Performance Improvement 1998. Health Resources and Services Administration

02/01/1998

Contents

Institutional Factors Which Influence the Likelihood of Living-Related Kidney Transplant Operations-- Phase II

Exploratory Study of Reasons Kidney Transplant Waiting List Patients are Unavailable for Organ Offers

Community Health Center User and Visit Study: Survey Methodology Report

Healthy Schools, Healthy Communities National Evaluation: Final Report

Exploratory Evaluation of Rural Applications of Telemedicine

Development of a Performance Management System for Ryan White Titles I, II, and SPNS

Development of a Performance Measurement System for the Division of Organ Transplantation

Profiles of Activities to Reduce Perinatal Transmission of HIV: Assessing the Response

Grantee-Level Evaluation Activities of the HIV/AIDS Programs of the Ryan White CARE Act

Bilingual Assistance Program Evaluation, Part I: Strategies for Reducing Cultural and Linguistic Barriers to Health Care for Hispanic and Asian/Pacific Islander Populations

Examining Relationships Between HIV/AIDS and Tuberculosis Programs in Title I Eligible Metropolitan Areas

Availability of Primary Care Services Under Medicaid Managed Care: How 14 Health Plans Provide Access and the Experience of 23 Safety Net Providers and Their Communities

The Registered Nurse Population, March 1996: Findings from The National Sample Survey of Registered Nurses

Service Integration for Multi-Risk Patients: Final Report

Measuring Expenditures for Personal Health Care Services Rendered by Public Health Departments

HIV Capitation Risk Adjustment Conference Report

TITLE: Institutional Factors Which Influence the Likelihood of Living-Related Kidney Transplant Operations-Phase II

ABSTRACT: Most transplant surgeons and physicians believe that kidneys can be obtained from live donors in a safe and effective manner, and that kidneys from live donors provide superior long-term graft survival rates for transplant recipients. Between 1987 and 1993, for example, the 1- and 2-year survival rates for patients who had received kidney transplants through living-related donations (LRDs) was superior to that of patients who had received cadaveric kidneys. The rate of living-related kidney transplantation varies considerably among States, however. This project assessed (1) the willingness of the transplant community to conduct, and the frequency with which it has conducted, kidney transplants from LRDs; (2) the medical and nonmedical institutional factors that influence decision making by transplant professionals about suggesting and conducting a living-related kidney transplant; (3) the range of transplant center responses to, and procedures for, living-related transplants; and (4) the circumstances and conditions under which a transplant team that does not encourage living-related transplants would refer a patient to another transplant center for evaluation. This study is based on a mail survey of kidney transplant centers in the Fall of 1995, which yielded an 80 percent response rate. A key finding is that while attitudes toward LRDs among transplant professionals are generally positive, survey respondents identified a number of deterrents to LRDs that are not related to characteristics or practices of individual transplant centers. Some of these factors relate to the characteristics of the individual patient and his or her family. Among the recommendations is that transplant centers distribute educationally and culturally appropriate materials about policies and procedures related to LRDs. (Executive Summary: 10 pages; final report: 78 pages, plus appendices.)

AGENCY SPONSOR: Office of Special Programs

FEDERAL CONTACT: D. W. Chen

PHONE NUMBER: (301) 443-4111

PIC ID: 4917.1

PERFORMER ORGANIZATION: George Washington University, Washington, DC

TITLE: Exploratory Study of Reasons Kidney Transplant Waiting List Patients are Unavailable for Organ Offers

ABSTRACT: Studies conducted in the early 1990's to examine the efficiency of the organ allocation system identified an additional factor that might influence the equitability of allocation decisions: patient unavailability and refusal of an organ. This study (1) further examines the extent of the problem of patient unavailability for, or refusal of, an organ offer; (2) explores the reasons underlying patient unavailability and patient refusal when an organ offer is made; (3) highlights strengths and weaknesses in recordkeeping and reporting practices; and (4) makes recommendations for improving the procedures for notifying patients of an organ offer. The contractor conducted telephone interviews with three groups: transplant center staff who make organ offers, transplant waiting list patients who had refused an offer or had been unavailable when staff tried to make an offer, and recent transplant recipients. Interviews with study participants, drawn from 31 randomly selected transplant centers, were conducted between November 1995 and September 1996. The major finding was that both patient unavailability and refusal occur but are not significant issues at most centers. (Final report: 38 pages, plus appendix.)

AGENCY SPONSOR: Office of Special Programs

FEDERAL CONTACT: D. W. Chen

PHONE NUMBER: (301) 443-4111

PIC ID: 5601

PERFORMER ORGANIZATION: Battelle Human Affairs Research Centers, Seattle, WA

TITLE: Community Health Center User and Visit Study: Survey Methodology Report

ABSTRACT: This project collects data on users of Community Health Centers (CHCs) and the services they use. The sample survey has two components: (1) a personal interview survey of 1,932 randomly selected patients at a representative sample of 48 CHCs, and (2) data extraction from 2,878 medical records concerning randomly selected encounters at the same centers. Clients and visits are surveyed using modified versions of two National Center for Health Statistics (NCHS) surveys: the National Health Interview Survey and the National Hospital Ambulatory Medical Care Survey, to capture the full range of users and services provided at a particular point in time. This approach allows for comparison of data on CHC populations with national estimates derived from the NCHS surveys. The project provides demographics of users, their reasons for seeking care, diagnoses, services used, and self-reported outcomes. The User and Visit Survey is part of an overall Health Resources and Services Administration (HRSA) evaluation strategy for collecting data regarding users, services, and outcomes of primary care programs. HRSA will be developing further reports based on the survey findings. (Final report: 147 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: (301) 594-4280

PIC ID: 5737

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Plainsboro, NJ

TITLE: Healthy Schools, Healthy Communities National Evaluation: Final Report

ABSTRACT: This project develops and implements a design to collect uniform data on access, use, and continuity of care in the Healthy Schools, Healthy Communities Program (HSHC). The Health Resources and Services Administration's (HRSA's) HSHC program is the first Federal categorical grant program specifically targeted to school-based health centers, and is jointly funded and administered by the Bureau of Primary Health Care and the Maternal and Child Health Bureau. The study includes the 25 (of 27) school-based health centers (SBHCs) funded initial projects that were first fully operational during the 1995-1996 school year. This evaluation, implemented concurrently with the HSHC program, was intended to document change in the students' ealth status, utilization of services, and outcomes related to the SBHC interventions. There are two data sources: a student-based clinical data system and a student/parent survey. Findings are informing the activities of participating grantees and the content of policies for grantees that join the program in FY 1998 or FY 1999. In addition, HRSA has gained new insights into collecting data from children and on working with school-based records.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: (301) 594-4450

PIC ID: 5739

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Exploratory Evaluation of Rural Applications of Telemedicine

ABSTRACT: The purposes of the Health Resources and Service Administration's (HRSA's) Rural Telemedicine Grant Program (RTMG) are (1) to facilitate the development of rural health care networks through the use of telemedicine, and (2) to develop a data base for systematic evaluation of rural telemedicine systems. This baseline study concerned (1) the current status of telemedicine in rural health; (2) the effects of telemedicine on access to care, practitioner isolation, and development of health care networks; (3) the organizational factors that aid or impede successful development and implementation of telemedicine systems; and (4) development, testing, and refinement of data collection instruments for use in subsequent evaluations. The study focused on telemedicine projects that link one or more rural hospitals or ambulatory sites ("spoke sites") with a multispecialty entity ("hub site"). A hub site might be a tertiary care hospital, a multispecialty clinic, or a set of facilities that, when combined, provide the required range of specialty consultations. In addition, the study was limited to systems that employ real-time or asynchronous video imaging systems. Data sources for the evaluation include three mail surveys to identify and describe telemedicine systems, and site visits to four networks. The report presents recommendations on the content of future evaluations and on data gathering approaches. Results have influenced the FY 1997 RTMG application guidelines and the content of authorizing legislation. The report has been distributed to other Federal agencies that fund telemedicine projects and to State Offices of Rural Health. Findings are being incorporated into the design of a common telemedicine evaluation instrument for use by HRSA grantees, and by other Federal funders at their option. Finally, five articles based on the study have been published and numerous presentations have been given.

AGENCY SPONSOR: Office of Rural Health Policy

FEDERAL CONTACT: Cathy Wasem

PHONE NUMBER: (301) 443-0835

PIC ID: 5749

PERFORMER ORGANIZATION: Abt Associates, Incorporated, Cambridge, MA

TITLE: Development of a Performance Management System for Ryan White Titles I, II, and SPNS

ABSTRACT: In the public sector, efforts to monitor program effectiveness go under the rubric of "reinventing government." Several legislative and executive initiatives, particularly the Government Performance and Results Act of 1993 (GPRA), spur the movement to establish measurable performance goals that can be reported as part of the budgetary process, thus linking funding decisions to performance. GPRA requires each Federal agency to develop comprehensive strategic plans, annual performance plans with measurable goals and objectives, and annual reports on actual performance compared to goals. This report focuses on the response to GPRA undertaken by the Bureau of Health Resources Development (now called the HIV/AIDS Bureau) within the Health Resources and Services Administration (HRSA) in regard to Titles I, II, and Special Programs of National Significance (SPNS) of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. The major results of this project were the development and articulation of an interactive process to be used in the development of a performance measurement system. This process includes (1) a clear articulation of the purposes and objectives of Ryan White Titles I, II, and SPNS; (2) linkage of these purposes and objectives to the broader functions of HRSA; (3) using program purposes and functions, and a clear understanding of accountability, responsibility, and activity throughout the programs, to enable the performance measurement system to capture the individual properties and components of each; (4) developing standard performance terminology and definitions; (5) identification of seven performance dimensions and linking them to the purposes and functions of the programs; and (6) identifying and narrowing potential measures for program performance. The report concludes with several recommendations for implementing a performance measurement system for these three programs. See also PIC ID Nos. 5954 and 5954.2.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Katherine Marconi

PHONE NUMBER: (301) 443-6560

PIC ID: 5954.1

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Development of a Performance Measurement System for the Division of Organ Transplantation

ABSTRACT: The Government Performance and Results Act of 1993 (GPRA) links funding decisions to program performance by calling for the designation of measurable performance goals that can be reported as part of the budgetary process. GPRA requires each Federal agency to develop comprehensive strategic plans, annual performance plans with measurable goals and objectives, and annual reports on actual performance compared to goals. This report focuses on the response to GPRA undertaken by Division of Organ Transplantation (DOT) within the Health Resources and Services Administration. The report provides a conceptual framework for the organ and bone marrow transplantation programs; outlines a recommended performance management system (including an articulation of program purposes and functions, language and tools of performance measurement, criteria for selecting measures and indicators, and identification of potential measures); and recommends next steps. These next steps include (1) identification of a process for selection of measures and indicators for DOT programs, (2) selection of the most important measures from the potential group, (3) identifying supporting data and data needs and gaps, (4) preparing an annual performance plan designed to meet GPRA requirements, and (5) identifying technical assistance needs for making a performance management system operational. See also PIC ID Nos. 5954 and 5954.1. (Final report: 26 pages.)

AGENCY SPONSOR: Office of Special Programs

FEDERAL CONTACT: Katherine Marconi

PHONE NUMBER: (301) 443-6560

PIC ID: 5954.2

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

TITLE: Profiles of Activities to Reduce Perinatal Transmission of HIV: Assessing the Response

ABSTRACT: In August 1994, the Public Health Service (PHS) published recommendations for the use of zidovudine (ZDV) to reduce perinatal transmission of HIV in response to findings from the Pediatric AIDS Clinical Trials Group (ACTG) 076 by the National Institutes of Health (NIH). In December 1995, the Health Resources and Services Administration (HRSA) issued a Program Advisory entitled "Use of Zidovudine (ZDV) to Reduce Perinatal HIV Transmission in HRSA Funded Programs," which provides background information and specific strategies and options for implementing the PHS recommendations. This study evaluates HRSA's activities in implementing the recommendations through case studies of Florida, Mississippi, Missouri, New Jersey, Puerto Rico, Texas, and Washington. Qualitative methods were used to describe the following for each site: (1) demographic and socioeconomic factors affecting HIV/AIDS prevention and care services, (2) nature of the HIV/AIDS epidemic, (3) structure of the public health system, (4) structure of the State health department, (5) structure of HIV/AIDS services, (6) issues affecting HIV/AIDS prevention and care services, (7) relevant policies and activities prior to the release of the ACTG 076 findings, and (8) specific responses to the ACTG 076 findings and PHS recommendations. The study finds that where providers have responded to the ACTG 076 findings, the results are extremely positive. Despite the complexities of the ZDV regimen, the majority of women elect to participate in the regimen after being informed about it, believing that the advantages outweigh the disadvantages. The study has been widely disseminated to HRSA HIV/AIDS and primary care providers and has been used in assessing the incidence of perinatal HIV transmission. (Final report: 101 pages, plus appendices.)

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Moses B. Pounds

PHONE NUMBER: (301) 443-6560

PIC ID: 6202

PERFORMER ORGANIZATION: U.S. Conference of Mayors, Washington, DC

TITLE: Grantee-Level Evaluation Activities of the HIV/AIDS Programs of the Ryan White CARE Act

ABSTRACT: This study provides a systematic review and synthesis of current Health Resources and Services Administration (HRSA) HIV-related evaluation activities conducted at the grantee level to identify gaps and set national funding priorities across HRSA HIV programs. The study, requested by the HRSA AIDS Advisory Committee, reviews grantee evaluation activities over the October 1995-October 1996 period. Studies are categorized by type (formative, process, outcome/impact, or economic). The information derived from this study is being used to improve the evaluation of HRSA HIV programs. One of the project outcomes is a current study to assess client satisfaction. In addition, HRSA is developing a series of technical manuals to assist grantees with issues of methodology and capacity for evaluation. The first of these manuals to be published, "Choosing and Using an External Evaluator," has been sent to all CARE Act grantees and will be made available to others upon request. (Final report: variously paginated.)

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Moses B. Pounds

PHONE NUMBER: (301) 443-6560

PIC ID: 6256

PERFORMER ORGANIZATION: Academy for Educational Development, Washington, DC

TITLE: Bilingual Assistance Program Evaluation, Part I: Strategies for Reducing Cultural and Linguistic Barriers to Health Care for Hispanic and Asian/Pacific Islander Populations

ABSTRACT: The Disadvantaged Minority Health Improvement Act of 1990 authorized the Bilingual Assistance Program, a 3-year initiative to improve the health status of racial and ethnic minorities. Under the program, the Health Resources and Services Administration (HRSA) awarded grants to three national organizations (the Association of State and Territorial Health Officials, the National Association of County Health Officials, and the U.S. Conference of Local Health Officials) which, in turn, awarded grants in 1993 to 13 State and local health departments. The purpose of the local projects, which were selected competitively, was to reduce cultural and linguistic barriers to health care among Asian/Pacific Islander and Hispanic populations. This study examines (1) factors that allow the local projects to leverage Federal funding and promote improved interagency working relationships; (2) realistic approaches to setting performance measures; (3) technical assistance needs of grantees, including exploring the use of national minority organizations and mentors; and (4) the replicability of the products or training curricula developed by the grantees. This is the first volume of a two-part final report; the second volume is entitled "Assessment of Three Training Curricula." The study was carried out through site visits conducted during April-June 1996 and a review of background documentation. HRSA's Office of Minority Health has shared the study products with interested groups. (Final report: variously paginated.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Laura Diaz-Baker

PHONE NUMBER: (301) 443-9966

PIC ID: 6356

PERFORMER ORGANIZATION: MDS Associates, Incorporated, Wheaton, MD

TITLE: Examining Relationships Between HIV/AIDS and Tuberculosis Programs in Title I Eligible Metropolitan Areas

ABSTRACT: This project (1) determines the extent to which specific Ryan White Comprehensive AIDS Resource Emergency (CARE) Act Title I grantees are providing guidance to funded providers on tuberculosis (TB) screening, prophylactic, and therapeutic regimes; and (2) describes working models of collaboration between human immunodeficiency virus (HIV) and TB control programs within individual Eligible Metropolitan Areas (EMAs). In March 1995, the 34 EMAs were asked to provide a brief description of TB epidemiology in the EMA, along with specific information regarding collaboration among programs to treat people co-infected with HIV and TB; 30 responded. A literature review provides background for site visits to seven EMAs. The visits were conducted to gain more detailed information about the nature of partnerships between TB and HIV/AIDS programs that result in the most successful models of TB prevention and control within Title I-funded programs, as well as to identify programmatic configurations that result in poorly implemented TB services at these sites. The study finds that TB was prevalent in EMAs, and that services vary across EMAs and across different care settings within them. Study results are being used in developing Title I program guidance and in planning for training and technical assistance. The report has been sent to CARE Act and TB control grantees.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Gloria Weissman

PHONE NUMBER: (301) 443-9052

PIC ID: 6359

PERFORMER ORGANIZATION: Matthew McClain, Philadelphia, PA

TITLE: Availability of Primary Care Services Under Medicaid Managed Care: How 14 Health Plans Provide Access and the Experience of 23 Safety Net Providers and Their Communities

ABSTRACT: This study examines strategies used by health maintenance organizations (HMOs) to generate access to health care services for Medicaid enrollees, who often live in inner city and rural underserved areas. The project also explores the implications of these strategies for overall access in underserved areas and for existing care providers. Third, the study considers how these strategies affect traditional Medicaid providers in the community. The study involved interviews and collection of secondary data at 14 HMOs with significant Medicaid enrollment, and at 23 traditional safety net providers, of which 13 were Community Health Centers. The study concluded that Medicaid managed care has had an overall positive effect on the availability of primary care to low-income residents in the 14 communities, and that the traditional safety net providers have not needed to reduce services. However, the future viability and range of services of public sector-supported providers might be endangered in a more competitive health system. The information derived from this study will be useful to policymakers concerned with the provision of appropriate care for vulnerable populations, providers in underserved areas, and those attempting to assure an adequate supply of health care personnel. The study has attracted attention in the professional community, as in a story in the American Medical News. In addition, an article under preparation for submission to a professional journal will reference this study, among other sources. (Appendices to the report are bound separately.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: (301) 443-0371

PIC ID: 6366

PERFORMER ORGANIZATION: Mathematica Policy Research, Incorporated, Washington, DC

TITLE: The Registered Nurse Population, March 1996: Findings from The National Sample Survey of Registered Nurses

ABSTRACT: The Sixth National Sample Survey of Registered Nurses gathered data to evaluate trends in the number, characteristics, and distribution of registered nurses in the United States. This study builds on the sample design and procedures developed in earlier surveys. Sampling procedures are devised to assure (1) the cooperation of all States and the District of Columbia, and (2) an overall response rate of 80 percent. The study resulted in a data base of 29,950 coded individual record responses, with weights for estimating characteristics of the sample universe, estimates of variances for key variables, and a technical procedures report prepared by the contractor. Health Resources and Services Administration (HRSA) staff then analyzed the data and developed the report named above. Results from this study will (1) be used in biennial reports to Congress to describe characteristics of the registered nurse population, (2) contribute to the data base underlying models used to project nurse supply and requirements; and (3) serve as input to analyses and evaluation of HRSA's nursing education programs and plans for future Federal programs to assure appropriate nursing resources. In addition, the nursing community will use the data base, the most comprehensive source of statistical information on registered nurses in the United States. (Final report: 30 pages, plus appendices.)

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Evelyn Moses

PHONE NUMBER: (301) 443-1451

PIC ID: 6367

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Service Integration for Multi-Risk Patients: Final Report

ABSTRACT: This study examines how selected community-based health care organizations integrate services for people with multiple risk factors (e.g., pregnancy, substance abuse, HIV/AIDS, and homelessness) for poor health outcomes. Since these conditions often overlap, the health care organization must integrate services to meet the needs of these individuals with multiple risks. This study targets six Community Health Centers and local health departments currently receiving funding from a combination of Health Resources and Services Administration (HRSA) programs. The report uses site visits, interviews, focus groups, and discussions to explore several topics, including (1) community-based health care organizations' use of multiple funding sources to provide integrated services to patients with multiple risk factors, (2) barriers to integration of services created by separate funding streams that target specific high-risk populations, (3) successful integration strategies used by organizations, and (4) ways in which HRSA might reduce barriers created through multiple funding streams. Based on these strategies, the report identifies characteristics of organizational approaches that facilitate integration and makes recommendations for addressing barriers to service integration. The report has been distributed to all the HRSA primary care grantees. Results will also be shared through articles in peer-reviewed journals. (Final report: variously paginated.)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: (301) 594-4450

PIC ID: 6369

PERFORMER ORGANIZATION: MDS Associates, Incorporated, Wheaton, MD

TITLE: Measuring Expenditures for Personal Health Care Services Rendered by Public Health Departments

ABSTRACT: As changes to the health care delivery system continue to occur, the way in which public health departments provide services may be affected in a very significant manner, making it critical for policymakers, managers, and researchers to be able to assess the impact of these changes on the public health infrastructure. Therefore, the Health Resources and Services Administration commissioned this report, which develops a categorization schema for reporting comparable information on State and local health department personal health care services. The project initiates development and testing of a methodology to collect consistent and complete expenditure data on State and local health department services directed toward individuals. Officials from 11 State and local health departments and 1 State association of local health officials assisted in the development of a survey instrument, which was tested by State health departments in Arizona, Iowa, and Rhode Island and by local health departments in Austin/Travis County, Texas, and New York City, New York. The report finds that (1) the provision of personal health care services accounts for nearly 50 percent of the health department expenditures in Austin/Travis County and 57 percent in New York City; (2) participants considered the methodology generally clear and potentially useful, although problems were encountered in trying to fit personal health care services into some survey categories; (3) among the survey respondents, Austin/Travis County is closest to the managed care end of the service delivery continuum and Iowa is closest to the traditional approach of delivering all services directly, bundling no services, and not using capitation; and (4) Rhode Island contracts for 99 percent of its services, and New York and Austin/Travis County offer a similar mix of department-run and contracted services. (Final report: 29 pages, plus appendices.)

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Michael Millman

PHONE NUMBER: (301) 443-0368

PIC ID: 6636

PERFORMER ORGANIZATION: Public Health Foundation, Washington, DC

TITLE: HIV Capitation Risk Adjustment Conference Report

ABSTRACT: Widespread adoption of managed care by public insurance programs (such as Medicaid) has raised concerns about whether capitated reimbursement affects the quality of care provided, especially to people with chronic illnesses or other special health care needs. One way to address these concerns is to create risk-adjusted capitation rates to provide equitable reimbursement for care of patients with costly illnesses, an approach several States had proposed or implemented by 1997. In May 1997, HRSA convened an invited conference to examine issues surrounding risk adjustment for HIV/AIDS, in collaboration with ASPE, HCFA, The Henry J. Kaiser Family Foundation, and the National Academy of State Health Policy. Participants included people living with HIV/AIDS and their advocates, providers of care, managed care plans, and purchasers, including representatives of State Medicaid programs. The report presents findings and recommendations concerning various risk-adjustment methods and their evaluation, issues related to the implementation of risk adjustment, and further research needed in each of these areas. Conference findings have been used in technical assistance to States on coordinating CARE Act programs with managed care. HRSA has distributed the report to all CARE Act grantees and to State Medicaid directors; the Kaiser Family Foundation, which financed production of the report itself, has also distributed it widely.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Richard Conviser

PHONE NUMBER: (301) 443-3075

PIC ID: 6894

PERFORMER ORGANIZATION: The Henry J. Kaiser Family Foundation, Washington, DC

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