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

Armida Ayala, M.H.A., Ph.D. Arthur DurazoOffice 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, 2004Hilton PortlandPortland, OR

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“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.

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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…

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

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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

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OBJECTIVES (Cont’d)

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

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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

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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

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KEY PARTNERS

Department of Health ServicesLos Angeles County Office of AIDS

Programs and PolicyEducational ServicesPrevention ServicesPublic AffairsPlanning & Research

Maternal and Child Adolescent HealthPediatric Surveillance of HIV Disease

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KEY PARTNERS (Cont’d)

Los Angeles County Sheriff’s Department Community Partners

Los Angeles Family AIDS Network Harbor Community Health Center East Los Angeles Women’s Center

Promotoras Consumers Target Population members

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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

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COST AND RESOURCES

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

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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

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BARRIERS

System Inadequate health insuranceFragmentation of services for hardest to

reach and low-incomeLimited community participation Insufficient focus on prenatal and HIV

prevention services Inadequate delivery of services

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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

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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

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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

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BARRIER BUSTERS (Cont’d)

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

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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

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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

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Promotoras Training

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Promotoras Training

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Media Campaign Bus Cards

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Media Campaign Bus Cards

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Media Campaign Refrigerator Magnets

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Media Campaign Refrigerator Magnets

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ResponsesLos Angeles Social Marketing Campaign

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ResponsesLos Angeles Social Marketing Campaign

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ResponsesLos Angeles Social Marketing Campaign