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The Health Resources and Services Administration Special Projects of National Significance launched the Systems Linkage and Access to Care for Populations at High Risk of HIV Infection Initiative in 2011. Six state departments of health were funded to utilize a modified Learning Collaborative model to develop and/or adapt HIV testing, linkage to care and retention in care system-level interventions. More than 60 Learning Sessions were held over the course of the Learning Collaborative. A total of 22 unique interventions were tested with 18 interventions selected and scaled up. All interventions were created to impact services at a systems level, with standardized protocols developed to ensure fidelity. Our findings provide key lessons and present considerations for replication for use of a modified Learning Collaborative to achieve state-level systems change.

Ensuring continuity of and retention in care after release from prison is critical for optimizing health outcomes among people living with HIV. As part of a large federal initiative, we conducted qualitative interviews (n = 24) with individuals living with HIV and recently released from prison in four states to understand their experiences in different navigation interventions to improve access to HIV care post-release. Interventions were delivered only in prison, only in the community, or in both settings. While the interventions varied by design, overall, participants appreciated the breadth of support received from interventionists, including health system navigation, case management and social support. Even when individuals leaving prison were returning to clinics that they were familiar with, systems navigation supported continuity of care. Our findings elucidate why navigational support was instrumental, and underscore the value of a variety of types of navigation programs in facilitating continuity of care and reintegration post-prison.

Gang members are exposed to unique sexual risks, yet little work has explored the influence of gang social norms. This study examines the functions and meanings of sex within gangs, with a specific focus on the ways in which sex is used to reinforce gang membership and norms, gender roles, and group cohesion. We conducted 58 semi-structured interviews with adolescent members of six gangs. Data were analyzed using thematic content analysis and constant comparative method in MAXQDA. Sexual risk behaviors within gangs are upheld and reinforced through unspoken norms and expectations. These high-risk sexual practices increase group cohesion and reinforce gender norms and power differences. Despite the prevalence of such practices, many gang members felt regret and remorse over their participation but noted it was just part of "the life." Our findings highlight the need for interventions to address the norms of the gang that reinforce sexual risk behavior.

Evaluation has become expected within the nonprofit sector, including HIV prevention service delivery through community-based organizations (CBOs). While staff and directors at CBOs may acknowledge the potential contribution of evaluation data to the improvement of agency services, the results of evaluation are often used to demonstrate fiscal prudence, efficiency, and accountability to funders and the public, rather than to produce information for the organization's benefit. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing the same evidence-based HIV prevention intervention. We use the lens of "audit culture" to understand how the evaluation and accountability mandates of evidence-based program implementation within HIV prevention service provision affect provider-client relations, staff members' daily work, and organizational focus in natural settings, or contexts without continuous support and implementation monitoring. We conclude with recommendations for improving the use and methods of evaluation within HIV prevention service delivery.

Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ("Sisters Informing Sisters on Topics about acquired immune deficiency syndrome"), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training.

Criminally involved adolescents engage in high levels of risky sexual behavior and alcohol use, and alcohol use may contribute to lack of condom use. Detained adolescents (n = 484) were randomized to (1) a theory-based sexual risk reduction intervention (GPI), (2) the GPI condition with a group-based alcohol risk reduction motivational enhancement therapy component (GPI + GMET), or (3) an information-only control (INFO). All interventions were presented in same-sex groups in single sessions lasting from 2 to 4 hr. Changes to putative theoretical mediators (attitudes, perceived norms, self-efficacy, and intentions) were measured immediately following intervention administration. The primary outcomes were risky sexual behavior and sexual behavior while drinking measured 3 months later (65.1% retention). The GPI + GMET intervention demonstrated superiority over both other conditions in influencing theoretical mediators and over the INFO control in reducing risky sexual behavior. Self-efficacy and intentions were significant mediators between condition and later risky sexual behavior. This study contributes to an understanding of harm reduction among high-risk adolescents and has implications for understanding circumstances in which the inclusion of GMET components may be effective. (Contains 2 figures, 2 tables and 4 footnotes.)

Human immunodeficiency virus (HIV) continues to disproportionately affect gay, bisexual, and other men who have sex with men (GBM) and transgender and nonbinary (trans/NB) individuals. This study investigated attitudes toward participation in HIV survey research, guided by Emanuel's framework for ethical clinical research (e.g., risk–benefit ratio, fair participant selection, respect for participants, social value, and collaborative partnership). GBM (n = 294) and trans/NB (n = 86) persons recruited at a Pride event in Milwaukee completed a survey assessing risks and benefits of participation in, and comfort responding to, sexual health surveys. Participants reported few ethical concerns (e.g., privacy and confidentiality), with notable differences by race, sexual orientation and gender identity, and prior research experiences. Implications for HIV research with GBM and trans/NB individuals are discussed. [ABSTRACT FROM AUTHOR]

Patient-centered medical homes (PCMH) are a key component in addressing the comprehensive physical and psychosocial needs of persons living with HIV. The AIDS Resource Center of Wisconsin (ARCW) is a PCMH that has become a nationally recognized leader in addressing barriers to HIV retention in care. Recently, ARCW has become interested in the use of short message services (SMS), as SMS have been found to have positive impacts on treatment adherence, CD4+ counts, viral load, and appointment attendance. The purpose of this research was to evaluate patient acceptability of receiving SMS from an HIV specific PCMH, in addition to evaluating patient privacy concerns and practical details of incorporating SMS into clinical care. These constructs were evaluated through a survey of 180 ARCW patients recruited from several ARCW waiting rooms. Patients were most interested in receiving SMS from medical, dental, and pharmacy services and message content regarding appointment and medication refill reminders. Participants did not indicate the presence of significant privacy concerns and were divided nearly in half over whether ARCW should refer to itself as "ARCW" or "Your medical/dental clinic." Prior to implementation of SMS at ARCW, further evaluation into the optimization of language into concise and easy to understand messages that maximize confidentiality and minimize patient anxiety is needed. [ABSTRACT FROM AUTHOR]

Background: Adolescent gang members are a source of concern due to their involvement in criminal activity, violence, substance use, and high-risk sexual behaviors. Adolescent gang theories hypothesize that social institutions, including the family and school, fail to meet the needs of adolescents who therefore feel less attachment to these institutions and find an unconventional institution (i.e. the gang) to meet these needs through the gang. Objectives: In this paper, we will examine the extent to which social disorganization and social control theories, in particular the rejection of conventional norms and aspirations, match adolescents' subjective reasons for their decisions and their future aspirations. Methods: Between 2012 and 2013, we conducted in-depth interviews with 58 gang members between the ages of 14 to 19. Interviews were coded for key themes using the constant comparison method. Results: Social disorganization and social control theories have both value and limitations in explaining reasons why adolescents join gangs and engage in criminal behaviors. Participants saw many of their aspirations blocked by negative school experiences and limited economic opportunities. Gangs provided a social organization in which to sell drugs. However, gang members did not reject conventional norms and aspirations. Rather, they view themselves as making decisions to survive in the present while recognizing that these strategies will not continue to work in the future. Conclusions: Gang members value education and aspire to obtain legal employment. Thus, interventions to help adolescent gang members with the immediate financial pressures that lead them to sell drugs may be particularly effective. [ABSTRACT FROM AUTHOR]

Interventions to decrease acquisition and transmission of sexually transmitted diseases among African American women using text messages versus small-group delivery modalities pose distinct research risks and benefits. Determining the relative risk–benefit ratio of studies using these different modalities has relied on the expertise of investigators and their institutional review boards. In this study, African American women participated in focus groups and surveys to elicit and compare risks and benefits inherent in these two intervention delivery modalities, focusing on issues such as convenience, privacy, and stigma of participation. Some risk/benefit variables were implicated in willingness to participate the two intervention modalities. [ABSTRACT FROM PUBLISHER]