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Enhancing Access for Women of Color Initiative

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The Special Projects of National Significance Enhancing Access to and Retention in Quality HIV/AIDS Care for Women of Color Initiative is 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 funds ten demonstration sites for up to 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 ancillary services. Interventions include community-based outreach, patient education, intensive case management and patient navigation strategies that promote access to care. The Albert Einstein College of Medicine, the Women of Color Evaluation Center (WOCEC) for this initiative, is coordinating  the multi-site evaluation and provide programmatic technical assistance to the demonstration sites. The study evaluation design will assess 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 are funded from 2009-2014.

Center for Human Services, Bethesda, MD

The Center for Human Services (CHS), together with its primary partner organizations, Community Health Care, Inc. (CHCI), Community United for Rehabilitation of the Addicted, Inc.(CURA), the Migrant Clinicians Network (MCN), and a solid team of local collaborating organizations, will work to improve access to and retention in quality HIV care for women of color by establishing: (1) a referral network, (2) linguistically and culturally appropriate case management system; and (3) interpreter services for those with limited English proficiency; and (4) a behavior modification intervention. CHS will target Latinas and migrant women living with HIV, who reside in Cumberland County, New Jersey, and surrounding areas.


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

Project I- ACT for Women of Color proposes 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 1) identify and remove all barriers along the continuum of care for women of color and 2) surround these women with a comprehensive and coordinated core of services. Proposed activities include 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. Activities will take place at the agency office, the mobile unit and home of clients. Collaborating entities include The Village, University of Miami / Jackson Memorial Medical, and Project Dress to Success. Care Resource will target women of color in all of Miami-Dade County, particularly Liberty City, Homestead, Little Haiti and Little Havana.


Health Services Center, Inc., Anniston, AL 

In the proposed project, HSC will expand and tailor 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 will expand 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 will tailor the expanded strengths-based model to the unique needs of rural women of color living with HIV. This rural demonstration project will serve women of color, primarily African-Americans, in a 14-county, largely rural area of Northeast Alabama.


JWCH Institute, Inc., Los Angeles, CA 

JWCH proposes to address 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 will be linked to HIV care and ancillary services through the work of promotoras, community health outreach workers and peer health educators, who will come from the target community. JWCH will further expand resources and bridge 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 include 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 will target 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 will use 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 include 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 will promote access and continuity of care for Latina women by using dually-teamed intensive case managers and peer Promotores who work in tandem. The model emphasizes five elements: early detection and case finding, effective treatment (including clinical trials), education, prevention, and continuity of care. The project will enhance 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 will deliver 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 provide primary care to HIV+ Latina women in Springfield. The project will also increase 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. An additional focus of the project will be to serve those 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 will provide referral to and facilitate connection with primary medical care; provide intensive case management, referral and information services, family and community HIV/AIDS awareness and education; and HIV/AIDS health care education to minority women infected with HIV. The education sessions will include clients, their families, and their communities. Information on the need for consistent health care for minority women with HIV/AIDS, the services available, referral sources and the reduction of stigma and fear in families and communities will be provided. Through intensive case management services to the clients and their families, the project will retain or re-connect the clients in health care services, monitor and track service delivery and collect appropriate data. The target population for this project is HIV-infected women of color who need to access quality HIV care and who are most likely not to follow through with care or to might drop out of care residing in 23 rural counties and small towns in Northeast Texas.


 The Core Foundation, Chicago, IL 

The HIV System Navigation Program includes two components designed to address individual-level barriers to care and to facilitate access to care for women of color with HIV. First, the patient navigator model, a demonstrated successful intervention with breast cancer patients will be replicated. Second, a five session, small group skills building/educational intervention Healthy Relationships (DEBI) will be offered to women enrolled in care at the CORE Center. These two interventions are designed 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 is 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 is a culturally competent, linguistically accessible, peer-driven demonstration project of SUNY Downstate Medical Center. POWER will 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 will work 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 will be added to maximize outreach effectiveness. Peer-based case management will be added at 2 Network sites where peer outreach is already in place, or where critical case management is needed. The peer outreach workers will work closely with Network case managers to guide newly diagnosed WOC through the linkage process at Network sites, provide mentorship to WOC transitioning from adolescent to adult care, facilitate support groups at selected Network sites, and 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 will lead to 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 is predominantly black women (including African, African-American and Afro-Caribbean) and Latinas, with or without children, who are 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 will implement and evaluate a program of primary HIV nursing care that uses formal assessments; adds new services to promote medical care engagement and health literacy; continues existing services for social support, psychiatric and addiction services on site; and uses a nurse to act as a guide to care. The program is a primary nurse-delivered HIV care program that enrolls women entering or re-entering care, assesses needs and provides outpatient primary nursing care services. Based on a model of racial health disparities, the program model includes self-determination theory and healing communication principles. Its three main interventions are linking services (providing rapid intake, needs assessments, improved access to appointments, enhanced communications skills); primary nursing care from a nurse guide to care (providing cell phones, care coordination, regular contacts, strengths perspective counseling, 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 are 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 is an evidence-based intervention targeting women of color (WOC) and 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) will collaborate with the Family Focused AIDS Clinical Treatment and Services Clinic (FFACTS), Alamo Area Resource Center (AARC), and Mujeres Unidas Contra El SIDA. Utilizing a team of patient navigators, peer educators, and outreach workers, participants will be 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 psycho-social needs. The FFACTS Clinic is the primary clinical facility in Bexar County that provides medical and psychiatric services for impoverished persons with HIV/AIDS. Once identified, participants will be engaged in a monthly educational retreat facilitated by peer educators at Mujeres Unidas Contra El SIDA, a community-based HIV service provider. The retreat is designed to address the emotional, social, mental and spiritual needs of women, in addition to fostering the communication between participants and the medical providers through group activities and discussion with other participants, peers, and FFACTS medical staff. Women’s HEART will serve women of color in the San Antonio TGA.


 Albert Einstein College of Medicine, Bronx, NY

The Albert Einstein College of Medicine (AECOM) Evaluation and Technical Assistance Center (ETAC) will rely upon a broad base of multi-site research expertise from several AECOM departments including HIV research, clinical, Ryan White Program and policy expertise from Montefiore Medical Center and a clinically sophisticated IT system all melded into a single ETAC core. The ETAC recognizes the eleven demonstration programs all differ in their intervention methodologies, intervention target populations, and resources available for data collection and evaluation. The proposed multi-site evaluation methodology will combine a health promotion and planning framework, Intervention Mapping (IM), and a chronic disease evaluation framework RE-AIM. The IM framework will identify how each program conceptualized its intervention, the theoretical rationale and evidence base for the intervention, and its proposed measures. The RE-AIM framework will concentrate 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). Project results will be disseminated in the form of reports, publications, and presentations in national conferences, HRSA All Grantee Meetings, and other HIV and women’s health venues.


Journal Articles

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

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

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

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


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