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Enhancing Access to and Retention in Quality HIV Care for Women of Color

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This SPNS initiative was a multi-site demonstration and evaluation of HIV service delivery interventions for women of color, a population at high risk to HIV/AIDS. The initiative funded ten demonstration sites for five years to design, implement and evaluate innovative methods for enhancing access to and retaining women of color living with HIV/AIDS in primary medical care and support services. Interventions included community-based outreach, patient education, intensive case management and patient navigation strategies that promote access to care. The Women of Color Evaluation Center (WOCEC) at Albert Einstein College of Medicine coordinated the multi-site evaluation and provided programmatic technical assistance to the demonstration sites. The study evaluation design assessed the effectiveness of the selected models in enhancing access to and retention in HIV/AIDS care for women of color.



Grants for this initiative were awarded to the organizations listed below, which link to abstracts that provide a brief description of each project. These grantees were funded from 2009-2014.

Center for Human Services,
Bridgeton, NJ

The Center for Human Services (CHS) worked with two partner organizations, the Community Health Care, Inc. (CHCI) Community United for Rehabilitation of the Addicted, Inc.(CURA) and the Migrant Clinicians Network (MCN). CHS' intervention focused on Latinas and migrant women living with HIV living in Cumberland County, New Jersey, and surrounding areas. Their intervention worked to improve access to and retention in quality HIV care for women of color by establishing a referral network; a linguistically and culturally appropriate case management system; interpreter services for those with limited English proficiency; and a behavior modification intervention.


Community AIDS Resource, Inc., (Care Resource)
Miami, FL

Project I- ACT for Women of Color sought to facilitate timely entry, access to and retention in quality HIV care for women of color by implementing the Assertive Community Treatment (ACT) intervention. This service delivery model relies on a multidisciplinary team approach to identify and remove all barriers along the continuum of care for women of color, and surround these women with a comprehensive and coordinated core of services. The intervention included testing to identify HIV infected women; continuous assessment of all women of color; development of a unique Service Plan for each client; and provision of multiple services. Intervention activities took place at the agency office, the mobile unit and homes of clients. Collaborating organizations included The Village, University of Miami & Jackson Memorial Medical Center, and Project Dress to Success. Care Resource targeted women of color in all of Miami-Dade County, particularly Liberty City, Homestead, Little Haiti and Little Havana.


Health Services Center, Inc.
Anniston, AL

HSC expanded and tailored an existing evidence-based model of HIV case management, Antiretroviral Treatment Access Study (ARTAS) Linkage Case Management (ALCM). This model was originally developed to provide a brief (5 or more sessions) case management intervention to link persons newly diagnosed with HIV to medical care within three months of initial diagnosis. HSC expanded this model to provide more intensive services that are not time or session-limited to link, engage, and retain women of color in HIV care. The model follows a strengths-based approach focused on addressing immediate needs and building personal skills for increased self-direction and long-term empowerment to meet life challenges. HSC also tailored the expanded strengths-based model to the unique needs of rural women of color living with HIV. This rural demonstration project served women of color, primarily African-Americans, in a 14-county, largely rural area of Northeast Alabama.


JWCH Institute, Inc.
Los Angeles, CA

JWCH's intervention addressed multi-level barriers to HIV care for women of color by combining innovative strategies including community-based outreach; comprehensive individual needs assessment; coordination and integration of community and medical services; and linkages to needed services. Women of color were linked to HIV care and ancillary services through the work of promotoras, community health outreach workers and peer health educators, who were drawn from the target community. JWCH further expanded resources and bridged local service gaps through a network of care model, engaging providers of a referral network of 45 community-based medical and service providers. Collaborating agencies included the County of Los Angeles, Weingart Center Association, Downtown Women’s Center, Skid Row Housing Trust, Safe Harbor Women’s Clinic and others from the area. The project targeted homeless African-American and Latina women of age 18 and above living with HIV/AIDS in area Los Angeles’s Skid Row Area.


New North Citizens Council, Inc.
Springfield, MA

This project used a network of care model that increases access and retention in HIV care for Latina women in Springfield, Massachusetts. The project’s partners in the network included a community-based, nonprofit HIV clinical research organization; an academic medical center with three community health centers; a culturally competent behavioral health care provider; and the region's largest provider of domestic violence services to women. The project promoted access and continuity of care for Latina women by using dually-teamed intensive case managers and peer Promotores who worked in tandem. The model emphasized five elements: early detection and case finding, effective treatment (including clinical trials), education, prevention, and continuity of care. The project enhanced current linkages in primary care and social support services by adding intensive case managers and peer Promotores teams to link women to care and supporting them while in care. These teams delivered home-based outreach and on-site continuity care through follow-up support services at the community health centers and the HIV clinical research site that provided primary care to HIV+ Latina women in Springfield. The project also increased the capacity of the collaborating health centers and clinical research site to provide medication-assisted treatment for opioid addiction within the HIV primary care and support service network. The project also served HIV-infected individuals with co-occurring disorders, posttraumatic stress disorder, and HIV-infected women recently released from jails.


Special Health Resources for Texas, Inc.
Longview, TX

This project facilitated connection with primary medical care for minority women living with HIV in 23 rural counties and small towns in Northeast Texas. The project included intensive case management, referral and information services, family and community HIV/AIDS awareness and education, and HIV/AIDS health care education. The education sessions included clients, their families, and their communities. The project also provided information on the need for consistent health care for minority women with HIV/AIDS, the services available, and referral sources, and sought to reduce HIV stigma and fear in families and communities. Through intensive case management services to the clients and their families, the project retained and re-engaged clients in health care services, and monitored and tracked service delivery by collecting relevant data. The project focused on HIV-infected women of color who needed access to HIV care and were either most likely not to follow through with care or to might drop out of care.


The Core Foundation, 
Chicago, IL

The HIV System Navigation Program included two components designed to address individual-level barriers to care and to facilitate access to care for women of color with HIV. First, the intervention replicated the patient navigator model, a demonstrated successful intervention with breast cancer patients. Second, a five session, small group skills building/educational intervention Healthy Relationships (DEBI) was offered to women enrolled in care at the CORE Center. These two interventions were implemented to dispel myths, increase knowledge and improve individual attitudes toward HIV and to assist women of color with HIV in accessing care services. The target population was women of color in Cook County who are newly diagnosed with HIV, lost to care, in sporadic care, and/or lost to follow-up.


The Research Foundation of State University of New York
Brooklyn, NY

The Peer Outreach Worker Entry and Retention (POWER) Program was a culturally competent, linguistically accessible, peer-driven demonstration project of SUNY Downstate Medical Center. POWER sought to ensure timely entry into care for newly diagnosed women of color, increase retention rates of those already receiving care, and re-link to care those lost to follow-up. The program was implemented through the FACES Network of nine programs, all providing multidisciplinary services to assist children, adolescents, and their families with or at risk for HIV infection in accessing comprehensive, coordinated, community-based HIV care by developing family-centered systems of care. At three network sites (the HEAT Program at SUNY-DMC; the PATH Center at Brooklyn Hospital Center; and Interfaith Medical Center) peer outreach workers representative of the target populations were added to maximize outreach effectiveness. Peer-based case management was added at 2 Network sites where peer outreach is already in place and where critical case management was needed. The peer outreach workers worked closely with Network case managers to guide newly diagnosed WOC through the linkage process at Network sites; to provide mentorship to WOC transitioning from adolescent to adult care; to facilitate support groups at selected Network sites; and to seek out and re-engage into care HIV+ women in the community who have been lost to follow-up. Peer-based outreach and case management interventions strove to improve timely enrollment in care following HIV diagnosis for WOC, retention of clients in care, and re-linkage into care of clients who have fallen out of care. The target population was predominantly black women (including African, African-American and Afro-Caribbean) and Latinas, with or without children, who were living with HIV in the Brooklyn NY area.



University of North Carolina at Chapel Hill
Chapel Hill, NC

The Guide to Healing: Enhancing Access for HIV+ Women in the Rural South Program implemented and evaluated a program of primary HIV nursing care that included formal assessments; addition of new services to promote medical care engagement and health literacy; continuation of existing services for social support; psychiatric and addiction services on site; and a Nurse Guide to work with clients in navigating their care. The program was a primary nurse-delivered HIV care program that enrolled women entering or re-entering care, assessed their needs and provided outpatient primary nursing care services. Based on a model of racial health disparities, the program model included self-determination theory and healing communication principles. Its three main interventions were linking services (providing rapid intake, needs assessments, improved access to appointments, and enhanced communications skills); primary nursing care from a Nurse Guide to care (providing cell phones, care coordination, regular contacts, strengths perspective counseling, and multidisciplinary team care); and a group co-led by nurse and peer counselor (providing support, life and coping skills building and HIV education). The target population was HIV positive African American women entering, re-entering or falling out of care in a university clinic.


University of Texas Health Science Center at San Antonio
San Antonio, TX

Women’s HEART (HIV Entry, Access, and Retention in Treatment) project was an evidence-based intervention targeting women of color (WOC) designed to provide innovative strategies to overcome barriers across the spectrum of engagement and retention in care. The University of Texas Health Science Center San Antonio, Dept. of Pediatrics, Division of Community Pediatrics (CP) collaborated with the Family Focused AIDS Clinical Treatment and Services Clinic (FFACTS) and Alamo Area Resource Center (AARC). Utilizing a team of patient navigators, peer educators, and outreach workers, participants were recruited from FFACTS medical case management referral and navigated through the HIV system of care based on the completion of a comprehensive acuity scale assessing both medical and psychosocial needs. The FFACTS Clinic is the primary clinical facility in Bexar County that provides medical and psychiatric services for impoverished persons with HIV/AIDS. The target population for Women’s HEART was women of color in the San Antonio Transitional Grant Area (TGA).


Albert Einstein College of Medicine
Bronx, NY

The Albert Einstein College of Medicine (AECOM) served as the Women of Color Evaluation Center (WOCEC) for the initiative, coordinating the multi-site evaluation and providing technical assistance to the demonstration sites. WOCEC drew upon a broad base of multi-site research expertise in HIV research, clinical research, Ryan White HIV/AIDS Program and policy expertise from AECOM and Montefiore Medical Center. Its multi-site evaluation methodology combined a health promotion and planning framework, Intervention Mapping (IM), and a chronic disease evaluation framework, RE-AIM. Intervention Mapping helped to identify how each program conceptualized its intervention, its theoretical rationale and evidence base for the intervention, and its proposed measures. The RE-AIM framework focused on both internal and external validity, using site differences to look at the trade-offs between measures of Reach, Effectiveness, Adaptability, Implementation and Maintenance (sustainability).


Journal Articles

Oliphant E, Young N, Amodei N, Villela-Perez V, Mammah R, German VF & Meissner P. The Use of Survival Stories to Empower HIV + Women of Color. International Journal of Business, Humanities and Technology, June 2015; 5 (3): 13-19.  Fulltext Access

Lounsbury DW, Schwartz B, Palma A, & Blank AE.  Simulating Patterns of Patient Engagement, Treatment Adherence, and Viral Suppression: A System Dynamics Approach to Evaluating HIV Care Management. AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S55-S63. PubMed Abstract

Sullivan KA, Schultz K, Ramaiya M, Berger M, Parnell H, & Quinlivan EB.  Experiences of Women of Color with a Nurse Patient Navigation Program for Linkage and Engagement in HIV Care.AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S49-S54.  PubMed Abstract

Sullivan KA, Messer LC, & Quinlivan EB. Substance Abuse, Violence and AIDS (SAVA) Syndemic Effects on Viral Suppression among HIV Positive Women of Color. AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S42-S48. PubMed Abstract

Espino SR, Fletcher J, Gonzalez M, Precht A, Xavier J, & Matoff-Stepp S. Violence Screening and Viral Load Suppression among HIV Positive Women of Color. AIDS Patient Care and STDs, January 2015; 29 (Supplement 1): S36-S41.  PubMed Abstract

Blank AE, Fletcher J, Verdecias N, Garcia I, Blackstock O, & Cunningham C.  Factors associated with retention and viral suppression among a cohort of HIV+ women of color. AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S27-S35.  PubMed Abstract

Blackstock O, Blank AE, Fletcher J, Verdecias N, & Cunningham C.  Considering care-seeking behaviors reveals important differences among HIV-positive women not engaged in care: implications for intervention. AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S20-S26.  PubMed Abstract

Quinlivan EB, Fletcher J, Eastwood EA, Blank AE, Verdecias N, & Roytburd K.  Health status of HIV-infected women entering care: Baseline Medical Findings from the Women of Color Initiative. AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S11-S19.  PubMed Abstract

Eastwood EA, Fletcher J, Quinlivan EB, Verdecias N, Birnbaum JM, & Blank AE. Baseline Social Characteristics and Barriers to Care from Special Projects of National Significance Women of Color with HIV Study: A Comparison of Urban and Rural Women and Barriers to HIV Care. AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S4-S10. PubMed Abstract

Xavier J and Cajina A. The Special Projects of National Significance Women of Color Initiative.  AIDS Patient Care and STDs, January 2015;  29 (Supplement 1): S1-S3.  No Abstract Available.

Precht AM, Espino SR, Perez VV, Ingram MV, Amodei N, Miller A & Gonzalez M.  Healthy Relationships: The Adoption, Adaptation, and Implementation of a DEBI Within Two Clinical Settings. Health Promotion Practice [E-published online September 25, 2014]  PubMed Abstract

Palma A, Lounsbury DW, Messer L, & Quinlivan EB.  Patterns of HIV Service Use and HIV Viral Suppression Among Patients Treated in an Academic Infectious Diseases Clinic in North Carolina. AIDS and Behavior, [E-published online September 21, 2014]  PubMed Abstract

Toth M, Messer LC, & Quinlivan EB.  Barriers to HIV Care for Women of Color Living in the Southeastern US Are Associated with Physical Symptoms, Social Environment, and Self-Determination. AIDS Patient Care and STDs, November 2013; 27(11): 613-620.  PubMed Abstract

Quinlivan EB, Messer LC, Adimora AA, Roytburd K, Bowditch N, Parnell H, Seay J, Bell L, & Pierce JK. Experiences with HIV Testing, Entry, and Engagement in Care by HIV-Infected Women of Color, and the Need for Autonomy, Competency, and Relatedness. AIDS Patient Care and STDs, July, 2013; 27 (7): 408-15. PubMed Abstract

Messer LC, Quinlivan EB, Parnell H, Roytburd K, Adimora AA, Bowditch N, & Desousa N. Barriers and Facilitators to Testing, Treatment Entry, and Engagement in Care by HIV-Positive Women of Color. AIDS Patient Care and STDs, July, 2013; 27 (7): 398-407. PubMed Abstract

Blank AE, Espino SL, Eastwood B, Matoff-Stepp S, & Xavier J. The HIV/AIDS Women of Color Initiative Improving Access to and Quality of Care for Women of Color. Journal of Health Care for the Poor and Underserved, February 2013; 24 (1): 15-26. PubMed Abstract


Part F - SPNS Resources

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The SPNS program began with some of the first Federal grants to target adolescents and women living with HIV, and over the years, initiatives have been developed to reflect the evolution of the epidemic and the health care arena.

Part F - SPNS Products and Publications

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