Promotoras, Peer Participant Providers and Community Outreach as Preconception in the Continuum of P

1
Promotoras, Peer Participant Providers and
Community Outreach as Preconception in the
Continuum of Perinatal HIV Transmission

• Armida Ayala, M.H.A., Ph.D.
• Arthur Durazo
• Office of AIDS Programs and Policy
• Kimberly West, M.D.
• Maternal and Child Adolescent Health
• Los Angeles County, Department of Health Services
  
• CityMatch Annual Urban Maternal and Child Health
  Leadership Conference
• Expedition 2004 Exploring the Boundaries of
  Urban MCH
• September 11 - 14, 2004
• Hilton Portland
• Portland, OR

2
I have the right to know what is written about
me. You have the duty to plan responsibly with
me. Then, we can all act on behalf of our health
and the future of our little girls. - Lisa,
Promotora.
3
ISSUE

• Perinatal transmission prevention is most
  effective in the presence of appropriate access
  to health education, prenatal care, HIV
  counseling testing and linkages to treatment.
  Who how is examined in the following

4
Rates of HIV-Newborns Los Angeles County by
Service Planning Area (SPA),1995-1998. (Total
Tested 79,242 Total Positive 65)
5
OBJECTIVES

• To recruit members and consumers of the target
  populations as providers and agents of health
  education
• To implement strategies and services designed to
  increase test acceptance rates among women
  without prenatal care and/or a history of
  injection drug use

6
OBJECTIVES (Contd)

• To recruit and train peer service providers to
  make perinatal HIV prevention services more
  accessible to pregnant women
• The increase proportion of pregnant women who
  accept an HIV test
• The increase proportion of pregnant women who are
  offered HIV counseling and testing

7
EXPECTED RESULTS

• Effective co-participation of Promotoras through
  peer model design
• A collaboration of government and community
  partners to reach pregnant women in Los Angeles
  County
• A multi-level intervention that will provide
  accessible prenatal care and perinatal HIV
  transmission prevention services to low-income
  pregnant women

8
METHODS

• System Integration
• Community Partnerships
• Participatory Action Research
• Focus Groups/Interviews
• Lay Health Promoter Approach (Promotora Peer
  Model)
• Multi-Level Intervention
• Social Marketing Campaign
• Provider Training
• Outreach

9
KEY PARTNERS

• Department of Health Services
• Los Angeles County Office of AIDS Programs and
  Policy
• Educational Services
• Prevention Services
• Public Affairs
• Planning Research
• Maternal and Child Adolescent Health
• Pediatric Surveillance of HIV Disease

10
KEY PARTNERS (Contd)

• Los Angeles County Sheriffs Department
• Community Partners
• Los Angeles Family AIDS Network
• Harbor Community Health Center
• East Los Angeles Womens Center
• Promotoras
• Consumers
• Target Population members

11
ROLE OF THE DEPARTMENT OF HEALTH SERVICES

• To create systemic changes in collaboration with
  departmental, interdepartmental and community
  partners
• Provide research-based knowledge to facilitate
  the development of effective prevention
  strategies
• To implement and evaluate key activities of a
  multi-level intervention

12
COST AND RESOURCES

• Multi-level intervention
• 120,000
• Federal/State funds
• Integration of existing resources

13
RESULTS

• Community partnerships facilitated the
  implementation and dissemination of the Loving
  Responsibly HIV prevention campaign
• Participatory training increased the acceptance
  of Promotoras to become active in the
  intervention
• Participant action research and peer
  reinforcement resulted in African-American women
  adopting the Promotoras model
• Outreach in targeted areas increased
  opportunities for leadership and communication
  about perinatal issues in a supportive
  relationship

14
BARRIERS

• System
• Inadequate health insurance
• Fragmentation of services for hardest to reach
  and low-income
• Limited community participation
• Insufficient focus on prenatal and HIV prevention
  services
• Inadequate delivery of services

15
BARRIERS

• System
• Low offer rates and minimal HIV counseling and
  testing
• Cultural distance between providers and patients
• Limited access to HIV counseling and testing
• Lack of outreach to youth, substance users and
  foreign-born.
• Minimal opportunities for women to address
  perinatal issues in a supportive relationship

16
BARRIERS

• Individual
• Fragmented knowledge of services available
• State of fear, isolation
• Distrust of institutional entities
• Stressed social networks and resources
• Domestic and environmental violence
• Incarceration and drug abuse
• Limited language skills
• Divergent future perspectives
• Minimal self-management of health education

17
BARRIER BUSTERS

• Integrate interdepartmental HIV prevention
  resources and programs
• Establish partnerships
• HIV service providers
• Non-HIV service providers
• Community Leaders
• Consumers
• Co-participation of target group members
• To advise
• To reach hardest to reach women
• To provide services as Promotoras

18
BARRIER BUSTERS (Contd)

• Focus outreach in areas of highest estimated need
• Target young women, substance users and
  foreign-born women in social marketing campaign,
  outreach and provider training
• Involve agencies who have earned the trust of
  respective women

19
LESSONS LEARNED

• System Integration is Key
• Ensures collaboration
• Enables coordination of services
• Acceptance Rates of HIV Tests Increase with
• Accessible HIV prevention information
• Peer-based counseling
• Familiar and trustworthy settings
• Culturally and Linguistically Relevant Social
  Marketing Campaigns
• Promote self-management of health education
• Facilitate the adoption of health promotion
  practices
• Increase participatory action

20
LESSONS LEARNED

• Collaboration Works Best when
• Power, decision making and knowledge are shared
  among key partners in government, universities,
  and community stake holders
• Is guided by an advisory group with consumer
  membership
• Promotes fair social structures
• Effective Multi-level Interventions
• Evidence based
• Actively involve key partners in all aspects of
  the research, intervention and dissemination
  process
• Include values central to the research process
  co-participation, supportive relationships,
  social justice and ongoing learning

21
Promotoras Training
22
Promotoras Training
23
Media Campaign Bus Cards
24
Media Campaign Bus Cards
25
Media Campaign Refrigerator Magnets
26
Media Campaign Refrigerator Magnets
27
ResponsesLos Angeles Social Marketing Campaign
28
ResponsesLos Angeles Social Marketing Campaign
29
ResponsesLos Angeles Social Marketing Campaign