Georgia HIV/STD Systems Evaluation Project

Advisory Board Meeting Summary Report

September 17-18, 1998

Savannah, Georgia

History

In December 1997 the Division of Public Health of the Georgia Department of Human Resources contracted with the Department of Psychology at Georgia State University to conduct a statewide assessment of HIV/STD public health delivery systems. The HIV / STD Systems Evaluation Project was charged to examine the following focal areas: models of counseling, testing, referral, and partner notification; training; access to health care; strengths and challenges in data collection and surveillance systems; and collaboration between and within health districts and between health districts and state agencies, community-based organizations, and private health care providers.

During June, July, and August 1998 the project team conducted a series of regional meetings to introduce the evaluation and project team to public health district staff. At these meetings, the following the following issues were discussed:

• the parameters and scope of the project as then conceptualized
• the rationale for the project in the current political and budgetary context
• initial timeline and general methodological plans, including preliminary site vists
• the development of an advisory board.

The preliminary site visits subsequently occurred from July to November 1998. The site visits were a tremendous success and a report documenting general findings will be forthcoming.

On September 17 and 18, 1998 the project team conducted an inaugural two-day advisory board meeting in Savannah, Georgia. The advisory board was made up of two representatives from each health district; many of these representatives serve a dual role and function as the project contact as well. The purpose of the advisory board is to provide the project staff with knowledgeable contacts who work in varying capacities within the public health department. These “experts” act as a sounding board for the project team as the evaluation methodology, goals, and data collection methods are developed. For example, the advisory board will be critical to the development of the in-depth study, because members can determine whether the project team would benefit from certain activities, and whether the team would adversely affect clinic operations. This first advisory board meeting provided the opportunity for the project team to explain further the goals of the evaluation, address advisory board member's questions and concerns, and update members on the progress to date. This report summarizes the activities and discussions of the advisory board meeting.

Meeting Goals and Project Update

The meeting began as Chauncey Cherry, Research Coordinator, welcomed district health primary and secondary advisory board members. Chauncey introduced new HIV/STD Systems Evaluation Project team member, Rich Mudge, and described progress on the preliminary site visits. Sarah Cook, project co-director, reviewed the concept of the advisory board and further defined its purpose. The goals of the meeting were to solicit:

1. feedback from the district health primary and secondary contacts about the preliminary site visits,
2. district-centered ideas about the content of the in-depth study, and
3. district-centered ideas about the criteria for the in-depth study site selection.

During the project update, several advisory board members expressed concern that the project goal statement uses the term “health delivery systems,” which seemingly omits activities outside of health delivery, such as surveillance, partner notification, and collaboration with community-based organizations. These representatives felt that the definition was too narrow. One expressed opinion was that public health priorities should extend beyond the delivery of health care to the assessment of health status, assurance of essential services, a healthy environment, health promotion, and policy leadership. Project staff agreed to address the issue with the Division of Public Health.

Preliminary Site Visit Feedback

The Advisory Board had small group discussions with HIV/STD Systems Evaluation Project team members to ask questions, offer feedback about the preliminary site visit process, and share observations about salient characteristics of each health district. Sarah Cook and Jim Emshoff met with districts that had not yet experienced a Preliminary Site Visit to explain the format and goals of the preliminary site visit. Valuable information was obtained, and team members and representatives alike appeared to appreciate the time spent discussing the progress made on the evaluation thus far.

District-Centered Ideas about Evaluation Content and Focus

The HIV/ STD Systems Evaluation Project utilized a technological tool called Concept Mapping to solicit input on the goals and content of the evaluation. Concept Mapping is both a specialized group process and statistical and graphics software program that first produces and then in a highly structured, hierarchical manner, analyzes and organizes data in the form of participants opinions and perceptions.

Arlene Edwards facilitated the concept mapping exercise. A preliminary report on the exercise was distributed in late October (a final report will be completed by mid December). This exercise enabled project staff to learn what advisory board representatives would like to learn from the evaluation. The most useful outcome of the concept mapping exercise was the finding that the majority of the health districts' expectations for the evaluation matched general framework of the evaluation plan (i.e. the focal areas).

Communication

Matt Ramsey announced the development of both a web page and an electronic discussion list for the HIV/STD Systems Evaluation Project. The web page is being developed and maintained by the HIV/STD Systems Evaluation Project team and will provide general information, updates, dates for future meetings, visits, and other events, as well as project documents.

The list serve discussion group can be accessed by subscribing to the following Internet address: LISTPROC@LISTPROC.GSU.EDU. When subscribing to the list serve discussion group, advisory board members or primary district contacts can send a message to the above email address with the following statement in the body of the message:

SUBSCRIBE HIV/STD PREVENT YOUR NAME

Members are encouraged to subscribe to the discussion group as soon as possible so that information can be disseminated electronically. Ideally, the list will serve as a valuable tool to increase communication between health districts.

Selecting In-depth Study Sites

A discussion on Friday concerned the best method for selecting sites for inclusion in the in-depth study. The project team wanted advisory board members' consultation on this process because the members are the experts regarding health district functions, similarities, and differences. The advisory board raised the possibility of random selection of sites, but this method would not be beneficial because it is possible many unique aspects of sites would not be available for evaluation.

Advisory board members responded in earnest and provided valuable ideas on considerations that could guide the selection of the in-depth study sites. The project staff is currently utilizing suggestions made during this discussion, and sites will be chosen soon as the in-depth study is anticipated to begin in early January.

Ideas, suggestions, and considerations made during this discussion included the following:

• Population density
• Poverty measures
• Health status indicators (mortality, infant mortality, years of premature life loss, etc.)
• Overlay with geography (sample different environments). Consider border states, metro-Atlanta, rural districts, etc.
• Use of behavioral surveys (Suggestion: Could these be aggregated and made district specific if combine multiple years?)
• State indicators
• Internal areas of the district (what are they allowed and not allowed to do?)
• Look outside public health at what the community has available as far as medical care. (Number of private physicians, number of hospitals...) This impacts what functions public health fulfills.
• Measure of percentage of hospitalizations allowing uninsured patients. This could be used as a measure of the burden of health care that needs to be taken care of.
• May be useful to have an economist on our team.
• Tie issues into funding. What money is available in the community, who has this money, and how is this impacted by public health?
• Suggestion: Use Metro –Atlanta as a benchmark. Evaluate the least supported districts, then move back up to mid-level. Could this give us a view of trends? Problems with this idea: transmigration of populations. Migration of many at-risk individuals will not be visible, which is especially important with regards to funding. One site suggested that Metro-Atlanta is often viewed as “having it all”, but they really do not. When resources are limited, they risk to the occasion and function as best they can, so it would be difficult to compare them to other districts. Another individual reiterated that it would be less of a comparison and more of a benchmark.
• Consider morbidity and mortality as a benchmark.
• Discussion continued regarding metro-Atlanta. Metro counties are different among themselves. Consider culture, diversity, language barriers, affluency. Metro is not homogenous.
• Consider in terms of the degree of services health departments provide to other state agencies.
• Consider amount of staffing. (Amount of people working, positions, etc.) Some areas go into jails and do screening, but others do not have staffing to do this. Therefore, staffing may affect disease rates.
• Revisit prevalence studies. Rates of infection.
• Unique programs – look at what districts are doing. If a district is doing something no one else is, maybe it is worth including in the in-depth study.
• Migrant population and diversity needs to be considered
• Consider Ryan White funding – Who has what types? Who has grants through the Health Department? Some sites subcontract with other organizations. What is the extent of contracting with other agencies?
• Consider collaboration across districts

Ideas, suggestions, and discussion made during the advisory board meeting that relate to general public health needs:

• STD needs including:

1. Behavioral focus (academic, media, etc.)
2. Advisory body
3. Better surveillance of diseases, behaviors, complications
4. Collaboration with medical schools
5. Improve work with hard to reach populations
6. Improve work with CBO's to reach partners

• Consider how epidemiologists are utilized. Are there resources within the district that epis could be involved with but are usually covered by other staff members such as health educators? How are districts staffed and what are the local responsibilities?

• Public health priorities should include:

1. Assessment of health status
2. Assurance of essential services
3. Healthy environment
4. Health promotion
5. Policy leadership

Next Steps

Sarah concluded the Advisory Board Meeting by thanking all advisory board members for their attendance, participation, suggestions, and feedback. A total of 14 Advisory Board Meeting evaluations were completed and returned. Overall, participants were satisfied with travel arrangements, scheduling and accommodations. Moreover, participants reported that they had a clear understanding of the function of the advisory board and its relationship to the project, and their role as members (see attached).

Through healthy and informative collaboration such as this meeting, this evaluation will continue to progress and develop in a positive fashion. The project staff appreciates the participation of all district health department staff, including advisory board members, project contacts, and other individuals interacting with this evaluation. Project staff will contact health districts in early December regarding the next phase of the study. The Advisory Board will not meet again until early 1999. It is likely that the Advisory Board will meet formally once or twice more, but they will be contacted via conference calls and the Internet (electronic mail and World Wide Web).

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