Evaluating outcomes of HIV prevention programs: lessons learned from Houston, Texas

The Centers for Disease Control and Prevention (CDC) fund state and local health departments to contract with community-based organizations for HIV prevention tailored to the needs of populations at risk. In 1999, the CDC began requiring health departments to develop the capacity to evaluate the outcomes of these programs. The CDC requirements create the need for practical, low-cost methods of outcome monitoring that can be applied at the local level. We describe the development of a multisite evaluation of seven city health department funded (via CDC) HIV counseling programs in Houston, Texas. Initial findings indicate that (1) behavioral change information that reflects program objectives can be obtained through a brief survey; (2) community providers were not able, or were unwilling, to follow the evaluation protocol related to surveying their clients; (3) that asking clients to mail back posttest surveys resulted in low response; and (4) a one-contact intervention made establishing rapport, commitment, and/or trust difficult for evaluation purposes. These findings suggest areas for improvement, including providing staff training and/or better motivation to ensure protocol fidelity, considering the use of an external evaluator to conduct pre-post surveys, and developing a different design to evaluate one-shot interventions.