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The Transitions Project provides capacity building assistance (CBA) and technical assistance to community-based organizations (CBOs) and health departments throughout the US to promote knowledgeable, sensitive, and effective HIV/AIDS prevention for transgender communities of color and HIV+ transgender people. The project particularly focuses on young transgender women of color. The goals of the Transitions Project are:

• To improve healthcare providers’ awareness around issues that impact trans health and access to healthcare.
• To expand the capacities of HIV/AIDS prevention organizations in order to serve trans clients more effectively.
• To increase transgender-specific resources in community-based health promotion programs.
• To promote community building and networking among trans and gender-variant persons and allied service providers and advocates.
• To help adapt evidence-based interventions that were originally developed for other populations so that they are culturally appropriate and relevant to young trans women of color.

The Transitions Team is available for consultation, training, capacity-building and technical assistance throughout the United States.

This three-year capacity building project targets labor and delivery departments in 120 California hospitals to implement HIV rapid testing with women presenting in labor with no previous documented HIV test or prenatal care. These women may be the hardest-to-reach populations who prefer to avoid contact with the health care system, such as migrant women, undocumented women, drug-addicted women, women who engage in sex work, and women with a child protective services history. Project components include:

• Curriculum development to train labor and delivery staff
• Development of materials (such as sample policies, procedures, patient education materials, consent forms, etc.) to support implementation of rapid testing
• Staff training
• On-going technical assistance to ensure policies are followed and antiretroviral prophylaxis medications are readily available when needed

The project uses a decentralized model, with implementation activities based at PAETC’s 11 local performance sites in California with oversight and management from PAETC’s Central Office at UCSF. This project is supported by a contract with the California State Office of AIDS, with CDC funds.

Through this project CAPS is partnering with the California Office of AIDS (OA) to provide on-going support for the Local Evaluation On-Line (LEO) system in California. LEO is a web-based information system that enables California’s prevention providers to systematically collect and access information that is critical to effectively prevent HIV infection. It provides primarily process monitoring and client-based evaluation data on a number of intervention activities (e.g., individual or group-level), and eventually it will provide data on how these local interventions are affecting HIV infection rates in the area being served. LEO combines all of the OA HIV prevention data-based systems into one integrated system. Our team will assist with the implementation process. Currently, our team provides programmatic technical assistance, including the use of data for evaluation of local programs’ effectiveness. We assist the OA staff on the development and implementation of HIV Education and Prevention Scopes of Work between the OA and the Local Health Jurisdictions, including assistance with the development of their LEO data-system and reviewing and approving interventions in the LEO system. Additionally, our evaluation and prevention scientists are currently analyzing LEO system data to learn more about the epidemic in California, as well as how effectively local and statewide efforts are at addressing the epidemic.

In collaboration with investigators at the Francois-Xavier Bagnoud Center at the University of Medicine and Dentistry of New Jersey, we are developing and pilot testing a set of evaluation tools for use by clinical sites implementing routine HIV screening in primary care settings in accord with updated guidelines released by the CDC in 2006. The tools will help staff in these settings to assess:

• Patient and provider preferences
• Satisfaction and attitudes with respect to CDC recommended practice, including opt-out screening
• Patients’ perceptions of their ability to decline testing
• Sufficiency and effectiveness of methods used to impart information prior to testing
• Acceptability of different methods for providing test results Development of the patient assessment tool has been accomplished in two steps.

In the first, we conducted interviews with patients who were routinely tested for HIV in the Kansas City Free Clinic. Results from the first phase were used to develop a quantitative assessment of patient attitudes, reactions and acceptance of new models for HIV screening and prevention and their outcomes in terms of patient care. In the second step, this assessment will be validated through administration to as many as 450 patients seen in three sites nationally, one emergency room and two primary care settings (one seeing primarily privately insured patients, the other publicly-insured ones). The provider tool was developed and tested at San Francisco General Hospital. Findings from this project will be collected in a toolkit of clinical evaluation instruments and protocols for assessing patient experiences and outcomes associated with the enhanced screening projects. The toolkit will be disseminated through tailored technical assistance provided through the Health Resources and Services Administration’s (HRSA) AIDS Education and Training Centers program.