Form 2 Submission Form

draft Emerging Strategies Submission Form Content

Purpose of Document

The HRSA HAB Ryan White HIV/AIDS Program (RWHAP) Compilation of Best Practice Strategies and Interventions (Best Practices Compilation), housed on TargetHIV.org, will allow recipients and sub-recipients to share emerging strategies for replication.

To support the development of this Best Practices Compilation, JSI has developed a two-part submission process to identify emerging strategies to include in the compilation: a four question screening form and an emerging strategy submission form.

The screening questions will appear on the best practices landing page on TargetHIV.org for recipients and subrecipients to complete to see if they are eligible to complete the full submission form on their emerging strategy. If they answer yes on all four questions, they will automatically be invited to complete the online submission form. If they answer no to any of the questions, the screening form will end (need to develop thank you script, including email to contact us for more information).

The information collected on the submission form will be used to 1) score the emerging strategy for potential inclusion into the Best Practices Compilation, and 2) populate the content for the Best Practices Compilation.

1. LANDING PAGE DESCRIPTION

This is the information that users will see when they arrive on the emerging strategies page on TargetHIV.org. It describes the purpose of the Best Practices Compilation and invites users to submit their emerging strategy. Note that this landing page will be edited at a later date to incorporate language on evidence-based and evidence-informed interventions.

Do you have an innovative strategy that you have implemented in your HRSA HIV/AIDS Bureau (HAB) Ryan White HIV/AIDS Program (RWHAP) that is showing success or has the potential to improve the lives of your clients? We want to learn more!

HRSA HAB is looking to document and share new strategies that improve the quality of life of people with HIV and can be implemented by RWHAPs. These strategies do not require rigorous evaluation or published evidence, but must work for the RWHAP care and treatment setting.

Our goal is to share information on the TargetHIV.org website on these emerging strategies that support the HIV care continuum with other RWHAP-funded programs looking to achieve similar outcomes.

Emerging strategies meet the following criteria:

• The strategy has been implemented in a RWHAP-funded setting for at least 12 months.

• Your agency has evaluated or is evaluating this strategy and has seen improvements in one or more HIV care continuum outcomes - either directly or indirectly.

An example of a strategy that directly influences an HIV care continuum outcome is an innovative peer model that links newly diagnosed clients to medical care.

An example of a strategy that indirectly influences an HIV care continuum outcome is one that focuses on a practice or social determinant of health, such as housing, that in turn results in an improved HIV care continuum outcome.

• Your evaluation results are not published or you are not planning to publish in a peer-reviewed journal, because we are looking for new or novel approaches that may not have been widely implemented or rigorously evaluated.

• Your agency is willing to share this practice with the RWHAP via the TargetHIV.org website.

Please complete this online submission form- it should take (add total time when we can better estimate it) to describe your strategy, the clients reached, and the effect on your RHWAP clients. We will be reviewing the submissions and following up with sites in [add timeline].

Please note that some of the information provided will be used to review the strategy for inclusion into the online compilation, while other information will be used to develop an online profile of your strategy. You will have the opportunity to review and approve any information that will be shared publicly in the online compilation.

Please contact bestpractices@jsi.com with any questions about this project.

2. EMERGING STRATEGY PRE-SUBMISSION FORM SCREENING QUESTIONS

1. Was this strategy implemented in a RWHAP setting for at least 12 months?

• Yes  Continue to Q2

• None  End form [need to develop thank you and explanation script]

2. Does your strategy influence a HIV care continuum outcome(s) either directly or indirectly by focusing on an intermediate outcome shown to influence care continuum outcomes? An example of directly influencing HIV care continuum outcomes is a peer model that links clients to HIV treatment. Examples of influencing an intermediate outcome shown to influence HIV care continuum outcomes includes strategies focused on increasing placement of people with HIV in permanent housing, enrollment in health insurance, or provision of trauma-informed care.
   
   

HIV Care Continuum Outcomes

• HIV diagnosis

• Linkage to HIV medical care

• Retention and engaged in HIV medical care

• Prescription of antiretroviral therapy (ART)

• Viral Suppression

• Yes  Continue to Q3

• No  End form [need to develop thank you and explanation script]

3. Have you published (or are planning to publish) any evaluation findings from your strategy in a peer-reviewed journal? (Select only one below)

• Yes, published or planning to publish evaluation findings in peer reviewed journal  End form [need to develop explanation script about focus of these programs on ES, pending decision by HAB on where to route EBIs/EIIs*]

• Evaluation findings not published/not planning on publishing in peer-reviewed journal  Continue to Q4

• This strategy has not yet been evaluated or is not being evaluated End form [need to develop thank you and explanation script]

4. Are you interested in describing and sharing your strategy with the RWHAP community via a website link on TargetHIV.org?

• Yes  Continue with Emerging Strategy Submission form below

• No  End form [need to develop thank you and explanation script]

*Note: this is where strategies and interventions will be triaged for EBI and EII review.

3. EMERGING STRATEGIES SUBMISSION FORM QUESTIONS

To start, please provide basic program information for your emerging strategy submission.

1. Please provide your contact information in case we have any questions on your submission:

   1. Name [text field]: _________________

   2. Affiliation (e.g. Organization, Agency, etc.) [text field]: _________________

   3. Position/Role [text field]: _________________

   4. Email Address [text field]: _________________

   5. Phone Number [text field]: _________________

2. What RWHAP funding does your organization receive? (Select all that apply)

Part A



Part B



Part C



Part D



Part F



None



3. HRSA HAB Project Officer/COR/Project Lead [text field]:______________

General Information and Context of Emerging Strategy

Please tell us about your strategy.

4. Name of strategy [text field – 100 character limit]: _________________

5. What problem or issue does your strategy address? Provide a concise description of the underlying problem that this strategy addresses. Discuss how you identified a need for this strategy. Describe the context that made this solution necessary. What problem were you looking to solve? [text field]: _________________

6. What HIV care continuum outcomes does your strategy aim to impact?
   (Select all that apply)

HIV diagnosis		Prescription of antiretroviral therapy	
Linkage to HIV medical care		Viral suppression	
Retention & engagement in HIV medical care	

7. Does your strategy influence an HIV care continuum outcome directly or indirectly? An example of directly influencing HIV care continuum outcomes is a peer model that links clients to HIV treatment. Examples of indirectly influencing HIV care continuum outcomes includes strategies focused on increasing placement of people with HIV in permanent housing, enrollment in health insurance, provision of substance use treatment, or provision of trauma-informed care. (Select all that apply)

Influences a direct care continuum outcome



Influences an intermediate outcome shown to be associated with improving HIV care continuum outcomes



7a. If an intermediate outcome is the focus of the strategy, please specify the outcome(s): (Select all that apply)

Placement of people with HIV in permanent housing		Screening for intimate partner violence	
Enrollment in health insurance		STI/HCV screening	
Provision of trauma-informed care		Treatment for depression	
Provision of substance use treatment		Navigation from adolescent to adult care	
Linkage from corrections to community providers		Other, please describe: [text field]:______________	

8. What was the strategy that you implemented to address the problem? Provide a brief description of the strategy. This includes the strategy goals, where the strategy was implemented, who the key implementers were, and core elements and activities. [text field]: _________________

8a. Is the strategy developed by your program, adapted from an existing strategy or intervention, or implemented as intended using an existing intervention?

Developed by my program		Implemented as intended using an existing intervention	
Adapted from an existing strategy/intervention	

• If “adapted” or “implemented”  Go to Q8b

• If “developed by my program” No  Skip to Q8c

8b. What is the name of the existing strategy or intervention that you adapted or implemented as intended? [test field]: ____________________________

8c. What makes your strategy innovative (new or novel approaches that may not have been widely implemented that show promise in improving outcomes of clients with HIV) or unique for the RWHAP? [text field]:_____________________

9. What is the type of strategy? (Select all that apply)

Service delivery model		Use of technology or mobile health	
Clinical quality management		Other please describe:_____________________	
Data utilization approach	

10. What are the funded HRSA HAB service categories for this strategy? Note that this list includes those service categories associated with HIV care continuum outcomes (as per HRSA HAB guidance, June 2015). (Select all that apply)

AIDS Drug Assistance Program (ADAP) Treatments		Substance Abuse Outpatient Care	
AIDS Pharmaceutical Assistance		Health Education/Risk Reduction	
Early Intervention Services (EIS)		Medical Transportation	
Home and Community Based Health Service		Non-Medical Case Management Services	
Home Health Care		Outreach Services	
Medical Case Management		Treatment Adherence Services	
Outpatient/Ambulatory Health Services	

Population of Focus for Strategy

11. Which population(s) is/are the primary focus for this strategy? (Select all that apply)

Gay, bisexual, and other men who have sex with men (MSM)		Transgender women	
Black gay and bisexual men		Transgender men	
Black men and women		Persons over 50 years of age	
Hispanic/Latino(a) men and women		Rural populations	
People who inject drugs (PWID)		People in the Southern United States	
Youth ages 13 to 24 years of age		Other, please describe:________________	

11a: Does your strategy specifically aim to reduce ethnic/racial disparities in HIV care continuum outcomes?

Yes



No



• Yes  Go to Q11b

• No  Skip to Q11c

11b: Please describe: [text field}______________________

11b: Was the strategy informed by the key population(s)?

Yes



No



Setting of Strategy

12. Where is this strategy implemented? (Select all that apply)

Community health center, including Federally Qualified Health Centers (FQHCs)		Community based organization/ non-clinical setting	
RWHAP funded clinic or organization		State health department	
Hospital or hospital-based clinic		City/county health department	
Behavioral health settings		Other, please describe: ______________	

13. What is the geographic setting? (Select all that apply)

Rural



Suburban



Urban



Funding of Strategy

14. Were RWHAP funds used to support the development and/or ongoing implementation of the strategy?

• Yes  Go to Q14a

• No  Skip to Q15

14a. If yes, what RWHAP Part(s) funded the strategy? (Select all that apply)

Part A



Part B



Part C



Part D



Part F (SPNS; AETC; DRP; CBDPP)



15. Were other sources of funding used to develop/implement the strategy?

• Yes  Go to Q15a

• No  Skip to Q16

15a. If yes, what were those other funding sources? (Select all that apply)

Minority AIDS Initiative Funding (MAIF)		State funding	
HRSA Bureau of Primary Health Care		City funding	
Centers for Disease Control and Prevention (CDC)		Program income	
Substance Abuse and Mental Health Services Administration (SAMHSA)		Other, please describe: _____	

Strategy Duration

16. In what year was the strategy first implemented by your program?

___ ___ ___ ___ (4 numerical digits for year)

17. Is the strategy currently a part of your program or has it ended?

• Part of current program  Go to Q18.

• No longer part of current program  Continue to Q17a.

17a. If the strategy is no longer part of your program, what are the reasons why not?
(Select all that apply)

Lack of leadership buy-in		Pilot project	
Change in leadership priorities		Funding ended	
Staff were no longer interested		No longer resulted in improved outcomes	
Too time intensive		No longer needed – addressed the clients’ needs	
Replaced with different strategy		Other, please describe: ____________________
Clients or patients were not responsive to program	

Evaluation Methods & Findings

18. What are the evaluation approaches you have used to determine if this strategy is successful or effective? Evaluation approaches could include small qualitative or quantitative local evaluations. (Select all that apply)

Qualitative interviews		Post-only studies	
Focus groups		Comparative case study/case study	
Key informant interviews		Correlation analysis	
Continuous quality improvement (i.e., PDSA cycle review, quality management)		Trend analysis	
Feasibility/pilot studies		Observational studies (e.g., prospective cohort, cross sectional, case-control), etc.]	
Pre/post, uncontrolled studies (e.g., time series, panel design)		Other, please describe: ____________________	

19. How did you measure effectiveness or success of the strategy? Describe the evaluation objectives or questions, process measures (e.g. number of clients linked to HIV medical care for direct outcomes or number of clients receiving trauma-informed care intervention for indirect outcomes), outcome measures (e.g. number of clients who achieved viral suppression), data collection methods, the data sources, frequency of data collection, analysis of data, and definitions of success benchmarks/targets. [text field]:____________________
    
    

20. Was a quality improvement approach used to monitor and inform the strategy implementation?

Yes



No



21. How many cycles of evaluation data were collected on this strategy? A cycle is defined as the completion of one data collection round following strategy implementation. For example, data collected after a 6-month community health worker client engagement strategy would constitute one cycle, including baseline data if available.

One Cycle of Data



Two or More Cycles of Data



22. Please describe the results of the strategy. What were the findings from your evaluation? Describe the outcomes or results of the strategy based on your evaluation methods. What improved? What is different for clients? [text field]:______________
    
    22a: What data demonstrate that the implementation of this strategy was successful, and achieved the desired outcomes that led to change and improvement? These data can be any data collected and used to monitor and evaluate program performance and achievement of outcomes. Data demonstrating impact should ultimately address the underlying problem described above.
    [text field]:______________
    
    
    

Please share key components related to your strategy or implementation development, implementation, and long-term planning. Think about what you would have wanted to know if you were considering to implement your strategy.

Planning and Start-up Needs and Infrastructure

23. What are the key planning steps to put this strategy in place?
    [text field]:______________
    23a: What organization, partnership, and infrastructure needed to be put in place at the start for this strategy to work? [text field]:______________

23b: Please describe how people with HIV and other community stakeholders provided feedback on the strategy design. [text field]:______________

Staffing, Resources, and Partnerships

24. What is the staffing needed to implement this strategy and how much time did each staff member dedicate to its implementation? (e.g., data analyst, case manager, clinical provider?) [text field]:______________

24a: Who are the key partners for this strategy? [text field]:______________

Tools and Resources

24b: What infrastructure, systems or supplies are needed to implement this strategy? [text field]:______________

25. Are there any resources or materials (e.g. implementation manuals, protocols, policies, curricula or other training materials, logic models) that support implementation or evaluation of the strategy available for sharing?

• Yes  Go to Q25a

• No  Go to Q26

25a: Name: [text field]:____
Description of resource: (drop down selection: implementation guide or manual, protocols and policies, other materials (e.g., curriculum, hand-outs, etc))
Document upload: ____
If more than one resource/document: 25b, 25c, etc.

Sustainability Planning

Sustainability

26. How well was this strategy integrated into existing services or processes in your organization sites? [text field]:___________

Fully integrated		Partially integrated	
Minimally integrated		Not at all integrated	

26a: Please describe? [text field]:___________
26b: What were the challenges to sustaining this strategy? [text field]:___________
26c: What would you recommend to sustain this strategy? Please discuss resource requirements such as staffing and infrastructure as well as other components including leadership support, community engagement, policies, partnership, etc.).
[text field]: ___________

Lessons Learned

27. What do you wish you had known from the beginning and would have done differently? What lessons would you share having implemented this strategy?
    [text field]:______________

Program Contact

28. If your strategy is included in the online compilation, please list the name of the primary contact to be listed on the webpage.

• Check if same as person listed in Question 1.  Go to Q29

• Check if different person  Go to below

1. Contact Name [text field]: _________________

2. Affiliation (e.g. Organization, Agency, etc.) [text field]: _________________

3. Position/Role [text field]: _________________

4. Email Address [text field]: _________________

5. Phone number [text field]: _________________

29. Are there any financial or competing interest disclosures, or business/professional affiliations related to the emerging strategy submitted?

• Yes  Please describe [text field]: _______________________

• No

4. References

30. Please provide citations of any references used for this submission content (e.g., needs assessment documents, existing literature about your focus population and priority area). Please describe [text field]: _______________________

5. Language once the form is submitted:

Thank you for your submission and willingness to share your strategy for improving outcomes and quality of life for people with HIV. We may follow up with you with any questions about your strategy. We will review and notify you via email within X-X weeks whether the strategy has been accepted or not for inclusion in the online compilation.

Draft RWHAP Compilation of Best Practice Interventions and Strategies Submission Form Content (Draft 8-30-19) 13