1. Lessons from Electronic Data Collection with Inmates in a County Jail Setting NATIONAL HIV PREVENTION CONFERENCE ATLANTA, GA AUGUST, 2009 Noah Carraher, MA San Francisco Dept. of Public Health HIV Prevention Section San Francisco, CA Shelley Facente, MPH Facente Consulting Richmond, CA

2. Background “PalmIT”: self-administered, computerized survey system Currently, copious paperwork is required for CTR We wanted to create a way for clients to reclaim their testing experience. Clients now have a way to assess their own risk, privately, before seeing a counselor. Then they can discuss with the counselor whatever topics they think are most important.

3. Questions include demographics, sexual and drug use history, and other HIV risk information. Pop-up prompts alert clients to available services or highlight key educational information when applicable. The data are uploaded at the end of each day and entered into a main database for later analysis. Background

4. PalmIT began as part of an NIH R-01 The UCSF Center for AIDS Prevention Studies collaborated with Magnet and the San Francisco Department of Public Health Magnet requested we go site-wide The rest is history

5. PalmIT has been available in many forms at Magnet

6. Background Magnet was easy – the question was, could it be done elsewhere? If it could be done in the county jails, it could be done anywhere.

7. 1,728 HIV tests were conducted in 2008 using the PalmIT system in the jails.

8. Factors Affecting Feasibility and Implementation Security in the jail Safety of deputies and inmates Jail subpopulations Multilingual, multicultural population Technological limitations HIV counseling and testing staff

9. Factors Affecting Use Language and translation Audio recording Digital divide Staff training Workflow

10. Language Initially, the questions that HIV test clients answered were written using a vocabulary geared specifically to the Castro population of gay men. Example #1: How frequently have you used condoms while topping with men in the last two years? One of our hurdles to implementing the survey in the jails was finding language that would be easy to understand for inmates filling out the survey on their own. Example #2: In the past 12 months, did you have anal sex with a man, when you put your penis in his butt?

11. Experimental Phase We experimented with making the language more graphic and descriptive. Version #2: In the last two years, how frequently did you use condoms when you were having sex in the butt (when your dick was in his butt)? One of the benefits of PalmIT is that language can be tailored and changed depending on the setting.

12. Feedback and Revision User feedback in the jails: there were positive and negative aspects to the more graphic speech. Humor In its final form we tried to avoid offensive speech and still convey the meaning of each question. Version #3: In the past 12 months, did you have anal sex with a man, when you put your penis in his butt?

13. Spanish Language Version We used a similar process to create a Spanish language version of the survey. Team translation: We gathered the bilingual staff of the jail testing team together in one room and went line by line through the survey to decide how to best translate each question into Spanish.

14. Spanish Language Version In Version #1 a professional translator was hired. The Spanish was more formal and used clinical vocabulary: ¿Ha tenido usted relaciones sexuales con hombres en el último año? [Have you had sexual relations with men in the last year?] In Version #2 the FAP team adjusted the translation. We revised the vocabulary and tone to make the questions easier to understand for Spanish-speaking inmates: ¿En los últimos 12 meses, tuviste sexo con hombres? [In the last 12 months, did you have sex with men?]

15. How to create your own system Avoid imposing a system from the outside Start small from the inside Organize your system around its users Don’t be afraid to admit mistakes along the way Be ready to change when necessary The ultimate goal is the end user’s experience Develop client-centered technology

16. Thank you! Noah Carraher PalmIT Coordinator HIV Prevention Section SF Dept. of Public Health San Francisco, CA Noah.Carraher@sfdph.org 415-703-7274 Shelley Facente Consultant Facente Consulting Richmond, CA shelley@facenteconsulting.com 415-999-1310