Multi-Site Process Evaluation Report: Targeted Peer Support Model Development and Evaluation, Caribbeans Living with HIV/AIDS (CHIVES) Study

2007·3.6 MB·English

MH08D8386
Thisevaluationwassupported through: grant# 1H97HA01125
01-00 (Academy for Educational Development); grant#
1H97HA01210-01-00 (Brookdale UniversityHospital); grant
# 1H97HA0124-01-00 (Community HealthcareNetwork);
grant#H97HA01150 (UniversityofMiami); grant#
H76HA00026- 6-00 (Lutheran MedicalCenter) and grant#
1
H97HA012070101 (Montefiore Medical Center) from the U.S.
Department ofHealth and Human Services, Health Resources
and ServicesAdministration, HIV/AIDS Bureau, Special
ProjectsofNational Significance.
Thecontentofthis reportdoesnotnecessarilyreflect the views
orpoliciesofDHHS. Responsibility for the contentofthis
report restssolely with the named authors.
The authors ofthisdocument are Laurine Thomas and
Sara WoldehannaofAED.
MfjC$D23^
Acknowledgements
T
heauthorswish to acknowledge thecontributionsot the CHIVES
studygroup, comprisedof: Andre Brutus, Adele Flateau, Francois
Roche, andPaul Alexis (Brookdale University Hospital and MedicalCenter,
New York, NY); TraceyWilsonand Susan Holman (State Universityof
NewYork, Downstate MedicalCenter, New York,NY); Yvette Walker,
Steve Hemraj, and Freddy Molano (Community HealthcareNetwork, New
York, NY); Susie HoffmanandJessicaAdamsSkinner (New York State
Psychiatric Institute atColumbia UniversityMedical Center, New York,
NY); Mike Bosket and Christian Richardson (Lutheran Medical Center,
New York, NY); Marcia Bayne Smith (QueensCollege,NewYork, Nf );
Alan Rodriguez, Lisa Metsch,Natalie DayTolentino, Cilbert SaintJean,
and EddyJean Baptiste (University ofMiami, SchoolofMedicine, Miami,
FL); Arthur Blank, PeteWilliams, Anitra Pivnick, EliciaJohnson Knox,
and PhilJohnson (Montehore Medical Center,New York, NY); Susan
Middlestadt (IndianaUniversity, Bloomington, IN); Adan Cajina, Alice
Kroliczak, and Moses Pounds (U.S. DepartmentofHealth and Human
Sendees, HealthResources and Services Administration, HIV/AIDS
Bureau, Rockville, MD).
The authors also wish toacknowledge the assistanceofPatNalls
and thestaffofthe Women’sCollective,Washington, DC;
MicheleShedlin, PhD, UniversityofTexas at El Paso, DepartmentofHealth
Promotion; and Daniel Sheahan ofAED torhis role asCHIVES editor.

Table of Contents
I - Rationale for the CHIVES Multi-site Process Evaluation 1
a. Methodology 2
b. Data Analysis 4
II - Why Was the Program Developed? 7
III - How Did the Program Operate? 9
a. Requirements ofthe Demonstration 9
h. Recruitment and Engagement ofPeer Promoters 12
&
c. Peer Promoters’ Roles, Responsibilities, Compensation 12
d. Peer Promoters’ Training and Support 18
e. Assignment ofClients to Peer Promoters 18
f. Other Staffing Beyond Peer Promoters 20
g. Sites’ Partners 23
h. Transitioning Clients 23
IV - Did the Program Operate as Intended? 27
V - Conclusions/Lessons Learned 37

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December 2007 Multi-Site Process Evaluation
Rationale for the CHIVES1
I.
Multi-site Process Evaluation
T
he Special Projects ofNationalSignificance (SPNS) Targeted Peer
Support Model Development forCaribbeans Livingwith HIV/AIDS
Demonstration Project2 is afive- site initiative funded by the Health
Resources and ServicesAdministration’s HIV/AIDS Bureau (HAB). Launched
in 2003, the projectcenters on creatingmodels ofpeersupport forHIV-positive
Caribbean immigrants residing in the United States inorder to increase their
knowledge ofHIV infection, theirunderstandingofHIV treatment options and
the service deliverysystem, and their timelyuse ofappropriate HIV medical care
and ancillaryservices.
The CHIVES multi-site process evaluation analyzes the early development and
actual implementationoftheprogram, and assesseswhether interventions were
implemented asplanned and whether expected outputwas actuallyproduced.
Itprovides information thatwill be essential for the future replication ofthe
intervention and documents lessons learned. Thisstudycomplements the multi-
site outcome evaluation and employs the same instruments across all five sites so
that theprocess datamaybe compared across thesites. Process evaluation can
provide answers to three important questions:
• Whywas the Demonstration developed?
• How did the interventions at eachsite operate?
• Did the interventions operate as intended?
The process evaluation includes peerpromoters’ perceptions rather than data
obtained directlyfrom clients andpotential clients, since the latter are thefocus
ofthe outcome evaluation. This approach has yielded valid data since CHIVES is
apeer-based intervention, and the peerpromoters are themselves members ofthe
population from whichclients are selected.
1CHIVESistheacronymforCaribbeanHIVEvaluationSupport.
1HereafterreferredtoastheCHIVESDemonstration.
CHIVES ProcessEvaluation • 2007 1
I
REPORT —
Multi-Site Process Evaluation DECEMBER 2007
Methodology
a.
Given the complexityofthe CHIVES Demonstration, AEDemployed
a mixed-methods approach designed to minimize the burden ofdata
collection on the sites and theresources expended on the evaluation
effort. AEDutilized document reviews, observational studies, encounter
logs, in-depth interviews, and group interviews. AEDcollected data only
from project staff, not from clients.
Document Review
AEDasked thesites tosubmitseveral site documents, including:
• Site research design;
• Site intervention manuals, includingoutreach protocols; and
• Site peerpromoter training manuals.
The document review informed assessmentsofthe fidelityofthe
intervention; the frequency, nature, and rationale forchanges in
the implementation ofthe intervention; the activities and resources
expended in the evaluation; and the roles and responsibilities ofall
involved.
Observational Studies
AEDobserved keyactivities and locations duringthe course ofvisits
to each site. These processes included staffmeetingswith and without
peerpromoters, outreach activities, service-delivery locations, intake
and enrollment activities, peerpromoter and client interactions, and
trackingactivities. AEDdeveloped a standard listofcontexts and
activities toobserve, and common guides for the observations to ensure
uniformity in the data-collection effort.
Encounter Logs
Some data were drawn frompeer-encounterforms that thesites
submitted to AED. These forms document each encounter that a peer
promoterhas with a client and record the length and settingofeach
interaction, aswell as thenature ofthe encounter in detail.
Thus, the form provides both qualitative and quantitative data on the
encounters. The evaluators used these data to respond to questions
about the intervention delivery.
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DECEMBER 2007 Multi-Site Process Evaluation
1
Brookdale
CHIVES
Intervention
FIGURE
InstitutionalContext:
The TreatmentforLife Clinic, theonlyAIDS
designatedcenterin Brooklyn, NY.
A
Staffing
a. Principal Investigator-overall direction
• Deliveredprimarycare tomostoftheclients
b. Health educator-trained and supervised peer-promoters
• Day-to-daymanagementoftheprogram
c. Program coordinator
• Day-to-daymanagementoftheprogram
d. Administrative coordinator
• Day-to-dayadministrationoftheprogram
Partners
a. Local Haitian TV and radio stations
• Clientreferrals
b. Faith-based institutions
• Clientreferrals
c. Local Haitian physicians
• Clientreferrals
d. Local testing and counseling centers
• Clientreferrals
«
7 Peer Promoters
Selectedfrom among the TLC patientswho were the mostadherent—to their medical regimen.
Conducted outreach, clientfollow-up and delivered the intervention 6 monthly one-on-one
sessionswith clients and 6 two hourgroup sessions, provided referrals and escortto healthcare
and other appointments as well as remindercalls.
CHIVES ProcessEvaluation 2007
REPORT —
Multi-Site Process Evaluation DECEMBER 2007
In-depth Interviews
AEDconducted telephone and in-person interviews withsite staff,
includingproject principal investigators and peer promoters, toobtain
additional insights that would complement those gained through the
document review and analysisofpeer-encounter forms.
Group Interviews
AEDconducted semi-structured group discussions utilizinga visual
mobilization technique with peer promoters and otheroutreach staff
regarding their involvement in key intervention processes. Visual
mobilization is a participatory data-collection method that involves
group discussion alongwith spatial exercises that assist participants in
identifying thecommon themes in thediscussion. This methodology
engages participants in a non-threatening manner to respond to
research questions, group similaror like responses, analyze the responses
bydeveloping a themeforeach majorgroup ofresponses, discuss
the results with a focuson identifying trends and patterns, and issue
recommendations. For example, in a discussion ofsuccessful outreach
techniques, visual mobilization with the peerpromoters assisted the
peers togroup similaroutreach techniques and prioritize theirrelative
importance at each site.
The evaluators collected data at various points throughout the project
year. They conducted annual visits to each site. They also collected
data fromselected projectstaffat the annual all-site meetingsand via
telephone calls.
b. Data Analysis
AED used content analysis to analyze the data collected via the various
methods outlined above. Analysiswas iterative, as is appropriate fora
study that is primarilyqualitative in nature. After each data-collection
activity, AEDdebriefed with the participants to interpret the data and
situate the meaningwithin thecontextofthe overall project. AED
alsoconvened sessions during annual all-site meetings todiscuss the
process data and arrive at a shared understandingofthe findings.
Content analysis revealed the factors thathad the greatest impact on
the operation ofthe intervention at eachsite.
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