181743 Assessing fidelity and exposure to physician-driven HIV prevention interventions: Lessons learned in an East Los Angeles HIV clinic

Monday, October 27, 2008

Ellen Iverson, MPH , Community Health Outcomes and Intervention Research Program, Childrens Hospital Los Angeles, Los Angeles, CA
Gary P. Garcia, MPH , Los Angeles County Department of Public Health, Office of AIDS Programs and Policy, Los Angeles, CA
Darshi Balasuriya, MPH , Community Health Outcomes and Intervention Research Program, Childrens Hospital Los Angeles, Los Angeles, CA
Jan B. King, MD, MPH , Los Angeles County Department of Public Health, Office of AIDS Programs and Policy, Los Angeles, CA
ISSUES: Provider HIV prevention models targeting seropositive patients are attracting increasing interest and funding. Assessing fidelity and exposure to HIV interventions with physicians as interventionists presents unique challenges. Physician-patient communication occurs in private, constraining objective assessment of whether and how they deliver the intervention. Uncertainty about how or if an intervention is delivered can compromise outcome interpretation.

DESCRIPTION: This presentation highlights challenges assessing exposure/ fidelity to Partnership for Health (PfH), a CDC evidence-based HIV prevention model (DEBI) delivered by physicians with seropositive patients during routine clinic visits. We focus on experiences implementing PfH in a Los Angeles HIV clinic.

LESSONS LEARNED: We present challenges of collecting valid fidelity/exposure data using "prevention prescription” scripts, chart abstraction, exit interviews and provider qualitative interviews. In spite of the model's promise, our experience underscores potential barriers to fidelity in the context of busy clinical practices. Understaffing, high patient volume, competing patient issues and the need to re-define providers' role can strain implementation. Chart data revealed 30% of monthly patient visits included prevention discussions. An unanticipated finding revealed prevention messages increased 250% following the launch of an electronic medical record (EMR) system prompting providers to discuss prevention.

RECOMMENDATIONS: An EMR proved to be effective for provider reinforcement. Additionally, fidelity/exposure may have improved if, the evaluation team had a daily presence to support intervention delivery; the implementation protocol included strategies for quality assurance and monitoring; and planning the intervention included clinic staff and provider input to ensure strategies were integrated into existing clinic routines and culture.

Learning Objectives:
LEARNING OBJECTIVES: Participants will be able to understand the unique challenges of evaluating efficacy of HIV prevention interventions delivered in the context of primary care settings. Specifically they will be able to identify proactive strategies to maximize buy-in of participating providers and compliance with implementing intervention protocols; identify structural and educational strategies to provide intervention reinforcement and support; and identify strategies and tools to track quality assurance, fidelity and intervention exposure.

Keywords: HIV Interventions, Evaluation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting public health research for over 25 years. I am currently on faculty at the Keck School of Medicine, Department of Pediatrics at the University of Southern California
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Providing Comprehensive HIV Prevention and Care Programs
See more of: HIV/AIDS