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Lessons from the CDC/RTC
HIV Integration Project
Marianne Zotti, DrPH, MS, FAAN
Team Leader
Services Management, Research &
Translation Team
NCCDPHP/DRH/ASB
Content
History of the HIV Integration Project
Current Project Overview
Logic Model
Regional Training Center (RTC) Role
HIV Integration Toolkit
Monitoring & Evaluation
History
Since 1993 CDC & OPA have
collaborated re HIV prevention
1993-1996 Operations research
 1996-1999 Focus on counseling about
risks, Title X
 1999-2004 Client centered counseling,
Title X, non Title X, also focus on teen
pregnancy prevention and prenatal
smoking cessation
 2004-2009 HIV prevention integration

Current HIV Integration Project
Objective
 To increase the number of reproductive
health clinics/settings that integrate HIV
prevention services at an appropriate
level into routine care
Future supplement

To increase the number of reproductive health
clinics serving American Indian/Alaska
Natives that integrate HIV prevention services
at an appropriate level into routine care
Levels of HIV Prevention
HIV Prevention Education
HIV Prevention
Counseling
HIV Testing Services
Health Care for HIV +
Women
Strategies of the Project
Build clinic
capacities through
training & technical
assistance by
RTCs
Establishment &
use of model
clinics
Logic Model
CDC Role
RTC Role
Capacity Building Outcomes
Short-term & Intermediate Outcomes
Long-term Outcomes
RTC Role in Integration
1. Discuss desired
integration level
with clinic
7. Evaluate
training and
technical assistance
activities
6. Conduct
training and
technical assistance
HIV
Integration
Program
5. Develop training
and technical
assistance plan
2. Determine
current level of HIV
Services
3. Determine
clinic proficiency
at current level
4. Assess clinic
capacities
Essential Capacities
Management awareness
&
motivation to integrate
Staff awareness &
motivation
Clinical staff skills
Adequate referral
systems
Short-Term & Intermediate Goals
Increased number of clinics integrating
HIV counseling & testing
Increased proficiency in HIV counseling
Increased proficiency in HIV testing
Increased number of HIV tests at clinics
More referrals for HIV testing
Increased number of HIV+ individuals
served
Long-term Goals
Reduced risky sexual behavior
among people served in RH
clinic/settings
Increased number of HIV+ individuals
seeking & adhering to treatment
Reduced incidence of HIV among
people in the service area
Essential Capacities
Management awareness
&
motivation to integrate
Staff awareness &
motivation
Clinical staff skills
Adequate referral
systems
Management Awareness & Motivation
Established policies and procedures
for HIV prevention integration
Motivated management staff
Adequate resources for services
Established clinic flow procedures
Established commitment to quality
assurance
Staff Awareness & Motivation
HIV-related knowledge of most staff
Staff motivation to provide HIV
prevention services
Staff comfort in delivering HIV
prevention services
Clinical Staff Skills
Knowledge & skills for HIV prevention
education
Skills in client-centered HIV
prevention counseling
Skills in HIV testing (traditional and/or
rapid)
Adequate Referral Systems
Referral lists
continually
documented and
updated
Established
mechanisms to
monitor success
of referrals
HIV Integration Toolkit
RTC product
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




Definition of integration
Supporting literature
Description of levels of HIV prevention
Common barriers to integration
Description of needed capacities
Tools for assessment of levels & training needs
Examples of training tools
Technical assistance tools
Monitoring & evaluation
Experiences of different types of providers
Monitoring & Evaluation
Process monitoring (all clinics)





# of clinics served (Title X & non Title X)
Needs assessment for technical assistance
(TA) performed
# & type of training sessions & TA events
# & demographics of people trained
# of clinics with > 1 PFA
Monitoring & Evaluation (continued)
Outcome monitoring (clinics with Intensive
TA)




Short-term = Capacities
Intermediate
Other factors
Case studies
Capacity Building Outcomes (Levels 1-4)
How well the clinic protocols &
policies outline HIV requirements for
each level
Level of motivation, knowledge and
skills & comfort level of staff to deliver
HIV prevention activities for each
level
Monitoring & Evaluation (continued)
Outcome monitoring (clinics with Intensive
TA)

Intermediate outcomes
 # of clinics integrating counseling & testing
 Proficiency in HIV prevention counseling
 Proficiency in HIV testing
 # of HIV tests across clinics
 # of referrals for HIV testing across clinics
 # of HIV + women served
Other Factors
Training plan
OPA funding
Use of HIV integration champions

HIV Integration champions are staff members
who not only actively advocate but boldly lead
in integrating HIV prevention services into
routine care at reproductive health
clinics/settings.
Qualitative Case Studies
Potential topics



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
Special populations
State family planning
systems
Non Title X providers
Unique TA
methodologies
Unique clinics
Potential factors

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
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Critical capacities
Biggest barriers & how
they were overcome
Role of RTCs & other
partners
Success institutionally
or personality driven
Next steps for
sustainability
Needed additional
resources
Questions and Discussions