July 29th, 2010
$7.5 million to Battle HIV/AIDS in the United States
Earlier this month, President Barack Obama set out a new domestic AIDS policy, which asked cities, states, federal agencies, and the private sector to find ways to cut new infections by 25 percent; get more patients treated quickly and consistently; and reduce the disproportionate impact of HIV/AIDS on gay and bisexual men, African Americans, and Latinos. According to the Centers for Disease Control and Prevention (CDC), more than one million people in the United States are living with HIV, which causes AIDS, and there are approximately 56,000 new HIV infections every year. And, in many cases, HIV is a silent epidemic: at least 21 percent of those infected are unaware that they are already living with HIV.
With a National AIDS Strategy just released and the recent International AIDS Conference in Vienna, we thought this was a timely opportunity to share some of our preliminary results from the Pfizer Foundation’s ConnectHIV program, which concludes this year. In 2007, the program selected twenty community-based organizations to receive a total of $7.5 million in funding and additional program support over three years with the overarching goal of building capacity in states disproportionately impacted by HIV. This funding was designed to “complete” local service networks that aimed to both prevent and treat HIV but were missing a key service component.
We understood that prevention efforts need to serve both people with HIV and those most at risk and that focusing on the continuum of HIV prevention and care is critical in decreasing new infections and improving the quality of life of those who are HIV positive.
ConnectHIV partners were supported in four specific funding areas across the continuum of care:
(1) prevention for at-risk HIV-negative people,
(2) prevention for people living with HIV,
(3) linkage to care and treatment, and
(4) treatment adherence and delaying progression of the disease.
ConnectHIV grants supported innovative, evidence-based prevention initiatives that also often addressed other interconnected HIV/AIDS challenges, such as HIV-related stigma, substance abuse, and mental health issues.
To evaluate the effectiveness of our partners’ strategies and to learn from their successes and challenges, Pfizer partnered with the Academy for Educational Development and Johns Hopkins Bloomberg School of Public Health to provide technical assistance and implement a national evaluation. Overall, the national evaluation aimed to answer questions such as:
(1) What impact did ConnectHIV have on clients’ HIV-related knowledge, risk behaviors, and health outcomes?
(2) What grantee best practices may be contributing to the client progress made in the different organizations?
(3) What grantee factors (that is, intensity of the intervention, staff–client ratio, level of service integration, best practices used) may be accounting for the progress in client outcomes?
(4) What did it cost per client to deliver these services, and what was the relative cost-effectiveness of the interventions?
To date, approximately 3,300 people have participated in the ConnectHIV national evaluation, which aimed to collect data at baseline, immediately post-program, and at three to six months after the end of the program. While a controlled evaluation design was not used, preliminary analysis of clients with matched data points has shown statistically significant positive results related to most ConnectHIV measures.
1) Increased knowledge and skills, such as knowledge of HIV transmission/prevention and HIV disease management; skills for condom negotiation and condom use with a main and nonmain partners; knowledge of partners’ HIV status and skills to disclose HIV-positive status to partners; and
2) Improved treatment adherence and health, as indicated by reduced injection drug use; fewer pills missed in the past seven days; improved health indicators (increased CD4 [specialized cells that help protect the body from infection] and reduced viral load); and overall perceived quality of life.
Final follow-up data are being compiled, and final outcome analyses are expected in late 2010.
Beyond those participating in the national evaluation, ConnectHIV has touched more than 17,000 people since the program began in 2007, through innovative public awareness campaigns, personalized outreach to HIV-positive drug users and to the incarcerated, peer-led sessions on drug adherence for people who are HIV positive, and group sessions targeting HIV-positive women from communities of color.
A specific ConnectHIV anecdote is “Positive Results for Positive People” from the Family Center in New York City. The wisdom of their family-based approach was seen with a client named Rona (name changed), who is an African American mother of four. Rona has a series of interlocking and complex health issues, including diabetes and high blood pressure. When she enrolled in 2008, she was often forgetting to take her evening HIV medicines, and her lab results reflected poor CD4 and viral-load numbers. Over several months, the Family Center team worked with the family and a home health aide and devised a strategy to mobilize various social and family supports. The team programmed Rona’s cell phone to remind her when it was time to take her twice-daily doses, educated the older children to remind their mother of her evening dose, and worked with the health aide to support Rona in taking her meds. Today, Rona’s lab tests show that she is living well with HIV.
Although the analysis of the ConnectHIV data is still ongoing and the final report is planned for early fall 2010, we feel we have learned these overarching lessons:
(1) It is difficult to find and to develop comprehensive and successful continuums of HIV/AIDS services—the lack of coordination among many AIDS service organizations and other related groups, such as those providing substance abuse prevention services and mental health care, is often a challenge. Better coordination of referrals between organizations supporting HIV clients is needed.
(2) Especially for high-risk populations, it is important to consider creative recruitment and retention strategies, such as offering incentives for participation, providing child care, identifying multiple ways to contact clients, and ensuring that caring, culturally competent staff are employed by the grantees.
(3) Beyond program grants, grantees appreciated the Pfizer Foundation’s emphasis on technical assistance and its additional support for program content, evaluation, organizational and staff development, and networking.
As a result of ConnectHIV, the Pfizer Foundation firmly believes that to decrease new infections, prevention and care efforts need to target both people who have HIV and those at high risk of contracting the virus. ConnectHIV attempted to address prevention, care, and health disparities in a way that is consistent with the National AIDS Strategy just released. Indeed, ConnectHIV was developed several years before the strategy was released, and we hope that some of the lessons learned from ConnectHIV can inform the implementation phase of the national strategy, which is now urgently under way.
This is just a sneak peek at the findings. The Pfizer Foundation and its evaluation team at the Academy for Educational Development and Johns Hopkins University are finalizing the ConnectHIV lessons and intend to share them this fall with our grantees, as well as other HIV/AIDS stakeholders.
We hope our ConnectHIV findings can help HIV/AIDS-focused organizations, as well as local policymakers, to understand that it is possible to round out local service delivery networks with the strategic use of resources from both the public and private sectors. We believe that our evaluations to date give an early validation of program effectiveness, and that, especially through our economic evaluation of the ConnectHIV grantees’ work, we will learn the per-client cost of the ConnectHIV services, so that local questions about affordability or the overall cost savings to local health care systems can be better understood.
We will post our findings on our Web site. In addition, we are compiling all of the resources gathered from the initiative onto a CD for distribution this fall; if you are interested in a copy, please email us at Pfizer.Foundation@pfizer.com.
Please note that the Pfizer Foundation does not accept unsolicited grant proposals.
On behalf of the Pfizer Foundation, we greatly appreciate the support from our ConnectHIV team—David Holtgrave from Johns Hopkins University, Susan Rogers from the Academy for Educational Development, and Sally Munemitsu from TCC Group—for their helpful comments and insights for this post.