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We will conduct formative research to inform the design of a discrete choice experiment (DCE) that will quantitatively assess the relative importance of gender, ethnicity and sexual orientation in providers’ decisions to provide Prevention with Positives (PWP) counseling. In the DCE, providers will be presented a variety of scenarios in which factors that impact provision of PWP counseling are varied. Information from their responses will be used to quantitatively assess the relative impact of each of the factors included in the scenarios on providers’ decisions to provide PWP counseling. This study involves three critical steps:

1. To develop preliminary versions of the questions to be used in clinical scenarios that involve decisions to offer HIV prevention counseling to an HIV+ patient.
2. To pilot test the preliminary questions and scenarios with a sample of 20 providers of HIV care in order to finalize the language used in the scenarios.
3. To obtain preliminary information from the 20 provider interviews on responses to DCE scenarios in order to estimate the number of scenarios and participants required.

The first aim will be accomplished by convening three focus groups of key informants with expertise of relevance to PWP counseling. Investigators will present broad outlines of potential scenarios and will ask informants to critique and help refine language that will become part of the information presented in the scenarios, of the questions to be asked during the scenarios, and of the potential response options. For the second and third aims, we will conduct 20 formative interviews with HIV providers in the greater San Francisco Bay Area. Specifically, we will employ cognitive interviewing techniques, in which we present the scenarios, questions, and potential answer options to participants, and ask them to explain their understanding of the items and the thinking that goes into their selection of a response. Providers will also complete a short assessment of their beliefs about clinical care and about their personal characteristics (e.g., race/ethnicity, gender, sexual orientation, professional training). Information from the cognitive interviews will be used to finalize response options, scenarios and sample size to be used in a full DCE study.

UCSF has a long and successful history of delivering Capacity Building Assistance (CBA) to Community-based Organizations (CBO), going back to the beginning of the epidemic. We provide information dissemination services, training, and technical assistance (TA), including the facilitation of peer-to-peer learning. Our CBA providers are also experienced at helping CBOs use social media in their prevention efforts. The purpose of our CBA project is to increase the capacity of the HIV prevention workforce at CBOs to optimize the planning, implementation, and maintenance of interventions and strategies for HIP. By doing so, UCSF will further the HIV prevention goals and objectives outlined in the National HIV/AIDS Strategy. Our Capacity Building Assistance (CBA) team includes expert CBA providers from UCSF’s Center for AIDS Prevention Studies (CAPS), Center of Excellence for Transgender Health (CoE), and Alliance Health Project (AHP—formerly AIDS Health Project). Additionally, we collaborate with the Bridging Group. We have the experience and expertise to provide HIP-related CBA services to CBOs to improve their capacity to conduct HIV testing, prevention with HIV-positive individuals, and prevention with high-risk HIV-negative individuals, especially:

• Gay/bisexual/and other men who have sex with men
• Transgender women
• Communities of color
• Incarcerated populations
• Injection drug users

While we can assist CBOs implementing and adapting a broad variety of evidence-based HIV prevention approaches, our team has specialized expertise on the following interventions and public health strategies:

• The Mpowerment Project (MP)
• Personalized Cognitive Counseling (PCC)
• Couples HIV Testing and Counseling (CHTC)
• Healthy Relationships (HR)
• Social Network Strategy for Counseling, Testing, and Referral (SNS)
• Project START
• The Bridging Group

The AIDS Education and Training Centers’ National Evaluation Center (AETC NEC) provides evaluation development and technical support to the national AIDS Education and Training program, a network of 11 regional centers conducting targeted, multidisciplinary education and training programs for health care providers treating persons living with HIV/AIDS. Through a national network of more than 130 local performance sites (LPSs) and four national centers, the AETCs target training to providers who serve minority populations, the homeless, rural communities, incarcerated persons, community and migrant health centers, and Ryan White Program-funded sites. As one of the national centers, the AETC NEC’s mission is to provide leadership in the development, design, testing and dissemination of effective evaluation models for determining the effect that AETC clinical education and training programs have on increasing trainee knowledge and skills and improving clinical practice. In collaboration with HRSA/HAB, the specific aims for the Center are:

• Aim 1 (Development): Design and conduct rigorous evaluation research across AETC regions and national centers that will measure the effectiveness and impact of training and education on clinical practice; uncover barriers and challenges to applying new knowledge and skills; and have maximum impact on evaluation practice and policy across the AETC network.
• Aim 2 (Capacity Building): Stimulate innovative evaluation projects and ensure scientific excellence by developing, designing and implementing outcome evaluation projects collaboratively in each region across the AETC network, as well as the organizational capacity to ensure integrity and quality of evaluation research.
• Aim 3 (Replication): Enhance evaluation across the network by adapting proven methods for measuring AETC clinical training outcomes and applying them across local performance sites, regions and national centers.
• Aim 4 (Support): Provide methodological (both quantitative and qualitative) evaluation research design consultation and technical support to AETC regional and national centers as they implement innovative tools and best practices for measuring training outcomes.
• Aim 5 (Dissemination): Disseminate findings from evaluation projects so that they have optimum impact on further HIV clinical education and training programs.

Six Pacific AIDS Education and Training Center (PAETC) local performance sites (LPSs) will target medical settings for activities to promote and support expanded HIV testing, per the 2006 Centers for Disease Control and Prevention Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. This decentralized model provides services based on an understanding of the local epidemic and local health care delivery services. The Hawai’i, Nevada and Arizona AETCs will each work with one hospital-based labor and delivery department to implement rapid HIV testing with women presenting in labor with no prenatal care or documented HIV test result. The East Bay and San Francisco AETCs will each work with one community health center (CHC) or public health clinic to implement opt-out HIV testing when feasible, given state laws and regulations, for primary care clients between the ages of 13 and 64. The University of California Los Angeles AETC will identify and target four CHCs in Los Angeles to expand HIV testing with primary care patients. All targeted health care settings will serve a majority of minorities, primarily Latinos and African Americans in California, Arizona and Nevada, and Pacific Islanders in Hawai’i. The LPSs will use a technical assistance model that includes identification of key decision-makers, support to implement clinic policies and procedures, and accompanying staff training. The San Francisco AETC will develop a binder of resource materials to support implementation in CHC settings. Materials will consist of:

• Federal guidelines and recommendations for testing and initial diagnosis
• Sample protocols, policies and procedures
• Fact sheets
• Staff training materials
• Patient education materials
• State regulations on testing and reporting
• References and resources

The LPSs that work with labor and delivery settings will use PAETC’s resources and reference manual developed for our current California Office of AIDS-supported Rapid Testing in Labor and Delivery program. Level I and II training will be provided to physicians, nurses, nurse practitioners, physician assistants, and pharmacists.