Intervention Research Program Literature Review or Cooperative Agreement for AIDS Community-Based Outreach Order Instructions: Research Manuscript: Literature Review Due

Your research manuscript literature review is due by Day 7. This section should be between 6–7 pages long, not including references. In this section, you will establish the limitations of the literature, thereby helping the reader to understand the issue. This literature review serves as the justification for your study.

The topic is on Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program,

Intervention Research Program Literature Review Sample Answer

 

Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program

Intervention Research Program Literature Review Literature Review

The National Institute on Drug Abuse has played an instrumental role in researching and making publications on outreaches as well as intervention programs. One reason attributed to their indulgence into these activities is because of the confidentiality of the information regarding HIV/AIDS. Because of confidentiality issues, there has been an increased need for secrecy so as to avoid stigmatization of the AIDS victims by the other members of their respective communities. As a result, organizations such as NIDA have a higher chance of accessing information regarding the outreaches and AIDS programs (Seal et al., 2010). They are given the mandate to collect information from hospitals among other sources that are relevant towards analysis and compiling of their reports as long as they consider all the moral and ethical requirements of conducting such research. Because of the factors of confidentiality and limitation towards access to data and information, there is limited literature on cooperative agreements while the available literature is outdated.

Dating back to history, NIDA first launched the national multi-site program to facilitate the growth of outreach-based intervention research and services. After the launch, a 29-site program on National AIDS Demonstration Research (NADR) was operationalized in the period between 1987 and 1991. The NADR program was succeeded by another 23-site program which came to be known as the Cooperative Agreement for AIDS Community Based Outreach/Intervention Research Program (National Institute on Drug Abuse, 1995). The program has been in operation since 1990 up to today and its significance is still growing. The multi-site interventions were made the basis of studies by NIDA which led to the tailoring of both the Cooperative Agreement Program and NADR in such a way that it would facilitate the application of approaches and models that would be integrated with communication theories and health behavior theories to help in shaping the perception of the vulnerable populations.

The outreach programs were facilitated by workers who were selected from within the native communities. This decision was supported by the premise that the indigenous workers could make better communicators than those selected from other communities because the natives could provide a reference to various situations that were facing the communities. The workers were charged with the duty of not only raising but also creating awareness on HIV while simultaneously providing materials that could be used by the people for protection. This was done in accordance with the Health Belief Model where the people were given condoms and bleach (Seal et al., 2010).  The health belief model posits that people are bound to change their health behaviors when they are made to believe that they are at serious risk of contracting the disease but they also have an alternative of protecting themselves. The development of the two programs more so the Cooperative Agreement for AIDS Community Based Outreach was aimed at discouraging people in the communities from practicing unsafe sex and drug use. It therefore employed a variety of strategies and messages to educate the people and create awareness. The programs were also described to facilitate the attainment of its objectives.

The workers employed to facilitate the NADR program were also deployed to the communities so as to initiate activities that reduced the risks associated with the use of unsafe drugs and unprotected sex. The target populations for these activities were remote and neglected communities where the use of injectors was prevalent (Jichuan & Kelly, 2014). The strategy employed to reach a large number of people involved face to face communications, provision of prevention services, issuing of relevant literature on HIV/AIDS disease, distribution of the bleach kits used to decontaminate instruments used for injections and lastly the distribution of condoms as one way of promoting safe sex. Several authors including Seal, MacGowan, Eldridge, Charania and Margolis, (2010) support that the NADR program supplemented the Community Based Outreach program thus their functioning was related in most aspects. In both programs, the workers had to make contact with small groups and individuals in not only the NADR sites but also the Community-Based Outreach sites. Network leaders were appointed to oversee the teaching process while making models that would help the locals reduce their risk of exposure to the HIV virus. The networking technique was seconded by the communication theory helped in diffusing information between the groups of people and create awareness on the importance of the programs.

The community based outreaches also encouraged people to use other facilities at their disposal to enhance the issuance of condoms and free drug treatment for the patients. Apart from participating in unstructured projects, NADR was involved in structured activities which entailed confidential practices of assessing and testing HIV. The various sites constructed by NADR and Community-Based Outreach allowed the leaders to tailor make their intervention activities according to the specific needs of the communities. This practice also entailed the use of preferential models to mold and encourage behavior change. Among the data collected for the activities on NADR program state that the testing, guidance and counselling services reached 79% of the people, the number of off street counselling sessions that lasted for an hour were ranked at 89%, the flexibility of the program was rated at 72% while the informative nature of the program was assessed to be at 73% (National Institute on Drug Abuse, 1995). This rating was attained by use of slides and video presentations which attributed towards lively and elaborate presentations which involved demonstrations on how the male condoms were supposed to be used. The bleaching of sharp objects was also demonstrated using the videos and this was rated at 61%.

The NADR sites worked on a strategy that involved a comparison of the effects accrued from the outreach-plus program under the structured activities against the benefits realized from the enhanced outreach-plus program. The comparison was conducted using IDUs that were assigned at random to the various target groups in the communities. The enhanced programs included a series of multiple activities such as role playing, community organizing, counseling for couples, group counseling, or hourly counselling for the vulnerable groups of people (Lopez, 2008). The Cooperative Agreement Programs which in this case are abbreviated as the Community-Based Outreach Program or the Cooperative Agreement has also steered research in the recent past. The investigators established that the Cooperative Agreement Program performed additional activities to those assigned to NADR. Whereas the former had specialized in the two activities elucidated in the preceding chapters, the latter was integrated with field experiments where participants of the exercise were selected at random after which they were assigned outreach plus basic services while in some cases, they were assigned to outreach plus enhanced services.

Furthermore, the National Institute on Drug Abuse, (1995) notes that the Cooperative Agreement Program promoted the adoption of systematic basic activities, which is the other differential element between the two programs. The grantees for the Cooperative Agreement made collaborations with the other leaders so as to develop standard multi-component interventions which were then used during the HIV testing and counseling as follow-up activities after the street outreaches. The other difference between NADR and Cooperative Agreement is that the duration and the content were standardized so that the leaders or the grantees could make a maximum of five contacts lasting for a maximum of 15 minutes. This was accompanied by the provision of education on HIV, recruitment of subjects, servicing referrals, and distribution of condoms and bleach. The recruitment overtures targeted to absorb five people after which they continued to offer their services to willing IDUs without encouraging them to participate in the study. According to empirical data collected in 1996, the grantees appointed for the Cooperative Agreement Program had issued 39000 bottles of the bleach, 32000 bottles of clean water for rinsing.

After five recruitment overtures, outreach workers continued to provide these services to any IDU they encountered, but they no longer urged them to participate in the study. Process data collected in 1996 showed that Cooperative Agreement grantees provided drug users with nearly 39,000 bottles of bleach, 200000 condoms for male, and 32,000 bottles of clean water. These items of goods were distributed to the hidden and vulnerable populations staying in remote areas. The Cooperative Agreement Program had a follow-on outreach where two sessions were used to promote off-street testing and counselling of HIV victims. The components included in the counseling process were demonstrations as it is seen in the case of NADR. The other follow-on activities were rehearsals and demonstrations on the use of condom and needle cleaning. The program was majorly grounded on the self-efficacy theory which encouraged that the grantees and the group leaders had to be trained so as to facilitate precision and efficiency (Lopez, (2008). This is because the theory states that work related skills and behaviors can be best learnt by observing and assimilating of the knowledge acquired.

The theory is a proponent for an apprenticeship which has been proved as an essential strategy towards acquiring both new and old knowledge. The training sessions were more focused on the testing of the HIV antibody. The process of testing and counseling accounted for 30 minutes of the process. The second phase of the follow-on activities involved the undertaking of post-test counseling for people tested with HIV and underwent the training process thus it was awarded 85%. The second session took approximately 25 minutes when there was a small number of untested clients while in the case that the number of tested clients increased, it could take up to 33 minutes. In spite of the differences in the administration of the two sessions, both made use of standardized cards. The cue cards were used to sets of hierarchical data on the messages for risk reduction. The advisor for the IDUs encouraged the people who used extensive drugs on the best therapies that would help suppress their addictions to injecting drugs. This was an initiative that further encouraged people to use alternative drugs rather than injections, the people had to dispose of used needles and syringes among other paraphernalia that could be hard to disinfect using the bleach.

IDUs in sex-related hierarchies were encouraged to have non-penetrative sex, abstain from sexual activities, reduce the number of sexual partners, or use other methods that could protect them against catching HIV infections (Lopez, Krueger & Walters, 2010). The issue of the risk factor was addressed by encouraging the people to use alternative drugs that did not require the sharing of needles and syringes as it is a potential risk factor in the transmission of HIV. A similar study was conducted by issuing the cue cards. The cards reinforced the results collected on the use of crack and the number of people practicing unprotected sexual activities thus these people were advised to use protection when having sex and secondly they were reprimanded to quit drugs altogether. Therefore the impact of the Cooperative Agreement Program has been felt for a long time now as it is still in use. The community-based outreach have been used to design suitable models that have been used to educate groups of people and individuals by way of demonstrations, public awareness, training, and HIV testing and counseling.

According to the Substance Abuse and Mental Health Services Administration, it is identified that the formation of the Cooperative Agreement was steered by the need to provide additional feature to the NADR program which employed the use of a generalized approach to outreach.  Hence, it is stated that the purpose of the Cooperative Agreement for AIDS Community Based-Outreach was to assess and monitor the prevalence of risky behaviors among the marginalized and vulnerable communities (Lopez, 2008). The outreach was also concerned with the identification of the rate of HIV infections, the use of injection drugs and the possible treatment to these addictions and unsafe lifestyles.

Intervention Research Program Literature Review References

Jichuan, W. & Kelly, B. (2014). Gauging regional differences in the HIV prevalence rate among injection drug users in the US. Open Addiction Journal.

Lopez, W. (2008). High-risk drug use and sexual behaviors among out-of-treatment drug users: An aging and life course perspective. Texas: University of Texas School of Public Health.

Lopez, W. D., Krueger, P. M. Walters, S. T. (2010). High-risk drug use and sexual behaviors among out-of-treatment drug users: An aging and life course perspective. Addictive Behaviors. 35, (5), 432-437.

National Institute on Drug Abuse. (1995). Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program, 1990-Present. Rockville, Md.: NIDA.

Seal, D. W.,  MacGowan, R. J., Eldridge, G. D., Charania, M. R., & Margolis, A. D. (2010). Chapter 15: HIV behavioral interventions for incarcerated populations in the United States: A critical review. African American and HIV/AIDS: Understanding and Addressing the Epidemic. New York: Springer.