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Biomedical subjects

G J Huba

Publications and source records attributed to G J Huba.

At least 37 records · Page 2Linked to original sources
PubMed2000

Effects of HIV/AIDS education and training on patient care and provider practices: a cross-cutting evaluation.

Initial and continuing training in HIV/AIDS service provision is a critical way to enable the nation's health providers to use state-of-the-art developments and perspectives. Typically, the efficacy of HIV/AIDS training programs is evaluated using assessments administered to trainees immediately following the training. This study reports cross-cutting findings from telephone interviews conducted with 218 trainees an average of 8 months after training. Long-term training effects are examined in three domains: (a) general perspectives on HIV/AIDS; (b) health care provider service provision; and (c) changes in procedures and operations at the health care system level. The findings show the different ways that the training experience had long-term positive and observable effects in these three domains. In some cases, background characteristics and job positions predicted the specific type of reported training effects. The pattern of results suggests ways in which training methods can be targeted to specific audiences.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Do characteristics of HIV/AIDS education and training affect perceived training quality? Lessons from the evaluation of seven projects.

Initial and continuing HIV/AIDS education and training has been a critical way to bring the nation's health providers up to date on emerging developments and approaches. This study reports cross-cutting findings from seven HIV/AIDS education and training projects. Trainers described over 600 training sessions from these projects in terms of their structural characteristics and design elements, while trainees described these sessions on several dimensions related to training quality. Training characteristics were compared to trainee assessments of training quality. Using a decision-tree analytic approach for major training attributes, considerable support emerged for links between training characteristics and perceived quality of the HIV/AIDS training experience. More favorable quality ratings were associated with certain projects, the training setting, the types of trainees served by the training, the intended training impact, discussion of special populations, and training methods involving interactive learning. With increased knowledge regarding how these educational experiences relate to the ways they are perceived and processed, more targeted approaches to training design on HIV/AIDS can be developed.

Adult↗
PubMed2000

Risk factors and characteristics of youth living with, or at high risk for, HIV.

Over 8,000 adolescents and young adults (4,111 males; 4,085 females) reported on several HIV-related risk behaviors during enrollment into 10 service demonstration projects targeted to youth living with, or at risk for, HIV. Distinct risk patterns emerged by gender when predicting HIV serostatus (versus unknown serostatus/negative serostatus). Males who had injection drug risk histories, had sex with an HIV positive partner, had sexually transmitted diseases, had sex with males, and/or were homeless had an inflated risk of being HIV positive. Females who engaged in sex with an HIV partner, had sex with an injection drug user, and/or had sexually transmitted diseases, were at the highest HIV risk. For both samples, engaging in sex with women reduced the likelihood of HIV positive status. Very basic information about risk factors obtained at service intake offers important information about HIV status of "high risk" youth presenting for care in community programs, as well as suggests clear risk factors for targeted preventive efforts.

Adolescent↗
PubMed1999

Systems change resulting from HIV/AIDS education and training. A cross-cutting evaluation of nine innovative projects.

An evaluation of nine diverse HIV/AIDS training programs assessed the degree to which the programs produced changes in the ways that health care systems deliver HIV/AIDS care. Participants were interviewed an average of 8 months following completion of training and asked for specific examples of a resulting change in their health care system. More than half of the trainees gave at least one example of a systems change. The examples included the way patient referrals are made, the manner in which agency collaborations are organized, and the way care is delivered.

Adolescent↗
PubMed1998

A model for adolescent-targeted HIV/AIDS services: conclusions from 10 adolescent-targeted projects funded by the Special Projects of National Significance Program of the Health Resources and Services Administration.

This article describes a model of service for youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and youth at high risk for HIV, based on the lessons learned from a set of innovative service projects funded by the Health Resources and Services Administration Special Projects of National Significance (SPNS) Program. Although each project has a unique focus, all collectively seek to enroll youth with HIV into care through new or existing HIV service networks, and direct recruitment via street outreach and other similar methods. The use of various outreach methods tends to yield different patterns of engagement of youth in services. An ideal approach may use a combination of complementary outreach methods. Data at both the national and local levels point to five major elements that capture the innovations of the collective service model: (a) peer-youth information and dissemination; (b) peer-youth advisory groups; (c) peer-youth outreach and support; (d) professional, tightly linked medical social support networks; and (e) active case management and advocacy, for individual clients as well as the programs themselves, to link the various components together. One of the most important factors in the model's success is that youth and professionals share an equal partnership in all stages of program design, planning, and implementation. Youth and professionals each share their expertise in a dynamic process. In addition, active case management is crucial, not only to ensure that clients receive needed services, but also to ensure that the programs themselves run in a coordinated, tightly linked way. Given needs of adolescent clients and existing adult-oriented service networks, the use of active case management and the active participation of youth in the services system are critical.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Bay Area Young Positives: a model of a youth-based approach to HIV/AIDS services.

Bay Area Positives, Inc. (BAY Positives), founded by and for youth living with human immunodeficiency virus (HIV), is a peer-run, peer-based organization including the board of directors, the executive director, staff, and volunteers, and was funded in part by the Special Projects of National Significance (SPNS) Program. It responds to the unique needs of HIV-positive adolescents and young people 26 years old and younger (n = 108) and targets gay and bisexual youth, youth of color, and young women. The organization has found that when young people are brought together to help one another and to mentor their peers, living with HIV becomes more manageable. It serves as an entry point into the HIV/acquired immunodeficiency syndrome (AIDS) service system, using member advocates (peer case managers) to guide members to youth-sensitive services and to help them through the delivery system. BAY Positives' goals are to provide emotional and other support to youth with HIV and to empower infected young people to get information about and access to the services they need. Its success also depends on the ability to provide as much support and development for staff as provided to members.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Childrens Hospital Los Angeles: a model of integrated care for HIV-positive and very high-risk youth.

Childrens Hospital Los Angeles (CHLA) provides an integrated care model for youth with and at high risk for human immunodeficiency virus (HIV) infection, through a grant from the Special Projects of National Significance Program, HIV/acquired immunodeficiency syndrome (AIDS) Bureau, Health Resources and Services Administration. The project has provided outreach to 8400 youth at risk and has provided clinical services to 296 young men (16.6% HIV positive) and 352 young women (9.1% HIV positive). Situated within the Division of Adolescent Medicine at Childrens Hospital Los Angeles, the project consists of a general medical clinic for youth along with psychosocial services including case management, counseling, and related ancillary services. A key part of the model is to provide health services within a general medical clinic for youth where participation in the clinic does not serve to identify a youth to his or her peers in the waiting room as having HIV. Another key part of the model is to provide extensive outreach within the community including contacts at bars and social clubs where high-risk youth congregate, on the street, and through the social networks of youth already identified as having HIV who participate in the CHLA clinics. In the last 2 years of the program, the peer outreach component has been strengthened and peer support activities have also been implemented. The program also has developed a Computer-Assisted Adolescent Referral System (CAARS), available on diskette and on the Internet, for the referral of youth to services in the Hollywood area.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Health Initiatives for Youth: a model of youth/adult partnership approach to HIV/AIDS services.

Health Initiatives for Youth (HIFY) in San Francisco, California, is an innovative organization providing health-related services for and by young people funded in part by the Special Projects of National Significance (SPNS) Program. The HIFY Youth Health Initiative (YHI) is composed of eight youth staff and aims to bring about individual and systemic change, enhance the quality of life for human immunodeficiency virus (HIV)-positive and at-risk young people, and increase the responsiveness and youth sensitivity of organizational and community systems. Comprehensive services have been delivered to 136 young men under 25 years, 33.1% of whom are HIV positive, and 164 young women, of whom 12.2% are HIV positive. In addition, thousands of youth and young adults have received lower-intensity services through dozens of educational workshops and presentations. YHI services are implemented through a comprehensive collection of education, training, and support activities that benefit the youth staff who produce them, along with the participants who benefit from the services provided. These activities include a speaker's bureau, health and advocacy trainings, internships, return-to-work and life skills training, publications, and conferences. Regional and national findings suggest that many youth do not yet comprehend their risk for HIV infection or understand the impact of HIV on their community. In direct response to these needs, HIFY programs inform and encourage access to counseling and testing, and provide meaningful access to adolescent care, treatment, and services.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Building comprehensive HIV/AIDS care services.

This article presents the experiences of three innovative programs for HIV/AIDS-related health care funded by the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The Comprehensive Healthcare projects were funded as part of a larger initiative for innovative HIV service delivery models, consisting of 27 grantees, the funding agency (HRSA), and an Evaluation and Dissemination Center. These projects--the University of Nevada School of Medicine's Early Nutrition Intervention in HIV and AIDS project, the University of Vermont and State Agricultural College's Rural HIV Service Delivery project, and Washington University School of Medicine's Helena Hatch Special Care Center for Women--have developed specialized medical care models within the context of a continuum of services in a medical clinic. This article serves to describe the initial experiences of these three service demonstration projects, and some of the lessons learned as a result of their implementation. All of these projects share the goal of providing integrated services, such as medical care, nutrition, case management, and social and mental health services to people living with HIV/AIDS. However, the projects target different populations, (e.g., those in rural areas versus those in a large inner city), and use contrasting service delivery models of comprehensive HIV care. These projects have undertaken diverse activities and have used numerous effective strategies to increase their ability to provide a continuum of care and services for people living with HIV/AIDS. Based on the valuable lessons that the Comprehensive Healthcare projects learned during the first 2 years of funding, a number of collective recommendations have been made. It is expected that these suggestions will prove extremely useful to other programs that consider offering comprehensive health-care services to people living with HIV/AIDS or other complex medical conditions.

Academic Medical Centers↗
PubMed1998

Evaluation of a linked service model of care for HIV-positive, homeless, and at-risk youths.

Two instruments were used to evaluate an agency's type and availability of services for HIV-positive and at-risk adolescents, and to assess opinions concerning healthcare referral patterns. These instruments were administered to representatives of 22 agencies from 10 categories of healthcare services. Nonmetric multidimensional scaling was used to model ratings of interagency knowledge, referral patterns, and general satisfaction with services. We found that no agencies offered youth services for inpatient adolescent-specific mental health treatment or short-term residential drug treatment; however, few offered long-term residential substance abuse detoxification services (5%), outpatient drug maintenance (5%), HIV-specific inpatient services (9%), intensive day treatment for substance abusers (9%), HIV home care (14%), HIV hospice care (14%), inpatient medical services (14%), short-term shelters (14%), long-term housing (18%), HIV-specific clinical trials (18%), and dental services (23%). Barriers to expanding care included lack of funding, transportation, and lack of awareness among youths about services. A multidimensional scaling analysis identified a tight service cluster of two community health centers and the largest public hospital serving poor communities of color, as well as a relatively tight cluster of three service agencies located on the Boston Common serving homeless youths. A third service cluster consisted of two university-affiliated medical centers and one community health center. In conclusion, we found that many critical services for HIV-positive youths are relatively scarce. Multidimensional scaling provides a visual presentation of the relationships of network sites. This evaluation of services indicates a need for increased, accessible youth-oriented HIV services and suggests that linkages across the three distinct clusters of service providers should be solidified. These methodologies can be used to develop a generic model describing the stages of linkage formation in HIV care service networks.

Adolescent↗
PubMed1998

A national program of innovative AIDS care projects and their evaluation.

As the number of people seeking HIV care in the U.S. has grown, the demand has increased not only for medical care, but also for a wide range of supportive services. This in turn has increased the need for demonstrated and tested HIV care service models that can address a comprehensive set of needs. The Special Projects of National Significance (SPNS) Program's HIV Innovative Models of Care Initiative funded by the Health Resources and Services Administration (HRSA) began on October 1, 1994. This initiative is an effort by 27 HRSA-funded projects to jointly establish goals and objectives, develop common evaluation methods, and produce comparable and measurable outcomes for innovative models of HIV care. The five projects of the SPNS Program Capitated Care Work Group share, as a central theme, the study of the health care provided to individuals with HIV disease under models where the health care is capitated, or paid on a "flat fee" basis per patient per month. These projects differ in the ways that they provide health care, ranging from community- and university-based clinics to a home-based hospice to a statewide health care system. Each of the projects shares the goals of determining costs for providing health care services to AIDS patients under a capitated care system and of ensuring that high quality care is provided under such a system.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Evaluation of the transprofessional model of home health care for HIV/AIDS.

OBJECTIVE: To determine if a Transprofessional care-management approach (experimental group) produces savings in service delivery dollars when compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active, medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRINCIPLE FINDINGS: Post-test measures indicate an 8 percent reduction in labor delivery costs for an average experimental patient's entire episode of home-care versus for an average control patient's. CONCLUSIONS: An integrated model of service delivery, which is based on interdiscriplinary, care-management and blended modalities of service, provides a cost-effective method in the provision of home-care services for terminally ill AIDS patients.

Adult↗
PubMed1998

A typology of service patterns in end-stage AIDS care: relationships to the transprofessional model.

OBJECTIVE: To determine the relationship among 11 types of home health care services for patients with HIV/AIDS and to develop a terminal-care, service-usage profile of persons receiving such services. Services include the number of psychiatric nurse visits, Medical Social Work (MSW) visits, evaluation visits, physical therapy visits, occupational therapy visits, homemaker visits, home health aide visits, public health nurse visits, registered nurse (RN) visits, Licensed Vocational Nurse (LVN) visits, and Intravenous (i.v.) nurse visits. DATA SOURCES AND STUDY SETTING: Data were collected on 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). The service utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: The relationship among the service types was evaluated with principal component analysis. A service-usage profile was developed for patients using cluster analysis. To control for the variability in the amount of time that patients were on service, the number of days that patients were in the VNA-LA program and were actually receiving services was included as a factor that yielded a variable reflecting the number of each type of service that a patient received per day. PRINCIPAL FINDINGS: Five components were found to best describe the relationships among the service-type variables. These were identified as being: the Number of Evaluation Visits, the Number of Intensive Nursing Visits, the Number of Physical Therapy Visits, the Number of Psychosocial Visits, and the Number of Attendant Visits. Patients were found to cluster into 1 of 5 groups based on the type of service utilization profile that they received. The variables that appeared to have the most influence on this profile were the number of home health aide visits per day that the patient received, the number of RN visits that were made, the number of i.v. nurse visits that were provided, and the number of LVN visits that were made. CONCLUSIONS: Terminally ill AIDS patients receiving home health care services can be identified as having a service utilization profile. This profile can be used to evaluate more precisely the service areas in which costs for patient services differ. Individually assigned to an experimental Transprofessional Model of care had a different service utilization profile than those assigned to a Traditional Model of care.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Retention of clients in service under two models of home health care for HIV/AIDS.

OBJECTIVE: To determine if a Transprofessional, care-management approach (experimental group) produces different patterns of retention in home treatment as compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). Initially, the Transprofessional Model should lead to a greater retention rate in the program as patients bond to blended care managers, but in later stages clients needing hospice should be moved off-services resulting in lower retention rates in the medical-surgical home care venue. DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRIMARY FINDING: In the earliest stages, Transprofessional patients tend to be more likely to stay in treatment, probably due to the greater bonding to the program. After about one year, the Transprofessional patients are more likely to leave the program as they are transitioned into hospice care. CONCLUSIONS: An integrated model of service delivery, which is based on interdisciplinary care-management and blended modalities of service, provides a quality of life enhancing and a cost-effective method in the provision of home-care services for terminally ill AIDS patients.

Continuity of Patient Care↗
PubMed1986

Determinants of sexual and dating behaviors among adolescents.

The study of adolescent sexual development has typically focused on the incidence and age of onset of particular behaviors. Recent developments in the analysis of covariance structures permit more powerful simultaneous tests of the determinants of adolescent sexual behavior. These new methods allow the assessment and evaluation of the interrelatedness between unobserved, latent constructs. Data were obtained from 183 males and 193 females ranging in age from 12 to 18 years old, selected from three birth cohorts using a stratified random sample. Eight latent constructs--Sexual and Dating Involvement, Self-Acceptance, Feminist Sex Role Attitudes, Deviant Social Network, Importance of Dating, Lack of Heterosexual Competence, Sexually Active Social Network, and Stressful Change Events--were hypothesized to explain the variance in 26 observed variables. Several causal models were tested that specified structural relationships among the latent constructs. A theoretically meaningful model was arrived at that linked the eight, error-free factors.

Adolescent↗