The Challenges of Assessing Fidelity to Physician-Driven HIV Prevention Interventions: Lessons Learned Implementing Partnership for Health in a Los Angeles HIV Clinic
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Documenting fidelity to HIV prevention interventions is critical to ensure consistency in intervention implementation and necessary for measuring intervention exposure and, ultimately, outcomes. Significant variation from prescribed protocols or inconsistent implementation can jeopardize the integrity of evaluation research and render outcomes uninterpretable. There is increasing support for HIV prevention models targeting seropositive individuals designed to be delivered by physicians during clinic visits. Assessing fidelity to physician-delivered interventions that occur during clinical exams present unique challenges. This paper presents findings from various data sources designed to track intervention fidelity and exposure to the Partnership for Health intervention, a physician-delivered HIV prevention intervention implemented in an urban community HIV clinic. We present findings from chart abstraction data, patient surveys and exit interviews, and provider qualitative interviews. Lessons learned and recommendations for maximizing the accuracy and validity of fidelity assessment in future evaluations of HIV prevention interventions in primary care settings are considered.
- Aberg, J. A., Gallant, J. E., Anderson, J., Oleske, J. M., Libman, H., Currier, J. S., Stone, V.E., Kaplan, J.E. & the HIV Medicine Association of the Infectious Diseases Society. (2004). Primary care guidelines for the management of persons infected with human immunodeficiency virus: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases, 39(5), 609–629.
- Barfod, T. S., Hecht, F. M., Rubow, C., & Gerstoft, J. (2006). Physicians’ communication with patients about adherence to HIV medication in San Francisco and Copenhagen: A qualitative study using Grounded Theory. BMC Health Services Research, 4, 6–154.
- Calfas, K. J., Long, B. J., Sallis, J. F., Wooten, W. J., Pratt, M., & Patrick, K. (1996). A controlled trial of physician counseling to promote the adoption of physical activity. Preventive Medicine, 25(3), 225–233. CrossRef
- CDC. (2003). Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recommendations and Reports, 52(RR-12), 1–24.
- Collins, C., Harshbarger, C., Sawyer, R., & Hamdallah, M. (2006). The diffusion of effective behavioral interventions project: Development, implementation, and lessons learned. AIDS Education and Prevention, 18(4 Suppl A), 5–20. CrossRef
- Cornuz, J., Zellweger, J. P., Mounoud, C., Decrey, H., Pécoud, A., & Burnand, B. (1997). Smoking cessation counseling by residents in an outpatient clinic. Preventive Medicine, 26(3), 292–296. CrossRef
- Dumas, J. E., Lynch, A. M., Laughlin, J. E., Smith, E. P., & Prinz, R. J. (2001). Promoting intervention fidelity conceptual issues, methods, and preliminary results from the EARLY ALLIANCE prevention trial. American Journal of Preventive Medicine, 20(1 Suppl), 38–47. CrossRef
- Epstein, R. M., Levenkron, J. C., Frarey, L., Thompson, J., Anderson, K., & Franks, P. (2001). Improving physicians’ HIV risk-assessment skills using announced and unannounced standardized patients. Journal of General Internal Medicine, 16(3), 176–180. CrossRef
- Epstein, R. M., Morse, D. S., Frankel, R. M., Frarey, L., Anderson, K., & Beckman, H. B. (1998). Awkward moments in patient–physician communication about HIV risk. Annals of Internal Medicine, 128(6), 435–442.
- Erbelding, E. J., Stanton, D., Quinn, T. C., & Rompalo, A. (2000). Behavioral and biologic evidence of persistent high-risk behavior in an HIV primary care population. AIDS, 14(3), 297–301. CrossRef
- Fisher, J. H., Fisher, W. A., Cornman, D. H., Amico, K. R., Bryan, A., & Friedland, G. H. (2006). Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-Infected Patients. Journal of Acquired Immune Deficiency Syndromes, 41, 44–52. CrossRef
- Golin, C. E., Smith, S. R., & Reif, S. (2004). Adherence counseling practices of generalist and specialist physicians caring for people living with HIV/AIDS in North Carolina. Journal of General Internal Medicine, 19(1), 16–27. CrossRef
- Janssen, R. S., Holtgrave, D. R., Valdiserri, R. O., Shepherd, M., Gayle, H. D., & DeCock, K. M. (2001). The serostatus approach to fighting the HIV epidemic: Prevention strategies for infected individuals. American Journal of Public Health, 91(7), 1019–1024. CrossRef
- Johnson, M. O., & Remien, R. H. (2003). Adherence to research protocols in a clinical context: Challenges and recommendations from behavioral intervention trials. American Journal of Psychotherapy, 57(3), 348–360.
- Kalichman, S. C., Rompa, D., Cage, M., DiFonzo, K., Simpson, D., Austin, J., Luke, W., Buckles, J., Kyomugisha, F., Benotsch, E., Pinkerton, S., & Graham, J. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. American Journal of Preventive Medicine, 21(2), 84–92. CrossRef
- Keitz, S. A., Stechuchak, K. M., Grambow, S. C., Koropchak, C. M., & Tulsky, J. A. (2007). Behind closed doors: Management of patient expectation in primary care practices. Archives of Internal Medicine, 167(5), 445–452. CrossRef
- Koropchak, C. M., Pollak, K. I., Arnold, R. M., Alexander, S. C., Skinner, C. S., Olsen, M. K., Jeffreys, A. S., Rodriguez, A. L., Abernethy, A. P., & Tulsky, J. A. (2006) Studying communication in oncologist–patient Encounters: The SCOPE Trial. Palliative Medicine, 20(8), 813–819. CrossRef
- Malitz, F. E., & Eldred, L. (2007). Evolution of the special projects of national significance prevention with HIV-infected persons seen in primary care settings initiative. AIDS and Behavior, 11(5 Suppl), S1–S5. CrossRef
- Marks, G., Richardson, J. L., Crepaz, N., Stoyanoff, S., Milam, J., Kemper, C., Larsen, R. A., Bolan, R., Weismuller, P., Hollander, H., & McCutchan, A. (2002). Are HIV care providers talking with patients about safer sex and disclosure?: A multi-clinic assessment. AIDS, 16(14), 1953–1957. CrossRef
- McGowan, J. P., Shah, S. S., Ganea, C. E., Blum, S., Ernst, J. A., Irwin, K. L., Olivio, N., & Weidle, P. J. (2004). Risk behavior for transmission of human immunodeficiency virus (HIV) among HIV-seropositive individuals in an urban setting. Clinical Infectious Diseases, 38(1), 122–127. CrossRef
- Morin, S. F., Koester, K. A., Steward, W. T., Maiorana, A., McLaughlin, M., Myers, J. J., Vernon, K., & Chesney, M. A. (2004). Missed opportunities: Prevention with HIV-infected patients in clinical care settings. Journal of Acquired Immune Deficiency Syndromes, 36(4), 960–966. CrossRef
- Ockene, J. K., Adams, A., Hurley, T. G., Wheeler, E. V., & Hebert, J. R. (1999). Brief physician-and nurse practitioner-delivered counseling for high-risk drinkers: Does it work? Archives of Internal Medicine, 159(18), 2198–2205. CrossRef
- Ockene, J. K., Kristeller, J., Goldberg, R., Amik, T. L., Pekow, P. S., Hosmer, D., Quirk, M., & Kalan, K. (1991). Increasing the efficacy of physician-delivered smoking interventions: A randomized clinical trial. Journal of General Internal Medicine, 6(1), 1–8. CrossRef
- Richardson, J. L., Milam, J., McCutchan, A., Stoyanoff, S., Bolan, R., Weiss, J., Kemper, C., Larsen, R. A., Hollander, H., Weismuller, P., Chou, C. P., & Marks, G. (2004). Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: A multi-clinic assessment. AIDS, 18(8), 1179–1186. CrossRef
- Sleath, B., Chewning, B., de Vellis, B. M., Weinberger, M., de Vellis, R. F., Tudor, G., & Beard, A. (2008). Communication about depression during rheumatoid arthritis patient visits. Arthritis and Rheumatism, 59(2), 186–191. CrossRef
- Wenrich, M. D., Curtis, J. R., Carline, J. D., Paauw, S. D., & Ramsey, P. G. (1997). HIV risk screening in the primary care setting. Assessment of physicians skills. Journal of General Internal Medicine, 12(2), 107–113.
- The Challenges of Assessing Fidelity to Physician-Driven HIV Prevention Interventions: Lessons Learned Implementing Partnership for Health in a Los Angeles HIV Clinic
AIDS and Behavior
Volume 12, Issue 6 , pp 978-988
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- HIV prevention
- Seropositive patients
- Primary care
- Industry Sectors
- Author Affiliations
- 1. Community Health Outcomes and Intervention Research Program, The Saban Research Institute, Childrens Hospital Los Angeles, 6430 Sunset Blvd., Ste. 1500, Los Angeles, CA, 90028, USA
- 2. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- 3. Office of AIDS Programs and Policy, Los Angeles County Department of Public Health, Los Angeles, CA, USA
- 4. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA