P6.018 Participatory Action Research, Evidence-Based Public Health, and Cooperative Agreements: Adverse Effects

Abstract

<h3>Background</h3> Racial and Ethnic Approaches to Community Health (REACH) 2010 was an ambitious multi-sector, multilevel, multicenter, and multi-phased community demonstration project designed to reduce health disparities in the United States. Requirements for a cooperative agreement with the Centers for Disease Control and Prevention were enumerated in Program Announcement 99064. Applicants had to represent coalitions of predominantly minority community members that would propose community action plans (CAPs) to address one or more serious health problems affecting one or more minority populations. The Broward Coalition to Eliminate Disparities in HIV Disease was one of 32 (out of 206) eligible applicants to receive a competitive award in Fiscal Year 2000 to develop a CAP. The CAP was one of 24 to be approved by CDC for implementation in Fiscal Year 2001. The primary goal was to eliminate disparities in new HIV infections reported among Black and Hispanic residents of Broward County by 2010. <h3>Methods</h3> A case study to illustrate how competing models of disease prevention can inhibit successful outcomes in public health. <h3>Results</h3> The participatory action research (PAR) programme designed, developed, and implemented by the Broward Coalition contained four interventions chosen by members after systematically working through the PRECEDE Health Promotion Planning Model. From 1999 through 2006, rates of new HIV infections among non-Hispanic Black residents of Broward declined from 193/100,000 to 81/100,000. On April 5, 2005, CDC site visitors informed the Coalition that funding for Broward would be cut in half in Fiscal Year 2006. They urged that only interventions recommended by CDC experts as “high impact” be continued. Subsequently, educational outreach efforts considered essential by local community members were curtailed and rates of new HIV infections among Blacks in Broward began to rise. <h3>Conclusion</h3> Project shortcomings were linked to the decrement of resources and reinterpretation of PAR interventions by evidence-based criteria.