416 Strategies to Improve Access for Caribbean PLW

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Peer Support Model for Caribbeans Living with HIV/AIDS in the U.S.: Implementation Strategies to Improve Access for Caribbean PLWHAs “Zanmi Ede Zanmi” (Friends Helping Friends): 

Peer Support Model for Caribbeans Living with HIV/AIDS in the U.S.: Implementation Strategies to Improve Access for Caribbean PLWHAs “Zanmi Ede Zanmi” (Friends Helping Friends) Francois Rony Roche – Program Coordinator Andre Brutus, M.D. – Principal Investigator Brookdale University Hospital & Medical Center Treatment for Life Center “TLC” – Brooklyn, NY Ryan White CARE Act 2006 Grantee Conference August 29, 2006

Original Program Goals & Strategies: 

Original Program Goals & Strategies Recruit & train 10 Haitian Peer Promoters Status: Senior Peer & 10 Peers completed training Enroll 2 * 100 clients (2 cohorts of 50 each) Status: 54 Intervention clients enrolled to date 33 Control clients enrolled to date Primary Recruitment - Haitian clients in TLC Clinic population: lost to follow-up, sporadic care, inpatient, ER, HIV Counseling & Testing Unit Secondary Recruitment - Obtain referrals from Community Providers, Haitian CBOs and ASOs Status: 36 clinic; 10 referrals; 7 outreach; 1 inpat. (54)

KEY CHALLENGES and ADJUSTMENTS: 

KEY CHALLENGES and ADJUSTMENTS Recruiting and Retaining Peer Promoters Intervention Design & Outreach Integrating the Program into the Clinic Program Space and Location Client Retention

1. Recruiting and retaining Peer Promoters: 

1. Recruiting and retaining Peer Promoters 1a. Challenges : Except Senior Peer, no experience working as Peer Candidates very “private,” unwilling to disclose History of personal stigma, or witnessed stigma History of broad and specific stigma against the Haitian community, in Haiti and the U.S. Insufficient monetary compensation Language skills and Communication skills Legal barriers, immigration status

1. Recruiting and Retaining Peer Promoters: 

1. Recruiting and Retaining Peer Promoters 1b. Adjustments: Slow process of recruitment, training and ongoing support Invited a pioneer Haitian Peer, with a lot of experience, to address and motivate the group Continuously address stigma in the community Initiating the Peers gradually to many activities Bi-lingual staff

2. Intervention Design & Outreach: 

2. Intervention Design & Outreach 2a. Challenges: Large pool of eligible clients turned out to yield less Intervention clients than anticipated Reasons: relocation, change of contact information, clients are receiving care at another facility, are “out of care,” are “unwilling” to come back, or have died Length of the intervention (9 months) Clients unwilling to participate in group sessions and be “exposed” to those they don’t know (or might know)

2. Intervention Design & Outreach: 

2. Intervention Design & Outreach 2b. Adjustments: Approach clients when they come to a visit for any reason New outreach plan with media activities, linkage with ER program, consistent outreach for counseling & testing, community meetings with physicians, faith and community leaders and linkage development with CBOs, ASOs Expansion of control site (SUNY) to include KCHC Tailoring intervention to individual client’s needs (6 month flexible intervention, home visits, buddy escort/support)

3. Integrating the Program into the Clinic: 

3. Integrating the Program into the Clinic 3a. Challenges: Educating Staff about the program, obtaining cooperation Non-Haitian clients feeling “left out” during peer and client recruitment processes Different views and perception of Haitian peers from other clients and Consumer Advisory Board (CAB) members “Time conflict” for the client between completing baseline interview and meeting all other staff for needed services.

3. Integrating the Program into the Clinic: 

3. Integrating the Program into the Clinic 3b. Adjustments: Regular participation in, and presentation at, CAB meetings On-going development of good rapport between SPNS program staff and clinic staff (updates at staff meetings, etc.) Conducting baseline interview when client doesn’t have to meet with many other staff on the same day Providing transportation and other logistical support to client for study visit

4. Program Space and Location: 

4. Program Space and Location 4a. Challenges: Not enough space in main Hospital site No clinical and social services provided at the satellite clinic Main hospital not close enough to the majority of clients? Satellite clinic “too close” to clients? Organizational structure & processes

4. Program Space and Location: 

4. Program Space and Location 4b. Adjustments: Setting the program in the satellite clinic in Flatbush area enabled more space and closer to the Haitian community Conducting outreach activities mainly at the satellite clinic Flexibility in location for program and study visits (client can go to whichever venue is more convenient) Group Session not mandatory to fulfill the needs of the intervention because many clients resisted groups

5. Client Recruitment & Retention: 

5. Client Recruitment & Retention 5a. Challenges: Clients need job, money, food, material resources … Undocumented clients not qualified for some services Clients in denial about HIV status Clients have competing priorities (family, job, immigration) Clients feels self-sufficient after a few sessions Stigma on a personal level and community level

5. Client Recruitment & Retention: 

5. Client Recruitment & Retention 5b. Adjustments: Reminder calls, incentives to motivate participation Home visits, escort services, emotional support Linkage and referral to other organizations for services Building networks to help clients find services, jobs … Building client’s self-esteem to face and cope with stigma Continuously addressing stigma in the community through Haitian-focused outreach, Media, Leadership meetings End.