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2.
J Public Health Manag Pract ; 24(3): 225-234, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28492452

RESUMO

OBJECTIVE: HIV prevention has changed substantially in recent years due to changes in national priorities, biomedical advances, and health care reform. Starting in 2010, motivated by the National HIV/AIDS Strategy (NHAS) and the Centers for Disease Control and Prevention's (CDC's) High-Impact Prevention (HIP), health departments realigned resources so that cost-effective, evidence-based interventions were targeted to groups at risk in areas most affected by HIV. This analysis describes how health departments in diverse settings were affected by NHAS and HIP. METHODS: We conducted interviews and a consultation with health departments from 16 jurisdictions and interviewed CDC project officers who monitored programs in 5 of the jurisdictions. Participants were asked to describe changes since NHAS and HIP and how they adapted. We used inductive qualitative analysis to identify themes of change. RESULTS: Health departments improved their HIV prevention practices in different ways. They aligned jurisdictional plans with NHAS and HIP goals, increased local data use to monitor program performance, streamlined services, and strengthened partnerships to increase service delivery to persons at highest risk for infection/transmission. They shifted efforts to focus more on the needs of people with diagnosed HIV infection, increased HIV testing and routine HIV screening in clinical settings, raised provider and community awareness about preexposure prophylaxis, and used nontraditional strategies to successfully engage out-of-care people with diagnosed HIV infection. However, staff-, provider-, and data-related barriers that could slow scale-up of priority programs were consistently reported by participants, potentially impeding the ability to meet national goals. CONCLUSION: Findings suggest progress toward NHAS and HIP goals has been made in some jurisdictions but highlight the need to monitor prevention programs in different contexts to identify areas for improvement and increase the likelihood of national success. Health departments and federal funders alike can benefit from the routine sharing of successes and challenges associated with local policy implementation, considering effects on the overall portfolio of programs.


Assuntos
Infecções por HIV/prevenção & controle , Avaliação de Programas e Projetos de Saúde/métodos , /organização & administração , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Prevenção Primária/métodos , Prevenção Primária/tendências , Avaliação de Programas e Projetos de Saúde/tendências , Estados Unidos
4.
AIDS Care ; 29(7): 858-865, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28132520

RESUMO

Timely linkage to HIV care (LTC) following an HIV diagnosis is especially important for pregnant women with HIV to prevent perinatal transmission and improve maternal health. However, limited data are available on LTC among U.S. pregnant women. Our analysis aimed to identify HIV diagnoses among childbearing age (CBA) women (15-44 years old) by pregnancy status and to compare LTC of HIV-infected pregnant women to HIV-infected non-pregnant women. We analyzed 2013 CDC-funded HIV testing data from 61 health departments and 151 directly funded community-based organizations among CBA women. LTC includes linkage at any time after an HIV diagnosis and within 90 days after HIV diagnosis. Pearson's chi-square was used to compare LTC of pregnant and non-pregnant women. Data were analyzed using SAS v9.3. Among the 1,379,860 HIV testing events among CBA women in 2013, 0.3% (n = 3690) were HIV-positive. Among all HIV-positive diagnoses with an available pregnancy status (n = 1987), 7%, (n = 138) were pregnant. Among women with pregnancy status data, LTC any time after an HIV-positive diagnosis was 73.2% for pregnant women and 60.7% for non-pregnant women. LTC within 90 days was 71.7% for pregnant women and 56.2% for non-pregnant women. Pregnancy was associated with LTC any time (p < 0.01) and within 90 days of diagnosis (p < 0.01). Compared with non-pregnant women, a higher proportion of pregnant women with HIV were linked to care overall, and linked within 90 days. Pregnancy appears to facilitate better LTC, but improvements are needed for women overall and pregnant women specifically.


Assuntos
Infecções por HIV/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Transmissão Vertical de Doença Infecciosa , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal , Estados Unidos/epidemiologia , Adulto Jovem
6.
Public Health Rep ; 131(1): 52-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26843670

RESUMO

In September 2010, CDC launched the Enhanced Comprehensive HIV Prevention Planning (ECHPP) project to shift HIV-related activities to meet goals of the 2010 National HIV/AIDS Strategy (NHAS). Twelve health departments in cities with high AIDS burden participated. These 12 grantees submitted plans detailing jurisdiction-level goals, strategies, and objectives for HIV prevention and care activities. We reviewed plans to identify themes in the planning process and initial implementation. Planning themes included data integration, broad engagement of partners, and resource allocation modeling. Implementation themes included organizational change, building partnerships, enhancing data use, developing protocols and policies, and providing training and technical assistance for new and expanded activities. Pilot programs also allowed grantees to assess the feasibility of large-scale implementation. These findings indicate that health departments in areas hardest hit by HIV are shifting their HIV prevention and care programs to increase local impact. Examples from ECHPP will be of interest to other health departments as they work toward meeting the NHAS goals.


Assuntos
Infecções por HIV/prevenção & controle , Planejamento em Saúde , Política de Saúde , Recursos em Saúde/organização & administração , /organização & administração , Infecções por HIV/epidemiologia , Planejamento em Saúde/métodos , Planejamento em Saúde/organização & administração , Humanos , Objetivos Organizacionais , Alocação de Recursos , Estados Unidos/epidemiologia
7.
Public Health Rep ; 131(1): 67-75, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26843672

RESUMO

OBJECTIVE: The Enhanced Comprehensive HIV Prevention Planning (ECHPP) project was a demonstration project implemented by 12 U.S. health departments (2010-2013) to enhance HIV program planning in cities with high AIDS prevalence, in support of National HIV/AIDS Strategy goals. Grantees were required to improve their planning and implementation of HIV prevention and care programs to increase their impact on local HIV epidemics. A multilevel evaluation using multiple data sources, spanning multiple years (2008-2015), will be conducted to assess the effect of ECHPP on client outcomes (e.g., HIV risk behaviors) and impact indicators (e.g., new HIV diagnoses). METHODS: We designed an evaluation approach that includes a broad assessment of program planning and implementation, a detailed examination of HIV prevention and care activities across funding sources, and an analysis of environmental and contextual factors that may affect services. A data triangulation approach was incorporated to integrate findings across all indicators and data sources to determine the extent to which ECHPP contributed to trends in indicators. RESULTS: To date, data have been collected for 2008-2009 (pre-ECHPP implementation) and 2010-2013 (ECHPP period). Initial analysis of process data indicate the ECHPP grantees increased their provision of HIV testing, condom distribution, and partner services programs and expanded their delivery of prevention programs for people diagnosed with HIV. CONCLUSION: The ECHPP evaluation (2008-2015) will assess whether ECHPP programmatic activities in 12 areas with high AIDS prevalence contributed to changes in client outcomes, and whether these changes were associated with changes in longer-term, community-level impact.


Assuntos
Infecções por HIV/prevenção & controle , /organização & administração , Infecções por HIV/epidemiologia , Planejamento em Saúde/métodos , Humanos , Avaliação de Programas e Projetos de Saúde , Saúde Pública/métodos , Administração em Saúde Pública/métodos , Estados Unidos/epidemiologia
8.
Public Health Rep ; 131(1): 185-94, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26843685

RESUMO

OBJECTIVE: The Enhanced Comprehensive HIV Prevention Planning project was the first initiative of the Centers for Disease Control and Prevention (CDC) to address the goals of the National HIV/AIDS Strategy (NHAS). Health departments in 12 U.S. cities with a high prevalence of AIDS conducted comprehensive program planning and implemented cost-effective, scalable HIV prevention interventions that targeted high-risk populations. We examined trends in health department HIV prevention programs in these cities during the project. METHODS: We analyzed the number of people who received partner services, condoms distributed, and people tested for HIV, as well as funding allocations for selected HIV prevention programs by year and by site from October 2010 through September 2013. We assessed trends in the proportional change in services and allocations during the project period using generalized estimating equations. We also conducted thematic coding of program activities that targeted people living with HIV infection (PLWH). RESULTS: We found significant increases in funding allocations for HIV testing and condom distribution. All HIV partner services indicators, condom distribution, and HIV testing of African American and Hispanic/Latino populations significantly increased. HIV tests associated with a new diagnosis increased significantly among those self-identifying as Hispanic/Latino but significantly decreased among African Americans. For programs targeting PLWH, health department activities included implementing new program models, improving local data use, and building local capacity to enhance linkage to HIV medical care, retention in care, and treatment adherence. CONCLUSIONS: Overall, these findings indicate that health departments in areas with a high burden of AIDS successfully shifted their HIV prevention resources to scale up important HIV programs and make progress toward NHAS goals.


Assuntos
Infecções por HIV/prevenção & controle , Planejamento em Saúde/organização & administração , Administração em Saúde Pública , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Planejamento em Saúde/métodos , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Administração em Saúde Pública/métodos , Estados Unidos/epidemiologia
9.
Public Health Rep ; 129 Suppl 1: 33-42, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24385647

RESUMO

OBJECTIVES: We identified the level and type of program collaboration and service integration (PCSI) among HIV prevention programs in 59 CDC-funded health department jurisdictions. METHODS: Annual progress reports (APRs) completed by all 59 health departments funded by CDC for HIV prevention activities were reviewed for collaborative and integrated activities reported by HIV programs for calendar year 2009. We identified associations between PCSI activities and funding, AIDS diagnosis rate, and organizational integration. RESULTS: HIV programs collaborated with other health department programs through data-related activities, provider training, and providing funding for sexually transmitted disease (STD) activities in 24 (41%), 31 (53%), and 16 (27%) jurisdictions, respectively. Of the 59 jurisdictions, 57 (97%) reported integrated HIV and STD testing at the same venue, 39 (66%) reported integrated HIV and tuberculosis testing, and 26 (44%) reported integrated HIV and viral hepatitis testing. Forty-five (76%) jurisdictions reported providing integrated education/outreach activities for HIV and at least one other disease. Twenty-six (44%) jurisdictions reported integrated partner services among HIV and STD programs. Overall, the level of PCSI activities was not associated with HIV funding, AIDS diagnoses, or organizational integration. CONCLUSIONS: HIV programs in health departments collaborate primarily with STD programs. Key PCSI activities include integrated testing, integrated education/outreach, and training. Future assessments are needed to evaluate PCSI activities and to identify the level of collaboration and integration among prevention programs.


Assuntos
Infecções por HIV/prevenção & controle , Relações Interinstitucionais , Administração em Saúde Pública , /organização & administração , Serviços de Saúde Comunitária/organização & administração , Comportamento Cooperativo , Infecções por HIV/epidemiologia , Hepatite Viral Humana/prevenção & controle , Humanos , Governo Local , Administração em Saúde Pública/métodos , Doenças Sexualmente Transmissíveis/prevenção & controle , Tuberculose Pulmonar/prevenção & controle , Estados Unidos/epidemiologia
10.
Am J Public Health ; 98(6): 1043-50, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18445795

RESUMO

OBJECTIVES: We assessed the efficacy of an HIV behavioral intervention adapted for Black men who have sex with men (MSM). METHODS: We conducted serial cross-sectional surveys, 1 baseline measurement followed by initiation of an intervention and 3 follow-up measurements, among Black MSM in 3 North Carolina cities over 1 year. RESULTS: We observed significant decreases in unprotected receptive anal intercourse at 4 months (by 23.8%, n=287) and 8 months (by 24.7%, n=299), and in unprotected insertive anal intercourse (by 35.2%), unprotected receptive anal intercourse (by 44.1%), and any unprotected anal intercourse (by 31.8%) at 12 months (n=268). Additionally, at 12 months, the mean number of partners for unprotected receptive anal intercourse decreased by 40.5%. The mean number of episodes decreased by 53.0% for unprotected insertive anal intercourse, and by 56.8% for unprotected receptive anal intercourse. The percentage of respondents reporting always using condoms for insertive and receptive anal intercourse increased by 23.0% and 30.3%, respectively. CONCLUSIONS: Adapting previously proven interventions designed for other MSM can significantly reduce HIV risk behaviors of Black MSM.


Assuntos
Grupo com Ancestrais do Continente Africano , Bissexualidade , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Comportamento Sexual , Adolescente , Adulto , Estudos Transversais , Comportamentos Relacionados com a Saúde , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , North Carolina , Comportamento de Redução do Risco , Inquéritos e Questionários
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