http://www.lapublichealth.org/aids
The Los Angeles County HIV Epidemiology Program (LACHEP) will offer expanded, active, community-based outreach to HIV counseling and testing, followed by referral and linkage into care at one of two clinics: AltaMed and Drew University Oasis Clinic.      

The program will offer Latino and African American YMSM intensive integrated case management (ICM) sessions at local clinics. A randomized controlled study of the intervention will be used, as well as qualitative and quantitative methods to follow clients and evaluate the program.

[click here to see Site Presentation given at January 2005 Grantee Meeting]

Intervention

• Active and passive community outreach, with mobile and clinic-based CTR, using incentives for post-testing
• One-hour integrated case management (ICM) sessions at two sites – one African American identified and the other Latino identified, with biweekly peer support groups for clients, partner counseling and referral services, and transition to standard case management after two years
• Weekly intervention visits at first, then bi-weekly, then monthly second year

Outputs 

• 2,000 people reached during outreach use CTR; 100-200 HIV+ identified via active outreach; 100 HIV+ identified via passive outreach: 100 African Americans and 100 Latinos linked to ICM—90 African Americans and Latinos linked to standard case management (as control)
• 90 African Americans and 90 Latinos complete 42 ICM sessions, average ICM caseload of 25-35 clients
• All clients receive medical care quarterly, 1,000 additional services visits
• Client receives 30 prevention messages during ICM, with 100 ICM clients transitioned to standard case management

Short Term Outcomes

• Increased knowledge of HIV, HIV threat, and personal serostatus 
• Increased use of HIV services, with decreased unmet need among HIV+ who are not getting care 
• 75% kept appointment rate; 50% decrease in viral loads; 50% increase in CD4 counts; 50% increase in condom use; 50% decrease in high risk behaviors; 50% increase in voluntary disclosure to of serostatus to partners; 50% increase in asking about partner serostatus 
• Increased rapport with ICM regarding prevention  

Long Term Outcomes 

• Increased use of HIV care services by previously undiagnosed HIV+.
• HIV care seen by clients as of higher quality and more culturally competent
• Decreased morbidity and mortality related to HIV among HIV+
• Increased use of ongoing local continuum of care by HIV+

Proposed Local Evaluation Strategy 

• Randomized, controlled design with two groups: African American and Hispanic (ni=90); control group of n=90 African American and Hispanic in traditional case management programs 
• Stratified blocked randomization (two sites, race/ethnicity-specific) 
• Data collection: repeated measures, structured face-to-face interviews, adopt validated tools where possible 
• Qualitative component with providers 
• Baseline and twice yearly follow-up face to face interviews over 36 months