HIV and Substance Use – took place from January 12 – 14, 2003 in San Antonio, Texas. Nearly 80 doctors, nurses, psychologists, social workers, therapists, outreach, counselors and substance abuse addiction and treatment providers from six different regions of the country attended the train the trainer program presented by a training team of national experts and speakers. A comprehensive curriculum comprising specific content areas related to HIV and substance use served as the core reference for the three day training conference.

Replication Summary

Modules at a Glance (in English)

Modules at a Glance (in Espanol)

During the spring and summer months of 2003, each of the six regions represented at the national training program convened and replicated a version of content from the training curriculum to an audience of local professionals involved in the care of HIV-infected substance users. Feedback and evaluation of the national training program was tremendous, and participants were very enthusiastic about applying the content and training techniques they learned with their local communities in the following months. HDWG participated in the local training replications as evaluators.

The original curriculum was translated into Spanish and pilot tested at the replication training in Puerto Rico.

Currently underway, HDWG is preparing a comprehensive evaluation of the training program – national and local replications – including recommendations for training initiatives designed to promote and sustain innovation and support in the care and treatment of HIV positive substance users.

The Center convened a National Advisory Committee to guide the work of the Center in developing performance standards, developing program typologies, addressing the barriers to the replication of innovative programs, and addressing issues related to racial/cultural diversity and competence. The Advisory Committee consists of HIV and substance abuse researchers, providers, and policy-makers from across the country. Key Staff for this project include:

Carol Tobias, M.M.H.S., Principal Investigator, Co-Director

Kate Brown, Project Director

Regina Murphy, Program Manager

Serena Rajabiun, Senior Evaluator

Rowland Yancey, Research Assistant

HRSA Page on Training Initiative