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Effective Interventions

Resources & Tools

The materials and resources listed on this page support the implementation of Taking Care of Me.  These downloadable resources are for use by health departments, community-based organizations, health care organizations, and other organizations seeking to implement Taking Care of Me.

What is included in the intervention package? 

The following Taking Care of Me items are available for download:

  • Taking Care of Me video (with English open captions and Spanish subtitles)
  • Taking Care of Me Posters (in English or Spanish) for printing

Video: The video includes a series of dramatic vignettes. In the vignettes the lead characters are shown confronting challenges, making a decision to change their behaviors, and finding solutions for each of their challenges. A brief summary of each vignette follows:

Javier’s Story: Javier’s choices create adherence and retention challenges. In the first scene, we see Javier, a gay Latino man in his early 20’s and his boyfriend Mateo having fun and drinking at a club where Javier is a DJ. Javier is HIV-positive and Mateo is HIV-negative. In their apartment the next morning Mateo asks Javier about forgetting to take his HIV medications. Javier admits that he’s been taking the weekends off. In reality, however, Javier has been missing a lot of doses, especially when he’s been drinking. One night, Javier and Mateo come home after drinking heavily and have sex. The next morning at breakfast, neither of them can remember if they used a condom. Upset, Mateo reminds Javier that Javier hasn’t seen a doctor in nine months and doesn’t know his viral load. Javier goes to the doctor, learns his viral load had gone up to the point that he “technically” has AIDS, and is reminded about the importance of regular care. This serves as a turning point for Javier, and in the last scene—also at a club—he turns away an offer of a drink, is seen using a phone app to remind him to take medication, and swallows the pill with water. Javier recites the strategies he uses to remember appointments and reports that his CD4 count rose out of the AIDS range. Mateo’s HIV test comes back negative, and he starts taking PrEP for extra protection.

Undetectable Me (Part One): ART initiation and adherence are the themes of the animated story. In the first part of the sequence, a doctor introduces James to his new HIV medication, Bill, a humanized pill bottle. Bill follows James everywhere, which annoys him and serves as a constant reminder that he is HIV-positive. Six weeks later, James complains to his doctor about Bill. The doctor reminds him about the importance of taking his medication every day. But James angrily says that he wants to be left alone and walks out of her office, leaving Bill behind.

Keisha’s Story: In the next vignette we meet Keisha, whose challenge is ART initiation. She is a heterosexual African American woman in her early 30s with a young daughter. Keisha hasn’t told anyone that she has HIV because she doesn’t think people would understand. She’s worried about finding time for treatment, its cost, and side effects. She feels that her diagnosis has made future plans impossible. One day, Keisha’s friend Michelle invites her to a dinner party at her co-worker’s house, where she meets Javier and Mateo (the characters from story 1). After listening to them talk openly about Javier almost losing his HIV medication during a camping trip, Keisha feels compelled to disclose her HIV status to Javier. He is very empathetic, encourages her to get on treatment, and gives her the name of his provider. We then hear from Keisha how much that moment changed things for her. She goes to see Javier’s doctor with a list of her concerns, and the doctor addresses all of them. Then, after a year on medication, she reports feeling great and taking steps toward a future career. While Keisha still hasn’t told her family about her status, she has told her friend Michelle. Michelle drives her to doctor appointments and to the pharmacy. Keisha’s case manager helped set up automatic prescription refills.  

Undetectable Me (Part Two): In the second part of the sequence, James is driving away from the doctor’s office he just left, when he realizes that maybe he is the problem and should keep Bill around. Distracted, he turns a corner to head back and nearly drives into a giant ditch. Thankfully, he is pulled to safety by Bill who had run after him. They reconcile and drive off together, happy to be friends. 

Michael’s Story: Michael’s circumstances create challenges for retention in care and adherence. When this vignette opens, Michael, an HIV-positive African American man in his late 30s, is breaking up with another man, Ty, who is upset about it. Michael has been in treatment for over a year but has not disclosed his HIV status to anyone. He’s worried what people will think and the impact on his job at a conservative firm. Work is hectic and causes him to miss meals, pills, and doctor visits. Because he grew up surrounded by homophobia, few people know that he is gay. He finds it hard to connect with his doctor and feels rushed at his appointments. He always uses condoms so he never discloses his HIV status to sex partners and breaks off relationships when they start to feel too close. After his breakup with Ty, however, Michael decides he needs to stop this pattern. He joins a support group for the first time and switches providers to one with whom he is more comfortable. They discuss strategies to protect his sex partners, including keeping his viral load undetectable. Michael describes his solutions for keeping up with appointments and taking medication on time. In the last scene, Michael meets with Ty at the park, where Michael tells Ty “I got to say some things that I should have said when we first started going out.”

Posters: The intervention includes four different posters consisting of one or more stills from the video. The posters are intended to either direct attention to the video or reinforce key messages from the video. Electronic versions (PDF files) of all posters are available for printing. The “Now Showing” poster is designed to be printed as 24” wide by 36” high. The key message posters are designed to be printed as 24” wide by 18” high.

What can be done to prepare for implementation?

There are a number of steps you can take to maximize the benefit of this video-based intervention in your clinic.

  • Introduce all clinic staff to the new intervention
    Prepare the entire clinic for the intervention. This shows that management considers the intervention to be an important part of clinic services. Show staff members the video and discuss how it will be used, giving them a chance to ask questions, raise concerns, and make suggestions. This will also provide an opportunity to explain how staff can support the intervention. For example, receptionists can suggest that patients watch the video, and clinicians may wish to discuss the video with patients during or following their examination.

  • Put someone in charge of the intervention
    Designate someone to make sure that the DVD is loaded into the player, the TV is turned on, and the DVD player is started each day. Designate someone to make sure that the DVD is stored safely at the end of each day. Approach back-up staff to do these tasks when the main person is not at work. Have a protocol for reporting and resolving equipment problems.

  • Ensure adequate placement of televisions and speakers 
    Make sure all seating locations in the waiting room directly face the TV where the video will be played. Although the captions help ensure that dialog is not missed, sound volume levels and quality are important to maximize patient attention and viewing. Determine whether your television speakers are sufficient.  Sound quality can be easily degraded by challenging acoustic conditions like large rooms or ambient noise. Consider adding additional speakers to optimize sound. If additional speakers are used, try not to place them in close proximity to staff members seated near or next to the waiting room.

  • Place Taking Care for Me posters in the waiting and exam rooms
    The package includes four posters, with versions in English and Spanish. One is designed to draw attention to the video and the other three reinforce key prevention messages from the video. Consider displaying these posters throughout the clinic in the waiting room, exam rooms, hallways, bathrooms, or other appropriate locations. Electronic versions (PDF files) of all posters are located on a CD in the package. You can print as many as you need.

  • Determine the best language version for your clinic 
    Taking Care of Me is available with English open captions and Spanish subtitles. The Spanish subtitles version would be appropriate if your clinic has a substantial monolingual Spanish-speaking population.

  • Determine the best playback frequency for your clinic
    The more patients who see the video, the greater the overall benefit will be for your clinic population. To this end, Taking Care of Me was designed to be played periodically throughout the day. You are encouraged to show the video as often as possible. However, a variety of factors should be considered in determining how often to play the video at your clinic. For example, if your clinic patients typically experience long wait times, reducing the playback frequency may prevent patients from being overexposed to the video. On the other hand, clinics with short wait times, or waiting rooms where patients rotate in and out often, may benefit from a greater playback frequency.

  • Solicit feedback from your patients
    Your patients can tell you a lot about their experiences watching the video. Ask them about it. Could they see and hear it all right? How much of the video did they see? What did they learn from it? If they didn’t watch it, why didn’t they?  Would they prefer captions in the other language? Use their feedback to inform and improve your presentation methods.

 

Research and Development

Why was Taking Care of Me developed for patients with HIV?

  • HIV treatment guidelines issued by the National Institutes of Health suggest that HIV treatment should be begun as soon as the patient is diagnosed with HIV.8
  • Persons with HIV who begin taking medication early have better outcomes in terms of opportunistic infections.9
  • Patients with well-managed HIV and resulting low viral loads are much less likely to transmit HIV to their sex partners.10
  • Keeping patients in treatment and consistently taking ART, however, continue to be challenges.
  • Taking Care of Me builds on other effective interventions that use dramatic video vignettes to decrease risk behaviors and increase positive behaviors among populations disproportionately affected by HIV.1-7,11
  • Taking Care of Me has the potential to have a widespread impact both for people living with HIV and their partners. 

How was Taking Care of Me Evaluated?

  • Taking Care of Me was evaluated using a quasi-experimental trial among patients (N = 2,023) attending two HIV clinics and who were exposed to the video during a 10 month period. Those outcomes were compared to data among patients (N = 1,979) visiting the clinics during the prior 10 months when the video was not playing. 
  • Electronic medical record data were used to evaluate ART prescriptions, viral load test results, and dates of return visits.
  • Among patients exposed to the video, there was an overall 10.4 percentage point increase in patients prescribed antiretroviral therapy (60.3% to 70.7%, p< 0.01). Additionally, there was an overall 6.0 percentage point improvement in viral suppression (56.7% to 62.7%, p< 0.01).11
  • Taking Care of Me has been evaluated by the HIV/AIDS Prevention Research Synthesis (PRS) project at CDC, and has been identified as an evidence-informed structural intervention.

 

References

  1. Warner L, Klausner JD, Rietmeijer CA, et al. Effect of a brief video intervention on Incident Infection among patients attending sexually transmitted disease clinics. PLoS Med. 2008; 5(6): e135.
  2. Neumann MS, O'Donnell L, Doval AS, et al. Effectiveness of the VOICES/VOCES sexually transmitted disease/human immunodeficiency virus prevention intervention when administered by health department staff: does it work in the "real world"? Sex Transm Dis. 2011;38(2):133-139.
  3. Sweat M, O'Donnell C, O'Donnell L. Cost-effectiveness of a brief video-based HIV intervention for African American and Latino sexually transmitted disease clinic clients. AIDS. 2001;15(6):781-787.
  4. Gift TL, OʼDonnell LN, Rietmeijer CA, et al. The program cost of a brief video intervention shown in sexually transmitted disease clinic waiting rooms. Sex Transm Dis. 2016;43(1):61-64.
  5. O'Donnell CR, O'Donnell L, San Doval A, Duran R, Labes K. Reductions in STD infections subsequent to an STD clinic visit. Using video-based patient education to supplement provider interactions. Sex Transm Dis. 1998;25(3):161-168.
  6. Besera GT, Cox S, Malotte CK, et al. Assessing patient exposure to a video-based intervention in STD clinic waiting rooms: findings from the Safe in the City trial. Health Promot Pract. 2016;17(5):731-738. 
  7. Harshbarger CL, O'Donnell LN, Warner L, et al. Safe in the City: effective prevention interventions for human immunodeficiency virus and sexually transmitted infections. Am J Prev Med. 2012;42(5):468-472. 
  8. National Institutes of Health. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Published July 14, 2016. Accessed April 16, 2017. Available at: https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/0
  9. Zolopa A, Andersen J, Powderly W, et al. Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One. 2009;4(5):e5575.
  10. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493-505.
  11. Neumann MS, Plant A, Margolis AD, Borkowf CB, Malotte CK, Rietmeijer CA, Flores SA, O’Donnell L, Robilotto S, Myint-U A, Montoya JA, Javanbakht M, Klausner JD. Effects of a brief video intervention on treatment initiation and adherence among patients attending human immunodeficiency virus treatment clinics. PLOS ONE 2018; 13(10): e0204599. https://doi.org/10.1371/journal.pone.0204599 

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