Field Placement: Los Angeles County Department of Health Services -- Office of AIDS Programs and Policy (OAPP)
Location: Los Angeles, CA
Preceptors: Donald Price (HCT Section Manager), Eduardo Alvarado (Epidemiological Unit Director), and Constance Chavers (Data Analyst )
Student Name: Karin Liu
Year: 2003

The HIV epidemic has long been recognized as a priority area in need of further research and resources. Although the numbers of AIDS diagnoses and related deaths decreased dramatically during 1996 and 1997, since then, they have only stabilized or declined slightly [3]. Primary and secondary prevention therefore play a crucial role in helping to ensure that fewer people become infected with HIV, and that those with HIV will still be able to live healthy lives. The Office of AIDS Programs and Policy (OAPP), a division of the Los Angeles County Department of Health Services, was formulated as a comprehensive response to the HIV/AIDS epidemic in Los Angeles County. The Prevention Services Division (PSD) of the OAPP oversees the provision of HIV prevention services in LA County to reduce HIV incidence, and facilitates the identification of persons infected with HIV [4]. The HIV Counseling and Testing (HCT) section of the PSD aims to prevent new cases of HIV infection from occurring, through client-centered risk reduction counseling, as well as identifying cases of HIV and offering referral services. One of the programs conducted through HCT is the Drug Expansion (DREX) program. As part of the program, HIV prevention counselors funded by OAPP are stationed at participating substance abuse treatment centers throughout Los Angeles County [5].

Through a preliminary cost-analysis conducted on the DREX program, it was found that actual costs were far exceeding what had previously been anticipated. During the summer of 2003, I conducted a preliminary assessment of the DREX program under the supervision of the HCT Section Manager Donald Price, the Epidemiological Unit Director Eduardo Alvarado, and Data Analyst Constance Chavers. With input from these and other key OAPP staff, a report was drafted detailing the DREX program’s areas of success as well as areas in need of improvement. Several key indicators of program impact were identified and recommendations provided to outline how improvement can be achieved in various areas. “The Preliminary Assessment of the Drug Expansion Program” report is a result of that effort.

Various methods were used in developing recommendations for the DREX program. It was necessary to conduct an extensive literature review, attend counselor training sessions, visit DREX program sites, observe client-counselor sessions and daily counselor tasks, interview counselors and other OAPP staff, create feedback forms, and analyze responses collected from those forms. It was also necessary to run reports of previously collected data from the HIV5 form—the standard form used to collect client information—to examine HIV Counseling and Testing performance statistics and client characteristics. Additionally, preliminary cost data from the period January 2002 through June 2003 were reviewed in order to complete the cost-analysis portion of the report.

Based on the information collected from these sources, preliminary recommendations for the DREX program were as follows: 1) streamline Drug Expansion program counselors’ daily activities; 2) implement client self-administered baseline and follow-up questionnaires; 3) conduct half-yearly surveys of counselor satisfaction and needs; 4) increase amount of data collection to gain better understanding of counselor daily tasks; and 6) offer additional training sessions to improve and/or diversify counselor skill sets.

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