DRAFT Planning Logic Models to Design Structural Interventions Description: This tool provides participants of our Social Determinants of Health/Structural Interventions course with an opportunity to practice designing a Structural Intervention (SI) using Logic Models. Participants are divided into groups to design a logic model around their assigned priority population and addressing gaps in the HIV Care or PrEP Continuum. By the end of the exercise, participants will define the type of SI designed, identify the appropriate level of intervention, and determined the NHAS indicator Logic Model Exercise DRAFT

Note to the Reviewer The purpose of this tool is to provide participants with an opportunity to practice designing a Structural Intervention (SI) using Logic Models. Participants are divided into groups to design a logic model around their assigned priority population through three parts. In Part A, participants choose a gap in the HIV Care or PrEP Continuum, summarize conditions contributing to the gap, identify 1-2 social determinants of health, and indicate which of the 3 As the SI will address: Acceptability, Accessibility and Availability. Part B involves participants describing the type of SI their designing, identifying stakeholders, and determining whether the SI will intervene on the community, organizational or societal level. In Part C, participants define the outputs, intermediate outcomes and NHAS indicators of the SI. This exercise is a total of 30 minutes.

Planning Logic Model Priority Population and Gap in Care/ PrEPContinuum: (HIV Status, Linkage, Engagement-Retention, Med. Adherence, or PrEP Awareness, Uptake, Adherence): Social Determinants 3A’s Level of Intervention SI Type and Description Outputs Outcomes •Poverty •Homelessness •Stigma •Racism •Education •Availability •Acceptability •Accessibility •Community •Organizational •Societal •Economic •Environmental •Social •Policy j• Agency deliverables •Population changes as a result of successful intervention implementation. NHAS Indicator: Stakeholders: 35 This is a template for completing a LM for a SI Many of the headings probably look familiar, as we have covered several of these terms (Review each heading beginning with the Priority population and continuum gap, ending with the NHAS indicators) Now, let’s look at how to complete this Go to next slide

Planning Logic Model for SIs Part A: Choose a gap in the HIV Care Continuum or PrEP Continuum for your assigned priority population. Summarize the conditions that contribute to the gap. Identify 1-2 social determinants to address. Indicate which of the 3As your SI will address. We have just reviewed the planning LM and described how to complete it. Now, we are going to give you all a chance to do the same, but in parts For this next exercise, divide participants into groups, based on priority populations If possible and depending on group composition, groups may be developed based on jurisdiction or HD If this is the case, have them identify a priority population in their small groups Review slide above instruct groups to identify a recorder, and a reporter to summarize to the larger group, once Part A is completed Distribute a LM work-sheet based on the above SI LM template Distribute one large LM template that small groups will transfer information onto for later sharing with the large group Briefly go to next slide, to illustrate an example of these completed steps, then return to current slide with instructions 3) Allow approximately 30 minutes for small groups to complete this exercise (including transferring information on LM template on wall)

Planning Logic Model: Part A Priority Population and Gap in Care/ PrEPContinuum: High HIV Incidence among Young Latino MSM Social Determinants 3A’s Level of Intervention SI Type and Description Outputs Outcomes •Poverty •Homelessness •Stigma •Homophobia •Racism •Education •Availability •Accessibility •Acceptability NHAS Indicator: Stakeholders: 35 a) So to summarize with the LM template: Select a continuum gap that your SI will address Identify the external conditions (e.g., SDH, HI, SV, etc) that contribute to the gap 3) Prioritize a few (1-3) that you will propose to address with a SI Underline and Bold or highlight those that will be prioritized in the column above 4) Indicate which of the 3 As your SI will address b) Review the example above, with the completed sections c) Return to previous slide, keeping instructions posted for participants

Planning Logic Model for SIs Part B: Determine level at which your SI will intervene (community, organizational, societal). Determine type of SI proposed (economic, environmental, social, policy). 3. Describe your SI, addressing the above factors. 4. Identify stakeholders.

Planning Logic Model – Part B Priority Population and Gap in Care/ PrEPContinuum: High HIV Incidence among Young Latino MSM Social Determinants 3A’s Level of Intervention SI Type and Description Outputs Outcomes •Poverty •Homelessness •Stigma •Homophobia •Racism •Education •Availability •Accessibility •Acceptability Community Organizational Societal Social - Hire popular opinion leaders to disseminate acceptance messages amongst their peers - Conduct social marketing campaign about the connection between bullying and HIV NHAS Indicator: Stakeholders: YLMSM, businesses, school officials, public health officials, clergy, government, etc. 35 Here is an example of the next steps completed (Part B): Note: items bold and underlined indicate prioritization Level, Type, This LM shows that the SI will be implemented at the community level The group has decided that this SI will address social factors for the priority population The LM further describes the proposed intervention Return back to previous slide keeping instructions posted for participants

Planning Logic Model for SIs Part C - Identify: Outputs - Should help measure agency activities carried out in intervention to address gaps (hint: AKA process objectives)… Outcomes (intermediate) -Should help measure desired changes in population as a result of intervention (hint: AKA outcome objectives)… NHAS Indicators (long-term) - Choose one of the 10 NHAS Indicators Part C of LM Exercise: Identify: 8) Outputs (HD activities to achieve the intervention) 9) Intermediate Indicators (results of the intervention) 10) Outcome indicator Choose one from the 10 NHAS indicators

NHAS 2020 Indicators: Increase the percentage of people living with HIV who know their serostatus to at least 90% Reduce the number of new diagnoses by at least 25% Reduce the percentage of young gay and bisexual men who have engaged in HIV-risk behaviors by at least 10% Increase the percentage of newly diagnosed persons linked to HIV medical care within one month of their HIV diagnosis to at least 85% Increase the percentage of persons with diagnosed HIV infection who are retained in HIV medical care to at least 90% Increase the percentage of persons with diagnosed HIV infection who are virally suppressed to at least 80 % Decrease the % of persons in HIV medical care who are homeless to 5% or less Decrease the death rate among persons with HIV infection by at least 33% Decrease disparities in the rate of new diagnoses by at least 15% in gay & bisexual men, young Black gay & bisexual men, Black females, and persons living in the Southern US Increase the % of youth and persons who inject drugs with diagnosed HIV infection who are virally suppressed to at least 80% IND.3 Reduce the percentage of young gay and bisexual men who have engaged in HIV-risk behaviors by at least 10 percent. IND 4 Increase the percentage of newly diagnosed persons linked to HIV medical care within one month of their HIV diagnosis to at least 85 percent. IND 5 Increase the percentage of persons with diagnosed HIV infection who are retained in HIV medical care to at least 90 percent. IND 6 Increase the percentage of persons with diagnosed HIV infection who are virally suppressed to at least 80 percent. IND 7 Reduce the percentage of persons in HIV medical care who are homeless to no more than 5 percent. IND 8 Reduce the death rate among persons with diagnosed HIV infection by at least 33 percent. IND 9 Reduce disparities in the rate of new diagnoses by at least 15 percent in the following groups: gay and bisexual men, young Black gay and bisexual men, Black females, and persons living in the Southern United States. IND 10 Increase the percentage of youth and persons who inject drugs with diagnosed HIV infection who are virally suppressed to at least 80 percent.

Relationship between Interventions, Outputs and Outcomes The total activities that are implemented to lead to the outcomes. Outputs (AKA process objectives): Helps describe agency activities (i.e. quantification of activities). Outcome Objectives: Desired changes in the population as a result of the intervention. So let’s review the intervention from the example (read intervention above) How many of you have written objectives before? Although we are not going to write objectives in this course, could this be turned into an objective? Yes, we could develop process and outcome objectives, which help determine outputs and outcomes Go to next slide to review SMART objective

Planning Logic Model Priority Population and Gap in Care/ PrEPContinuum: (HIV Status, Linkage, Engagement-Retention, Med. Adherence, or PrEP Awareness, Uptake, Adherence): Social Determinants 3A’s Level of Intervention SI Type and Description Outputs Outcomes •Poverty •Homelessness •Stigma •Racism •Education •Availability •Acceptability •Accessibility •Community •Organizational •Societal •Economic •Environmental •Social •Policy j• Agency deliverables •Population changes as a result of successful intervention implementation. NHAS Indicator: Stakeholders: 35 This is a template for completing a LM for a SI Many of the headings probably look familiar, as we have covered several of these terms (Review each heading beginning with the Priority population and continuum gap, ending with the NHAS indicators) Now, let’s look at how to complete this Go to next slide

Peer Review of Logic Models What are 3 strengths of the LM? How well does the proposed SI match the prioritized determinants? Is there a logical flow between the 3As, level, and type of SI? What suggestions do you have for improving the LM and SLI plan? Visit www.californiaptc.com for more tools and information.