HIV/AIDS case managers and client HIV status disclosure: perceived client needs, practices, and services.

People living with HIV/AIDS often need assistance in deciding whether or how to disclose their HIV status to others, and case managers are in a unique position to offer this assistance. The current study surveyed 223 case managers providing services to people living with HIV/ AIDS in NewYork State. The survey was conducted anonymously, and case managers were sampled at the agency level. Results showed that two-thirds of case managers routinely discuss disclosure issues with their HIV-positive clients. However, case managers often felt that they lacked the resources to provide assistance with disclosure decisions, and 66 percent of those who routinely discuss disclosure issues had not received training in assisting with disclosure to sex and injection drug-sharing partners. HIV disclosure issues were also seen by case managers as only one of many pressing issues facing their HIV-positive clients; other pressing issues were housing, food, medical care, mental health treatment, and preventing HIV transmission. These results indicate a need for training and resources to facilitate HIV status disclosure assistance services offered by case managers.

A randomized trial of two quality improvement strategies implemented in a statewide public community-based, long-term care program.

BACKGROUND: It has not been demonstrated that the implementation of computerized quality improvement strategies can improve client-centered outcomes in public community based, long-term care (CBLTC) programs. OBJECTIVES: To test and evaluate 2 innovative computer-assisted, client-centered quality improvement strategies for public community-based, long-term care. The first strategy, the Normative Treatment Planning (NTP) program, assesses needs, prescribes services, and evaluates outcomes. The second strategy, the Client Feedback System (CFS) program, provides service vendors with feedback on client perceptions of services. RESEARCH DESIGN: A 2 x 2 factorial design with the 2 strategies using cluster randomization. SUBJECTS: A total of 2222 clients (86% of eligible program clients) enrolled in Indiana's state case management program and/or the Medicaid home and community-based services waiver program for the aged and disabled as of January 1, 1995. MEASURES: Outcomes of needs met and client satisfaction were measured through telephone surveys every 6 months for 2 years. RESULTS: A total of 1006 participants (45%) completed the 2-year evaluation study. For the group using only the NTP program, perception of needs met and client satisfaction were significantly better than the control group over the 2 years. During this period, the group using only the CFS program had significantly better client satisfaction than the control group. However, the effect sizes of the significant differences were small, and no statistically significant effects were found for the group using both programs. CONCLUSIONS: Client-centered quality improvement strategies can be implemented to enable public CBLTC programs to meet client needs better and increase client satisfaction.