The Effects of Service Type and Dosage on HIV Risk Factors Among Participants of Minority AIDS Initiative Programs

This paper examines the links between the type and intensity of health care services received and the psycho-behavioral outcomes among participants of prevention programs funded by SAMHSA’s Minority AIDS Initiative (MAI). The analyses focus on changes between program entry and exit in HIV and other STD risk and protective factors such as risky sexual behaviors and substance abuse, as well as attitudes and knowledge measures (e.g. perception of risk of harm from unprotected sex and sharing unsanitized needles, HIV knowledge, and sexual self-efficacy). We also investigate how the types of services received (e.g. counseling, case management, health education, mentoring), the format of service delivery (individual vs. group), and the length of service exposure are associated with these risk and protective factor outcomes, as well as how participant characteristics moderate these associations.

The data for these analyses came from direct-service interventions implemented by MAI grantees between federal fiscal year (FFY) 2010 and FFY2015. Data from baseline and exit surveys were combined with dosage data from service providers to conduct multilevel regression analyses, with participants as Level 1 and grant sites as Level 2. All models controlled for relevant baseline characteristics such as risk levels at program entry and sociodemographic characteristics. Separate models were conducted for each outcome measure to investigate the impact of the different types of services or combinations of service that were most conducive to positive change for each measure, along with examining the impact of dosage by service type. In addition to participants’ demographic characteristics, the analyses tested the effects of membership in high-risk groups such as young adults, homeless individuals, men who have sex with men, African American women, and transgender individuals.

The results of this analysis shed light on the interrelationships among participant characteristics, services received, and prevention outcomes. This information will be useful to program planners in developing appropriate HIV- and substance abuse-related service combinations for different high-risk populations.