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H H S Department of Health and Human Services
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SPNS Initiative: Targeted HIV Outreach & Intervention Models for Underserved HIV-positive Populations Not in Care, 2001-2006


Identifying effective models of outreach to underserved people living with HIV (PLWH) who are not receiving care is a critical concern in responding to the changing HIV epidemic.  While HIV treatment advances have slowed death rates and HIV transmission, there are vulnerable and marginalized groups who are not benefiting from these advances as much as other populations. Creative and intensive outreach efforts can assure timely and continued treatment for people facing persistent barriers to access of care, and new, innovative outreach strategies are being developed to engage and retain underserved PLWH in care. These include street outreach, mobile vans, community outreach workers, peer educators, promotores, and patient navigators.

The Outreach Initiative was a two-phase, five-year program supporting multi-year demonstration projects to implement, refine, and evaluate innovative outreach strategies for bringing PLWH into HIV primary care. In September 2001, 17 individual projects were funded for Phase 1 (project years 1-2). During this phase, the projects implemented their outreach and intervention programs, conducted a local evaluation of those strategies, and planned activities to enhance or modify their programs for Phase 2 (project years 3-5). Grant recipient planning activities included refining intervention models based on the findings of their local evaluation, adjusting their local evaluation plans as needed, and participating in a multi-site evaluation.

The Boston University School of Public Health served as the CORE Evaluation and Technical Assistance Center for the initiative.  Demonstration project grant recipients included Access Community Health Project (Chicago, IL); Health Services Center (Anniston, AL); Blacks Assisting Blacks Against AIDS (St. Louis, MO); Care Resource (Coral Gables, FL); Charles R. Drew University School of Medicine and Science (Los Angeles, CA); Fenway Community Health (Boston, MA); Harm Reduction Services (Sacramento, CA); The Miriam Hospital (Providence, RI); Montefiore Medical Center (Bronx, NY); Multnomah County Health Department (Portland, OR) University of California, Los Angeles Schools of Medicine & Public Health (Los Angeles, CA); University of Miami School of Medicine (Miami, FL); University of Texas Health Sciences Center (San Antonio, TX); University of Washington, Department of Psychiatry (Seattle, WA); Wayne State University (Detroit, MI); Well Being Institute (Detroit, MI); and Whitman-Walker Clinic (Washington, DC).

Journal Articles

Outlaw A, Naar-King S, Green-Jones M, Wright K, Condon K, Sherry L, & Janisse H. Brief Report: Predictors of Optimal HIV Appointment Adherence in Minority Youth: A Prospective Study. Journal of Pediatric Psychology, October 2010; 35 (9): 1011-1015. PubMed Abstract

Naar-King S, Outlaw A, Green-Jones M, Wright K, & Parsons JT. Motivational interviewing by peer outreach workers: a pilot randomized clinical trial to retain adolescents and young adults in HIV care. AIDS Care, July 2009; 21 (7): 868-873. PubMed Abstract

Rajabiun S, Rumptz MH, Felizzola J, Frye A, Relf M, Yu G, & Cunningham WE. The Impact of Acculturation on Latinos' Perceived Barriers to HIV Primary Care. Ethnicity & Disease, Autumn 2008; 18 (4): 403-408. PubMed Abstract

Drainoni ML, Rajabiun S, Rumptz M, Welles SL, Relf M, Rebholz C, Holmes L, Dyl A, Lovejoy T, Dekker D, & Frye A. Health literacy of HIV-infected individuals enrolled in an outreach intervention: Results of a cross-site analysis. Journal of Health Communication, April-May 2008; 13 (3): 287-302. PubMed Abstract

Sacajiu G, Fox A, Ramos M, Sohler N, Heller D, & Cunningham C. The evolution of HIV illness representation among marginally housed persons. AIDS Care, April 2007; 19 (4): 539-545. PubMed Abstract

Tobias C, Cunningham WE, Cunningham CO, & Pounds MB. Making the Connection: The Importance of Engagement and Retention in HIV Medical Care. AIDS Patient Care & STDs, 2007; (Supplement 1): S3-S8. PubMed Abstract

Rajabiun S, Cabral H, Tobias C, & Relf M. Program Design and Evaluation Strategies for the Special Projects of National Significance Outreach Initiative. AIDS Patient Care & STDs, 2007; (Supplement 1): S9-S19. PubMed Abstract

Rajabiun S, Mallinson RK, McCoy K, Coleman S, Drainoni ML, Rebholz C, & Holbert T. "Getting Me Back on Track": The Role of Outreach Interventions in Engaging and Retaining People Living with HIV/AIDS in Medical Care. AIDS Patient Care & STDs, 2007; (Supplement 1): S20-S29. PubMed Abstract

Rumptz MH, Tobias C, Rajabiun S, Bradford J, Cabral H, Young R, & Cunningham WE. Factors Associated with Engaging Socially Marginalized HIV-Positive Persons in Primary Care. AIDS Patient Care & STDs, 2007; (Supplement 1): S30-S39. PubMed Abstract

Naar-King S, Bradford J, Coleman S, Green-Jones M, Cabral H., & Tobias C. Retention in Care of Persons Newly Diagnosed with HIV: Outcomes of the Outreach Initiative. AIDS Patient Care & STDs, 2007; (Supplement 1): S40-S48. PubMed Abstract

Bradford J, Coleman S, & Cunningham W. HIV System Navigation: An Emerging Model To Improve HIV Care Access. AIDS Patient Care & STDs, 2007; (Supplement 1): S49-S58. PubMed Abstract

Cabral HJ, Tobias C, Rajabiun S, Sohler N, Cunningham C, Wong M, & Cunningham W. Outreach Program Contacts: Do They Increase the Likelihood of Engagement and Retention in HIV Primary Care for Hard-to-Reach Patients? AIDS Patient Care & STDs, 2007; (Supplement 1): S59-S67. PubMed Abstract

Sohler NL, Wong MD, Cunningham WE, Cabral H, Drainoni ML, Cunningham CO. Type and Pattern of Illicit Drug Use and Access to Health Care Services for HIV-Infected People. AIDS Patient Care & STDs, 2007; (Supplement 1): S68-S76. PubMed Abstract

Mallinson RK, Rajabiun S, & Coleman S. The Provider Role in Client Engagement in HIV Care. AIDS Patient Care & STDs, 2007; (Supplement 1): S77-S84.  PubMed Abstract

Bradford, J. The promise of Outreach for Engaging and Retaining Out of Care Persons in HIV Treatment. AIDS Patient Care & STDs, 2007; (Supplement 1): S85-S91. PubMed Abstract

Wong MD, Sarkisian CA, Davis C, Kinsler J, & Cunningham WE. The Association between Life Chaos, Health Care Use, and Health Status among HIV-infected Persons. Journal of General Internal Medicine, September 2007; 22 (9): 1286-1291. PubMed Abstract

Coleman S, Boehmer U, Kanaya F, Grasso C, Tan J, & Bradford J. Retention Challenges for a Community-Based HIV Primary Care Clinic and Implications for Intervention. AIDS Patient Care & STDs, September 2007; 21 (9): 691-701. PubMed Abstract

Kinsler JJ, Wong MD, Sayles JN, Davis C, & Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care & STDs, August 2007; 21, (8): 584-592. PubMed Abstract

Tobias C, Cunningham W, Cabral H, Cunningham CO, Eldred L, Naar-King S, Bradford J, Sohler NL, Wong MD, & Drainoni ML. Living with HIV But Without Medical Care: Barriers to Engagement. AIDS Patient Care & STDs, June 2007; 21 (6): 426-434. PubMed Abstract

Andersen M, Hockman E, Smereck G, Tinsley J, Milfort D, Wilcox R, Smith T, Connelly C, Adams L, & Thomas R. Retaining women in HIV medical care. Journal of the Association of Nurses in AIDS Care, May-June 2007; 18 (3): 33-41. PubMed Abstract

Cunningham CO, Sohler NL, Wong MD, Relf M, Cunningham W, Drainoni ML, Bradford J, Pounds MB, & Cabral HD. Utilization of Health Care Services in Hard-to-Reach Marginalized HIV-Infected Individuals. AIDS Patient Care & STDs, March 2007; 21, (3): 177-186. PubMed Abstract

Naar-King S, Green M, Wright K, Outlaw A, Wang B, & Liu H. Ancillary services and retention of youth in HIV care. AIDS Care, February 2007; 19 (2): 248-251. PubMed Abstract

Cunningham WE, Sohler NL, Tobias C, Drainoni ML, Bradford J, Davis C, Cabral HJ, Cunningham CO, Eldred L, & Wong MD. Health Services Utilization for People with HIV Infection - Comparison of a Population Targeted for Outreach with the US Population in Care. Medical Care, November 2006; 44 (11): 1038-1047. PubMed Abstract

Cunningham CO, Sohler NL, McCoy K, Heller D, & Selwyn PA. Health Care Access and Utilization Patterns in Unstably Housed HIV-Infected Individuals in New York City. AIDS Patient Care & STDs, October 2005; 19 (10): 690-695. PubMed Abstract

Mallinson RK, Relf MV, Dekker D, Dolan K, Darcy A, & Ford A. Maintaining Normalcy: A Grounded Theory of Engaging in HIV-oriented Primary Medical Care. Advances in Nursing Science, July-September 2005; 28(3): 265-277. PubMed Abstract