AIDS Partnership MichiganMiriam Holbrook

Douglas Manigault IIISusan Shadley

Joshua SchuylerKenny Sparks

The Highway to Health Initiative Grant Proposal

Cabin, SW 663July 28, 2014

The Problem

In 2012, Dr. Ronald Valdiserri wrote to inform organizations like Aids Partnership

Michigan (APM) about an unfortunate trend in HIV-care. While there are over a million

Americans with HIV, only eighty percent of these people are aware of their HIV status.

Sixty two percent of those aware of their HIV status have been linked to HIV care; forty-

one percent of these stay in care1. Of those HIV positive who stay in care, only twenty-

eight percent of them are able to adhere to their treatment and sustain undetectable viral

loads2. There is a great need to address a clear local and national health disparity.

Prisoners are more than three times likely to have HIV than the general population

and men with HIV who return to their communities after incarceration are likely to return

to communities where they will not have

access to medical care. The period after

release is associated with considerably

higher HIV-related death rates than those

HIV positive who have never been to

prison. There is support for some

transitional care and getting these

individuals linked with medical care can lead to better compliance and retention of care3.

Research has demonstrated a more positive outcome for those who accept their HIV-

positive status and incorporate it as part of their identities. Volunteering in HIV related

programs and educating others about HIV may help those struggling with their HIV

positive status. It has also been shown that learning more about HIV is positively correlated

with obtaining medical intervention. Having a support network can also help those with

HIV move on to normalize their illnesses and deal with the stigma often associated with

being HIV-positive4.

Mission, Goals and Objectives

The Mission of APM is two-fold: the prevention of the disease and providing the

best services for those who are infected. Our organization wants everyone to be safe, and if

they cannot be safe, we want them to be

well-informed5. The Highway to Health

Initiative (HHI) will support us as we

move forward in our mission by providing

both excellent services and education to

our participants. The mission of the HHI is

to reduce the viral loads of our participants

and decrease their likelihood of

transmitting the HIV virus to others in the

community, as well as to reduce stigma through HIV and AIDS education.

We will accomplish the mission through the following goals and objectives:

Goal 1: Increase participants’ knowledge of HIV, AIDS and the benefits of

medication compliance.

Objective 1.1: Provide six two hour training classes to be completed by

July 2015.

Objective 1.2: Assess learning of 100% of attending participants after

each training session.

Objective 1.3: Provide feedback and additional training if needed to 100%

of attending participants after each training session.

Goal 2: Reduce viral load and HIV transmission for HHI participants.

Objective 2.1: Provide education on medication compliance and its effect

on viral load and HIV transmission to 90% of participants by

end of second training session and throughout the program.

Objective 2.2: Monitor 100% of participants for medication compliance bi-

weekly, six and twelve months after the program.

Objective 2.3: Assess viral loads of 100% of participants through medical

testing at the end of the program, six and twelve months after

program completion.

Goal 3: Help decrease stigma related to HIV and AIDS status in the community*.

Objective 3.1: Hold three community speaking events by July 2015.

Objective 3.2: Have 20% of community members attending these

events by the end of the program.

Evaluation Plan

To determine the effectiveness of our program, we intend to evaluate the outcomes

to ensure proper implementation and goal achievement. We will first need to evaluate any

outlying factors that could make obtaining goals more difficult for certain participants, such

as whether they have secured housing and transportation, for example. In order to evaluate

the effectiveness of our training, we will assess each participant’s learning after each

training session and follow up with any retraining as necessary.

 The objectives of our program are to

increase education of HIV/AIDS and the

benefits of medical compliance, to reduce

viral load and transmission and decrease

stigma in the community. Our model would

require all participants to be pre-tested

(medically and by self-report) for compliance and current knowledge. Stigma among

community members would be evaluated through self-report surveys for stigma/feelings of

those infected with HIV/AIDS. All participants and community members would then be

post-tested after completion of the program.

        As the program progresses and participants graduate from the training, we will

monitor all for medication compliance bi-weekly for the first three months after the

program and then at six and twelve months after completion. The self report likert scale

questionnaire will consist of five questions measuring their daily compliance and

feelings/attitudes about compliance. Viral load will be medically tested at three months, six

months and twelve months after completion through a blood test administered at our test

location.

Though there is likely no accurate method to determine the impact our initiative

will have on community stigma, our hope for the community is that through speaking

events, we can help to establish a connection through common concerns and understanding

between those without the disease, those who are affected by it, and those living with the

disease. When the community understands the benefits for all involved, we can work

together to help reduce the transmission of HIV and improve the lives of those living with

it.

Budget

1 http://www.michigan.gov/documents/mdch/DET_YMSM_06292010_326598_7.pdf

2 Valdiserri, R. “HIV/AIDS Treatment Cascade Helps Identify Gaps in Care, Retention”

3 Christopoulos, K.A., Massey, A.D., Lopez, A.M., Geng, E.H., Johnson, M.O.,Pilcher, C.D., Fielding, H., Dawson-Rose, C.. (2013). “Taking a half day at a time:” Patient perspective and the HIV engagement in care continuum. AIDS Patient Care and STDs. Vol 27:4

4 Baumgartner, L.M., David, K.N.. (2009). Accepting being poz: The incorporation of the HIV identity to the self. Qualitative Health Research.

5 AIDS Partnership Michigan. http://www.aidspartnership.org/index.php/history-and-mission/

* the community is defined as the area within a one mile radius of the AIDS Partnership for Michigan building. We do not plan to evaluate community stigma at this time, though our hope is to desensitize the community and help those with HIV to bring it to the forefront for education and discussion.