Using Community-Based Participatory Research to Assess the Needs of HIV-Related Services for Infected Individuals in Rural Communities

HIV/AIDS remains a significant health concern in rural communities, which may also experience many disparate issues including reduced access to health services (Department of Health and Human Services, 2015). Community efforts should be increased to improve services to people living with HIV/ AIDS (PLWHA), especially in rural communities. In the state of Tennessee, using a community-based participatory research (CBPR) approach, a needs assessment was conducted to identify gaps, barriers, and strategies for improving HIV-related comprehensive care services for people diagnosed with HIV/ AIDS in 26 rural counties. The paper describes the CBPR partnership and the needs assessment project that was conducted and how the results may support community leaders and health care providers in planning and allocating resources for non-medical services of PLWHA in rural communities, and thus maximizing both individual and community benefit.


Data Collection
The faculty researchers and community partners agreed to use both qualitative and quantitative methods to conduct the needs assessment project.The first data collection activity entailed conducting an epidemiological assessment of PLWHA in the 26-county rural area to better understand specific populations as it relates to: 1) the most heavily burdened by the HIV epidemic, 2) experiences of infected individuals, 3) opinions related to the HIV care continuum from initial linkage, 4) subsequent retention in HIV care and services, and 5) long-term adherence to HIV treatment.Current gaps in services, consumer needs, and challenges that impact treatment attrition were also evaluated.Numerous state and local officials were contacted by faculty researchers and graduate students via telephone, email, and face-to-face communication to gather the epidemiological data.Additional data were compiled from the TDOH (i.e., HIV/AIDS/STD

Organizations
The Community HIV/AIDS Partnership is a consortium of community leaders, community-based organizations, healthcare providers, local public health agencies, and individuals infected and affected by HIV/AIDS.

Community HIV/AIDS Partnership (CHAP)
The Tennessee Department of Health is an agency of the Tennessee state government responsible for public health.This community agency works to improve the lives of people in Nashville by focusing on health,

Intravenous drug users (IDU)
This term refers to male persons who engage in sexual intercourse with members of the same gender.

Men who have sex with men (MSM)
People living with HIV/AIDS (PLWHA) People living with HIV/AIDS have been diagnosed with the human immunodeficiency virus/acquired immune deficiency syndrome.
Table 1.Organizations and HIV-Related Terms section) using data reported in the Tennessee Electronic HIV/AIDS Reporting System for the years 2010-2014.Second, a resource audit within the 26-county area was also conducted to assess the services currently available for PLWHA.The services commonly available to PLWHA were gathered through a comprehensive web search and information provided by PLWHA.The data were subsequently entered into an electronic database for assessment.
Third, two surveys (i.e., one for PLWHA and one for service providers) were developed and administered to PLWHA to evaluate their experiences regarding HIV non-medical services, challenges, and facilitators who impact their utilization of services, and their met and unmet service needs.CHAP members and the UWMN Community Impact Unit, under the consultation of the faculty researchers, compiled a 31-question quantitative survey and a 12-item qualitative survey (Brown, Johnson, Inman, Brown, Briggs, Burrell, Theriot, Williams, Buford, Burton, & Burton, 2015).PLWHA, who received services through the primary health care agencies in the 26-county area, were invited to complete the survey.If individuals were interested in completing the survey, the UWMN staff distributed the survey via mail.Individuals were informed via mail that the survey was voluntary and confidential.Survey respondents mailed back their completed surveys to UWMN staff.To prepare for data entry and analysis, the completed surveys were sent from UWMN to the faculty researchers.The second survey, the service provider survey, was generated to collect information about perceptions of service providers regarding the gaps in comprehensive care of individuals diagnosed with HIV/AIDS and their families.The questions for the service provider survey were developed based on findings presented in previous years' needs assessment reports and comments shared during a planning meeting with faculty researchers and community partners.To increase completion rates, the length of the service provider survey was kept short (six questions) to reduce the time it takes the providers to complete the survey.The provider survey was loaded into Survey Monkey, and a survey link was created.The link to the survey was sent to the identified providers servicing the 26-county area.After collecting all of the data from the service provider survey, the results were entered into a Microsoft Excel spreadsheet by graduate students.
The fourth and final data collection activity involved conducting focus groups within the 26-county area.The purpose of the focus groups was to assess whether gaps existed in services and resources among PLWHA in the area.The faculty researchers, in collaboration with the community partners, prepared the focus group survey items, scheduled the focus group sessions, and provided the incentive gift cards for participants.
All volunteering participants received a gift card at the conclusion of the focus group session.The gift card incentive was provided to enhance the community engagement and provided an opportunity to promote access to health care.The gift card could be used for food, gas, or hygiene products.
The focus group sessions were conducted across three separate regions in the 26-county area over a three-day period in two-hour sessions each day).All focus group participants-PLWHA and their families/caregivers-were part of a convenience sample.Informed consent was obtained from all participants.Confidentiality and full-disclosure statements were read to the participants.A 12-item focus group questionnaire was used to gather information and feedback.All data collected were anonymous and demographic quantitative data were collected before the focus group session began.Each focus group session followed the same format.The faculty researchers documented the responses from each focus group session through the use of note-taking and audio recordings.Two note takers and two audio recording devices were used to capture the qualitative data.

Data Analysis
The analysis of the quantitative survey data involved using SPSS Statistics 20.0.Frequencies and percentages were calculated to determine demographic characteristics of participants, criminal justice status, educational level, living conditions, and service utilization.The qualitative data collected from each of the focus group sessions were transcribed and analyzed using the qualitative software Atlas.ti7.During the qualitative data analysis process, common themes were identified that emerged from the participant discussions.
To improve the accuracy and credibility of the study findings, a member checking technique (Lee, Hoffman, & Harris, 2016) also known as "informant feedback" or "response validation" was employed by the faculty researchers to gather feedback from PLWHA about the preliminary findings of the needs assessment project.Also, consistent with the CBPR approach, the faculty researchers debriefed the community partners about updates regarding the needs assessment project and preliminary findings on a regular basis.Lincoln and Guba's study noted (as cited in Creswell & Miller, 2000) that peer reviews or debriefings provide support, play devil's advocate, challenge the researchers' assumptions, push the researchers to the next step methodologically, and ask hard questions about methods and interpretations.Over a two-month period, debriefings and member checking were carried out at several meetings held among faculty researchers, community partners, and PLWHA.A PowerPoint presentation and handouts, with content from the quantitative and qualitative results, were also shared during the meetings by faculty researchers to help the community partners and PLWHA understand the initial findings.Consequently, the faculty researchers sought to integrate the feedback from the community partners and PLWHA into the final results of the study findings.

Results
This section presents the results of the needs assessment project.The results are organized by the data collection methods, which include an epidemiological data assessment, resource audit, surveys, and focus groups.

Epidemiological Data Assessment
At the end of 2014, there were 997 PLWHA residing in the 26-county area and 4,975 PLWHA living in the metropolitan regions of Middle Tennessee.In this study, the term HIV prevalence is used to describe how many people are living with HIV disease at a given time, regardless of when HIV infection was diagnosed.Among the 26-county area, the prevalence of HIV disease has continued to rise over the past five years (i.e., 2010-2014), increasing from 829 to 997.HIV disease incidence refers to people who were newly diagnosed with HIV disease.From 2010 to 2014, the proportion of new HIV diagnoses in the 26-county area was approximately three times higher for men, comprising 77.7% of the total reported (i.e., 264 cases) and non-Hispanic whites (61.4%).

Resource Audit
The most commonly needed services identified by PLWHA in the 26-county area were basic dental providers, disability services, domestic violence interventions, expectant mother programs, health insurance providers, HIV/AIDS testing and screening sites, homeless shelters, medical care, local transportation, safer sex education, services for sexual assault, suicide prevention, transit to health care, tuberculosis screening sites, unemployment insurance, veterans assistance, childcare providers, and workers compensation assistance.Lack of transportation was cited as one of the barriers to accessing HIV services.Other noted challenges included respondents did not know where to go for services, cost or ineligibility, and waiting time to get an appointment to see a provider.

PLWHA Survey
Eighty-nine (n=89) HIV positive participants voluntarily completed and returned the PLWHA Survey.The characteristics and HIV transmission route of the survey respondents are listed in Table 2. Respondents were predominantly male (n=64, 72.7%), English-speaking (96.6%) and born in the U.S. (94.4%).The ages of respondents ranged from 20 to 74 years, with a median age of 46.Whites Notes: a Survey respondents were asked to self-report their race and, separate from race, their ethnicity.b Men having sex with men.c Intravenous drug use.† Includes those under 15 years of age with a reported HIV transmission route of perinatal mother-to-child and those with no reported transmission route.‡ Other risk includes occupational exposure, recipient of transfusion with blood products, and no risk reported.Respondents could report more than one transmission category.

N %
represented the majority of individuals completing the survey (n=50, 56.8%), followed by blacks (n=36, 40.9%), and Hispanics (1.1%).Of the 42 participants who responded to the question involving sexual orientation, 17 (42.5%) said they were heterosexual/straight, 2 (5.6%) said they were bisexual, and 1 claimed to be transgender.(From answers to other questions, we can assume that those not answering the sexual orientation question, 46 in all, or 51.7%, were likely homosexual or bisexual.)Asked how they thought they became infected, most (n=55, 61.8%) said men having sex with men (MSM), next was heterosexual contact (n=8, 9.0%), followed by intravenous drug use (n=7, 7.9%).Two (2.2%) said MSM or IDU (intravenous drug use).Over 10 percent (10.1%) reported "unknown" or "other" route.Among survey respondents, most (89.0%) were diagnosed with HIV disease for more than two years, and 39% reported they had been diagnosed with AIDS, which remained the same from the previous needs assessment findings.
Other findings, from the PLWHA survey, were that only 14 (15.7%) reported using illegal drugs in the past year; 13 (14.6%)reported as being homeless in the past year; nine percent (9.0%) reported as having been in jail or prison in the past year.While 82.1% of respondents completed vocational, some high school or at least some college education, 15.7% did not finish high school.
Some survey respondents (39.3%) reported first accessing HIV non-medical services within one month of initial HIV diagnosis, while 24.8% first accessed those services between three and 12 months after diagnosis, and 13.5% delayed more than one year to access non-medical services.Table 3 shows the numerical ranking and list of non-medical HIV services not currently offered through Ryan White Part B funding identified by the respondents.Non-medical case management (21%), transportation to care or service appointments (16%), and dental services such as check-ups, fillings, and extractions (16%) represent the top three non-medical services.Table 4 illustrates the numerical ranking and list of services identified by the respondents as gaps in care and services that need to be addressed.Eye care (23%), rent assistance (22%), and utility assistance (22%) represent the top three gaps in care and services as identified by the respondents.

Service Provider Survey
The provider survey was sent to more than 60 providers.Only nine providers participated in the survey, which is a very low response rate.Six respondents were administrators, and three respondents were case managers from various agencies within the 26-county area.While the response rate was small, there was relevant information discovered from the nine respondents.

Focus Groups
Common themes were found from the focus group data.The themes were service availability, utilization, access, satisfaction with services, quality and barriers to services, and unmet needs.The main items listed under the service availability theme were dental and medical services that are located in the metropolitan area in Middle Tennessee and local health departments.The feedback responses for the theme "utilization" included support groups, mental health services, dental services, and utilization of available transportation as the most critical HIV-related services that PLWHA are using now or have used in the last year.Under the access theme, respondents self-reported experiencing financial difficulties (e.g., no insurance, signing up for insurance/waiting period, no income, relocation costs, cost of living changes, and lack of local resources) as the reasons care was not accessed for 12 or more months.Most respondents indicated that they were satisfied with the pharmacies and various private primary care physicians within the local areas along with two agencies (Nashville Cares and the Vanderbilt Comprehensive Care Center) located in a metropolitan area within Middle Tennessee.Under the satisfaction with the quality of services theme, respondents identified transportation services, re-certification steps to obtain insurance, and access to primary care as the things that clients would like to see changed.Discriminatory practices and being discriminated against were listed as barriers to accessing services.The last identified theme was unmet needs.Participants listed the following: 1) lack of local access to primary care services, 2) lack of transportation, 3) nutritional needs not being met, 4) unsure of resources, 5) only having a nurse practitioner providing primary care services instead of a doctor, and 6) the long waiting time to see nurses and doctors.

Study Limitations
The use of a convenience sample limits the application of the results to be generalizable.Another limitation of the study was low response rates on the surveys and a short length of time to promote the study to the target population, which affected the sample size.Also, the PLWHA Survey was only distributed primarily through the main community agencies within the 26-county area.As a consequence, individuals who were not clients of these agencies, as well as those not currently engaged in HIV-related services, might not have been aware of the opportunity to participate in the study.In general, the potential pool of participants was limited to individuals currently receiving HIV-related services, and the results could not be generalized to all PLWHA other than those who completed the survey and volunteered for the focus groups.

Discussion
The CBPR approach was used to guide the process of conducting the needs assessment project among faculty researchers and community partners.As a result of this collaboration, an epidemiological data assessment, resource audit, surveys, and focus groups were conducted to complete the needs assessment project.The epidemiological assessment identified the population living with HIV in Tennessee (i.e., 26-county rural area).Although the total number of prevalent cases of HIV disease is small in the 26-county area, these cases were distributed over a large and diverse geographic area with generally fewer medical and support services available for HIV-infected persons, which poses an additional challenge for people living with HIV in the 26-county area.The resource audit revealed that PLWHA identified 18 non-medical support service needs within the geographic area.The surveys and focus groups also provided varying perspectives to existing gaps in care services.

Conclusions
The purposes of this study were to describe collaboration of faculty researchers from Tennessee State University and community partners, to conduct a needs assessment project of people living with HIV/AIDS related to their HIV-AIDS continuum of care and services in the 26-county rural area, and present the results of this project.The collaborative partnership approach helped to identify the non-medical service needs and interpret the results of the study.The results indicated that there were few HIV positive individuals linked to HIV non-medical services within one month of being diagnosed with the HIV disease.Additionally, numerous survey respondents noted that early intervention services, routine dental services, non-medical case management, eye care, psychosocial support, emergency food bank, rent assistance, utility assistance, and adequate transportation to appointments are critical non-medical services for meeting the needs of PLWHA.This study identified the needs of PLWHA who participated in the project and were currently receiving services through community agencies in the 26-county rural area.
This study may not represent the overall needs of PLWHA who are residing in the 26-county rural area and who are not currently receiving services.This needs assessment was the first step toward identifying the non-medical service needs of PLWHA in the 26-county rural area.The results of this study will be used by Community HIV/AIDS Partnership members as it relates to making recommendations to the Tennessee Department of Health for direct planning and resource allocation of Ryan White HIV/AIDS (Part B) funds.The findings and recommendations from this needs assessment study can also support community leaders and health care providers in planning and allocating resources for non-medical services of PLWHA in rural communities.

Introduction
As a Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) accredited institution, we are required to develop and implement a Quality Enhancement Plan (QEP) every 10 years as part of our accreditation reaffirmation (SACSCOC, 2012).The QEP should focus on positively impacting students' learning, while integrating institutional assessment.A successful QEP initiative requires significant input from relevant campus constituencies, and should have an implementation plan, specific outcomes, and an assessment plan.Ideally, it should be an institutionalized part of the campus culture following an initial five-year implementation period.QEPs provide many institutions with opportunities to develop cultures of assessment (Loughman, Hickson, Sheeks, and Hortman, 2008;McConnell, Van Dyke, and Culver, 2011) and serve as catalysts for faculty and staff engagement (Fallucca, 2017).QEPs also provide structure and prioritize resources for focused activities that support student learning and the mission of the institution (SACSCOC, 2012).
In this paper, we describe the development and implementation of our QEP, focused on academic community engagement; provide vignettes from some of our classroom projects; and offer lessons learned for educators as a proposed model for other institutions with both a primarily diverse student population and a substantial, non-traditional, commuter student population.

About Our University
Clayton State University is a predominantly black institution located in the south Atlanta metro area.In fall 2017, our student body was more than 70% minority, over 60% female, and the average student's age was 26.We have a large firstgeneration college population, as indicated by student responses (approximately 60% of respondents on the 2017 administration) to the National Survey of Student Engagement (NSSE).Over 40% of our students attend part time and nearly 30% of our students are non-traditional (Clayton State University Fact Book, 2017).We currently offer over 30 baccalaureate degrees and multiple master's degrees, focused on careeroriented education with a solid liberal arts foundation.Our student body directly represents our local communities; the overwhelming majority of students originate from the county in which we are located, and adjacent counties.The university mission and vision emphasize community engagement and experience-based learning.
Figure 1 presents a general organization and flow of our QEP since its inception.In spring 2012, our university began the process of identifying a QEP topic by examining existing institutional data and initiatives focused on student success.Existing initiatives included Complete College America, the American Association of Colleges and Universities' Liberal Education and America's Promise (LEAP) initiative, and our ongoing university strategic-plan-based initiatives.A campus-wide survey asked participants to rank several theme areas derived from the LEAP initiative's High Impact Practices (HIPs).Service/Community-Based Learning yielded the highest ratings, whether it was focused on course-related service projects or courses tied to service organizations (intra-campus and between campus and community).Following this initial data-collection period, in fall 2012 a cross-campus steering committee consisting of faculty, staff, and student members was created and began the real work of narrowing the focus of the topic.
One of the first tasks of the committee was to verify the overall topic for the plan based on institutional data, the results from the previous survey, and input from committee members.Balancing our university resources with what would directly benefit our students, the committee agreed that our planning should focus on "lowhanging fruit, " using programs, activities, and initiatives the university had begun, but had not yet fully implemented.Because our university was already connected with the community in a number of ways, including through our faculty and staff activities, the idea of community engagement continued to be the most viable focus for our QEP.
After further detailed examination of institutional data including from the NSSE, the Faculty Survey of Student Engagement (FSSE), and  surveys of existing course offerings, the committee determined that while our value and commitment to service were evident in our current university mission and faculty responses, the majority of the university's listed courses did not incorporate community-based activities and less than half of our NSSE respondents had engaged in community work as of the 2011 NSSE.
The plan required broad institutional involvement; we developed and executed a stakeholder assessment plan, including students, faculty, and staff.Input from students attending steering committee meetings, broadly shared surveys of the student body, individual meetings with the committee chair, and student focus groups provided insight on student-specific concerns in the design and implementation of a community engagement course requirement.The primary issues centered on time management, work-life balance, and perceived increased requirements from community engagement projects.This feedback was expected given the particular challenges for non-traditional students to participate in course activities outside of regular class meetings (Kelly, 2013), differences in how non-traditional students perceive service learning (Rosenberg, Reed, Statham, & Rosing, 2012), whether documented benefits of such activities would differ for these students (Reed, Rosenberg, Statham, & Rosing, 2015), and challenges for students who commute (Jacoby & Garland, 2005).
The steering committee also collected information directly from the academic and nonacademic departments regarding specific engagements with community groups, not only to reinforce the appropriateness of this focus for the campus, but to gauge the existing community partnership connections in the area.The chair of the committee also visited with each academic department, convened multiple town hall-style meetings, and presented to the university's faculty senate and the student government association to further spread awareness regarding this QEP focus, and to gather additional input from the affected campus constituencies.
In early 2013, our campus chose to focus on student engagement through community projects that enhance learning, while taking into consideration the concerns of non-traditional students.We defined academic community engagement as intentional efforts within courses to engage students in planned and purposeful learning related to service experiences within the community.We then further defined our goals, developed activities and assessments, and prepared for the accreditation visit in early 2014.We also convened subgroups focused on assessment and overall program design.

Academic Community Engagement Definitions
Academic community engagement intentionally marries community service activities with course-related concepts and outcomes to benefit both the community partner and the students.What distinguishes it from other more volunteer-based community service activities is the direct and deliberate link to academic goals.A service-learning (or any successful academic community engagement) experience incorporates a learning component, a service component, and a reflection component; combined, these entities link classroom material to service activities.Several variations on best practices have been offered (e.g., Howard, 2001;Neuwald, 2003) but common threads include specific service or civic learning goals and explicit links to the course material; reflection or other connection of the service experience to the learning; direct and ongoing communication among stakeholders and carefully selected service experiences; adequate preparation of students; preparation, training, and support for faculty; and integration of the community engagement project into the course plan/ curriculum.
Felten and Clayton ( 2011) also note that one of the additional requirements for this pedagogy to be successful is that it be flexible to accommodate changing situations and be responsive to the needs for building capacity and learning for all involved; this component is particularly important given our student body.A sizable proportion of our student body is non-traditional; many students commute, rather than live on campus.
While not specifically focused on service learning, Gilardi and Guglielmetti (2011) identified various characteristics of non-traditional students that make them more vulnerable to leaving higher education, including the additional pressures of maintaining employment and not always seeing the value of connecting to the campus while on their individual journeys.Yob (2014) notes that many of the characteristics of successful student retention programs are also seen in academic service learning, and that these are important to non-traditional students as well as traditional students.These include academic and social integration, active participation, engagement in learning, direct interactions with faculty and fellow students, and application and relevancy of academic information.All of this speaks to the value of incorporating academic community engagement into our curricula, but also cautions us to consider balancing the benefits with the additional pressures on our students that the pedagogy might entail.A number of course-based strategies to address these needs are discussed in the section entitled "Course Vignettes."

Student Benefits of Academic Community Engagement
The academic and other benefits of community-based learning to students have been documented in multiple venues.Service learning has been linked to higher GPAs, increased critical thinking and problem-solving abilities, and increased self-efficacy and tolerance for and appreciation of diversity.It also affords students the opportunity to apply course and curriculum content to practical and concrete contexts (e.g., Astin, Vogelgesang, Ikeda, & Yee, 2000;Peters, McHugh, & Sendall, 2006).Additionally, increases have been reported in students' academic engagement and intention to continue study (Gallini & Moely, 2003).Engaging in communitybased learning is also linked to increases in civic engagement, sense of citizenship, and sense of social responsibility, as well as enhanced social development and leadership skills (e.g., Peters et al.;Joseph, Stone, Grantham, Harmancioglu, & Ibrahim, 2007;Yoon, Martin & Murphy, 2011).Specifically relevant to our institution, service learning/community-based learning is a growing area of research with documented benefits to both minority (Ellerton, Di Meo, Pantaleo, Kemmerer, Bandziukas, & Bradley, 2015;Ward & Wolf-Wendel, 2000) and first-generation college students (Yeh, 2010;Ward & Wolf-Wendel, 2000;Pelco, Ball, & Lockeman, 2014).

Designing for Success
Bringle and Hatcher (1996) identify planning, awareness, resource, expansion, recognition, monitoring, evaluation, research, and institutionalization activities-approached from the various standpoints of institution, faculty, student, and community partner-as important components in service learning.In our case, these include the previously described student surveys and focus groups, contacts and meetings with academic and non-academic departments regarding preexisting community contacts, and survey of preexisting courses with community engagement projects.
Following the acceptance of the QEP, a small group of faculty was recruited to design and deliver select pilot sections of our first-year experience seminar course that incorporated academic community engagement in fall 2013.To help prepare the pilot faculty, we worked with university resources to develop a four-session workshop series called the Community Engagement Academy for summer 2013.Sessions were conducted as a mixture of presentation and application where participating faculty completed the training with a specific course that is, for the most part, designed to be offered as one of our community-engaged courses in a subsequent semester.The first two sessions focused on pedagogy, specifically designing and assessing a course for community engagement.Attendees were provided with copies of the Service-Learning Course Design Workbook (Howard, 2001) in addition to materials developed by our own faculty and other service-learning resources.The third and fourth sessions focused on building community partnerships and preparing projects.
We conducted other awareness-raising activities, including branding exercises, during 2013 and early 2014.The campus selected Partnering Academics and Community Engagement (PACE) as the initiative's name.Campus leadership also identified a director for the initiative reporting to the Academic Affairs Division.The director then recruited additional members from across campus to focus on implementation and assessment planning, and constructed an advisory board that included external community representation.Our initiative did not have a dedicated physical space on campus, but there were clearly identified points of contact (the director and other committee members) for on-campus and off-campus communications.
According to Bringle and Hatcher (1996), assessment is key to the monitoring and evaluation activities.For our QEP, we identified both program-level and student-learning outcomes and appropriate assessments.Some of the program-level assessments could be tracked by our institutional research infrastructure, such as student enrollment in community-engaged classes, student completion rates in those courses vs. other non-impacted sections of the same course, and numbers of courses offered under the initiative's banner.Student-learning outcomes included course-level assessments, reflection assignments within community engagement courses, and scores on the Community Service Attitudes Scale (CSAS) constructed by Shiarella, McCarthy, and Tucker (2000), and administered at the beginning of the term (pre-test) and following project completion (post-test).

Implementation and Sustaining the Momentum
The Comprehensive Action Plan for Service Learning outlined by Bringle and Hatcher (1996) suggests several clearly identified actions that reinforce the need for careful planning, development of resources, attention to evaluation and assessment, and the involvement of all stakeholders, including faculty, students, and community partners.Here we describe key activities and actions taken by each stakeholder group to initiate, grow, and sustain PACE from years 1-4 (fall 2014-spring 2018).

Our Faculty
Through our Community Engagement Academy, faculty from disparate disciplines work together on the common goal of designing community-engaged courses; during the training sessions, attendee brainstorming regarding common faculty concerns often yielded creative or transferable solutions.An informal community of teachers and scholars has formed as a consequence of the Academy and the growth of the initiative.Bringle, Hatcher, and Games (1997) distinguish between faculty recruitment and faculty development in outlining things that should be kept in mind when developing service-learning initiatives.Faculty should be encouraged to participate by means of various incentives, and should be supported through training and other opportunities to develop, implement, and evaluate community engagement as a pedagogy.Bringle and Hatcher (1996) note that the collection of data to evaluate the effectiveness and impact of the pedagogy on student and faculty outcomes can support the work, and that the institutionalization of the faculty's commitment to service learning can be reinforced by the recognition and acknowledgment of service learning in activities such as promotion and tenure and annual reviews.Pribbenow (2005) identifies benefits to faculty, including more meaningful engagement, deeper connections to their students as learners and individuals, and greater involvement in a community of teachers and learners.Cushman (2002) 2016;Miller, 2017;Norflus, 2017;Parrott, 2017;Parrott & Ritter, 2016).

Community Connections and Partnerships
Bringle and Hatcher (1996) state that while it's a complex endeavor with many possible iterations, community representatives need to be involved in planning service-learning (and by extension other academic community engagement) programs.Many of our first course/community partnerships arose from previously existing connections, identified either through the initial QEP development information gathering or faculty's own community service activities and interests.
In fall 2015, the university launched a networking event connecting representatives of community groups from surrounding counties and the metropolitan area.This now annual event combines community-partner networking, needs assessment, and information sharing, and forms the basis for many of the other opportunities to connect community partners and specific courses throughout the year.Many of our faculty and students from community engagement courses share their experiences.The event allows our stakeholder groups to celebrate the partnerships between our students and our communities.In recent years we have expanded our invitations to include additional university resources that can engage with community partners with needs that go beyond the scope of our classroom-based projects.
For each community engagement course, the faculty member is required to complete a memorandum of understanding in direct collaboration with their community partner(s).
Please rate the following statements regarding the course project (1=Strongly Disagree, 5=Strongly Agree) The course project had a positive impact on our organization's efforts to meet community needs. mission.

The project was asset to our
The course instructor understood our organization's mission as part of the greater community.
The students were aware of our organization's mission as part of the greater community.
Overall communication with students/faculty.
Level and of interaction with students/faculty.
Quality of student work.
Feedback and input into planning experiences.
Scope and timing of activity.
Level of trust with faculty and students.The memorandum articulates only the responsibilities of all parties (students, faculty, community representative, and PACE director) but also the specific learning outcomes for the students and the service outcomes for the community partner that will be addressed by the course project.This memorandum clarifies expectations, duties, and benefits to the stakeholders, provides PACE with important information to connect future courses with those partners, and helps provide relationship continuity across time as people may change, as suggested by Bringle and Hatcher, 1996.

Institutional Impact
During our first four full years of (as of fall 2018), we trained over 60 full-time faculty and designed more than 60 courses to include community engagement projects.Over 2,000 students have taken at least one (many more than one) PACE communityengaged course.Course completion rates have increased in more than half of the PACE courses relative to historical (pre-fall 2014) baseline or comparable sections in the same semester.Additional measures including student retention, graduation, GPA, and performance on standardized measures of critical thinking and communication will be examined following the five-year QEP implementation.
Perhaps the most tangible impact on our institution has been the establishment of an infrastructure and culture to support academic community engagement that is specifically tailored to our student population.This includes emphasis on designing course engagements that are more project-based than direct service, projects that can accommodate student scheduling and transportation stressors, and increased development of online community-engaged courses.This infrastructure includes Academy training that emphasizes careful course project design and where faculty complete learner analyses that incorporate a wide range of student variables, including those specific to nontraditional students.The variables, therefore, consider and attempt to anticipate non-academic factors that can present challenges to students' project completion, and closely align the in-class learning with the project activities.

Community Impact
Since our launch in fall 2014, PACE courses have completed over 170 projects, working with over 100 partners.Our courses have worked with local schools, nonprofits, governmental entities, and (in rare cases) small businesses or franchises.Project types include direct service such as clearing trails for a local nature preserve, tutoring, and volunteering at local senior centers.Other courses incorporate project-based service such as document drafting, basic research, design and execution of educational programs, and development of video and other promotional items.Given our substantial non-traditional and/ or commuter student population, most of our community engagement projects have been project-based service, leveraging many of the usual activities in college classrooms (research, writing, creation of materials) to support the outcomes of our community partners, and mitigating many of the scheduling and other issues students may   & Garland, 2005;Reed, Ferrari, & Bothne, 2010).Table 1 summarizes the types of service and projects completed by our students to date.Community-partner feedback, collected by survey after each project, has been positive (Table 2).While challenges such as scheduling, student preparedness, and short project time were noted, benefits including new connections with other community groups, increases in the services they could offer, and improvements in their organization's communication or public relations were also cited.Collectively, each stakeholder was able to contribute to the implementation and sustainment of our QEP efforts.

Student Impact
In addition to increased course completion rates, positive gains have been documented on some of the subscales of the CSAS between pre-test and post-test results.Specifically, students show gains in their perception that there are actions that could relieve community need; recognition of one's own ability to do something to provide help; feeling a sense of responsibility to become involved based on a sense of connectedness with the community or the people in need; and reassessment of the seriousness of the need and the need to respond.
In the next section, we will detail some of the service-learning courses that were developed as part of the QEP.Instructor reflections offer insight into effective ways to ensure that non-traditional students are well-supported in these efforts.

Course Vignettes
Several of our co-authors have designed and delivered community engagement courses as part of PACE.Following are vignettes written by those instructors, describing their course partners, projects, and student benefits and instructional impacts.Students in these classes included high school students dual-enrolled in our classes (English Composition), traditional first-year students (English Composition and University Foundations), and a mixture of traditional and non-traditional students (Wills and Testaments, Writing for Nonprofits, Literatura Infantil).Table 3 summarizes each course's community partner and project activities.

University Foundations, First-Year Experience:
LEGO robotics seminar (Scott Bailey).The University Foundations course was designed to help new students make a successful transition to Clayton State University, while refining academic goals and preparing them to meet the challenges of higher-level learning and the demands of their chosen field by connecting them with faculty who share a common interest.This section of University Foundations consisted of students majoring in mathematics, computer science, and information technology, many of whom were first-generation students from nearby counties.For several years, Clayton State University has annually hosted a state super-regional competition for FIRST LEGO League (FLL), a national robotics program for children aged 9 to 14 years.Historically, there has been very little representation from the counties the university directly serves.Our course project focused on assisting the development of FLL teams in the local middle schools.
My students were affected by the experience.One student noted in his reflection that the middle school group he worked with continually struggled with the tasks given to them, and expressed frustration that the group did not ask questions that he could address.He started asking more questions in his own college algebra course (I was the instructor) and his grade steadily improved.Another student noted that "Hard work doesn't always yield immediate results, " while another determined that the most important lesson learned is not every student wants to be in college and points out that learning is more about interest and passion.The importance of addressing personal issues, time management, personal responsibility, teamwork, and assisting peers in need were common observations from the more engaged students.
Before engaging in this project, although I was aware of the personal issues non-traditional students have and the roadblocks to success they present, I was largely unaware of the severity of the issues that K-12 students in the public school system, and thus our incoming students, possess.From my experience, and those of my students as viewed from their reflections, the most important roadblock to success is that ambition can easily be stolen by personal issues.It is important to note that inspiration, encouragement, and assistance that teachers can provide serve to alleviate emotional roadblocks to ambition and allow for a greater flow of information.However, passion can be transferred from teacher to student if there is a mutual trust and respect between the two.In this course, the more passionate and successful students who developed non-trivial connections with the middle school students were those that graduated from similar public school systems thus could immediately empathize and relate to their personal or emotional roadblocks.
English composition, first-year writing (Margaret Fletcher).Research suggests that college freshmen and dual enrollment students who encounter some success during their critical first year are more likely to stay in school.Encouraging first-year writers to make writing real and to educate others through their writing is a good place to start that journey toward graduation.My purpose for getting involved in the PACE program at Clayton State University was threefold.First, I wanted my students to learn more about volunteering in their community.Second, I wanted them to see that composition activities can be a part of volunteering, that writing serves an important purpose in the community.Finally, I wanted my first-year composition students to begin to feel that they can play an important role in an academic environment.Thus, with the guidance of the PACE director, I structured a program that was tied to the writing skills I teach in my classes.
I have a large number of dual-enrollment students as well as traditional and non-traditional students.Many of my students are first-generation college students; and some might be considered at-risk students.I wanted my students to use their beginning writing classes as a strong start toward continuing their education by becoming more involved in their campus community as well as in our classroom.I discovered that there are many campus activities that need volunteers and found some matches; thus, my students learned more about campus involvement by volunteering for on-campus PACE projects.Each project they worked on was linked to the larger community, but students had to be a part of the campus community.First-year writing classes are centered on peer review and group interaction; therefore, the activities the students completed in class fully aligned and even surpassed course objectives.
My students partnered with the university library for two consecutive semesters.Our first undertaking was a voting rights project just prior to the presidential election.Political science faculty and students helped my freshmen prepare booklets on voter registration, on candidates and their stances, and on guidance for further assistance in voting, such as locating the correct voting polls and taking appropriate identification to the polls.
Many students in our overall school population are first-time voters, so we developed the booklets to meet their needs and to encourage them to feel more comfortable with the voting process.Students distributed their voting guides to other students in a program held on campus.Thus, they got to know more upperclassmen, and meet new people.Many students told me they had fun.During the same semester, the university library was sponsoring an exhibit on civil rights, and we worked as volunteers for that program also.My classes prepared the program for a civil rights historical seminar, attended the meetings on a voluntary basis, and interviewed speakers.Students wrote essays on the Voting Rights Act of 1965, and their culminating activity was a bulletin board outlining the history and significance of the Voting Rights Act of 1965 intended to educate today's young people.
The following semester, we worked with a traveling exhibit on Harry Potter books sponsored by the library.During both semesters, the library sponsored sessions with speakers, which my students assisted with and attended when possible.Students interviewed the speakers and produced a blog, which was included on the library's official blog page.The most interesting part of the second semester was a section on developing Pathfinders, a type of research guide for younger students, working under the guidance of a university librarian.Thus the students themselves learned more about research as they prepared research guides for younger students.
When I began the course, I wasn't sure how to handle the number of students involved, but by the time we finished, all four of my class sections of first-year writing were involved.Because students collaborated and worked together in groups on many aspects of the project, I think they learned from each other and the quality of the finished products was more than acceptable.When the Harry Potter exhibit was open to the public, the Pathfinders, complete with student names as authors, were available to community members who attended.My students were excited to see their "published" work disseminated to the local community.As college freshmen, they succeeded in presenting useful information to the student body and to community visitors.In other words they not only belonged to the academic community, they also became authors.
I would suggest that those considering this work find creative people on campus to work with, make certain that the work is and link the project to the learning goals of the class.Also, don't expect every student to be involved to the same degree, but do try to get all students working on some aspect of the project.Freshmen and dualenrollment students who undertake projects are stepping outside their comfort zones, and in many ways, such as reading Harry Potter for the first time and learning about voting rights, as well as how to prepare a Pathfinder, I too stepped out of my comfort zone.Ultimately, my students and I felt good about our hard work.
Wills, mid-program legal studies course (Antoinette France-Harris).As Strait and Sauer (2004) note, increases in online course offerings have created a need to develop experiential learning opportunities such as service learning in an online course setting.Additionally, online courses have become increasingly popular with our non-traditional students, many of whom are juggling family and work obligations as they complete their education, so Clayton State University has offered a mid-program online legal studies community engagement course for five consecutive spring semesters.Offering this class online has allowed non-traditional students the flexibility that Felten and Clayton (2011) indicate is necessary for successful service-learning projects.Despite their busy schedules, my students have been able to partake in experiential learning and become involved in service to their community.This involvement is extremely important for my students, who are planning to become either attorneys or paralegals.Attorneys should aspire to offer at least 50 hours of pro bono services annually (American Bar Association, 2018).Paralegals should contribute 24 hours of pro bono services annually (National Federation of Paralegal Associations, 2006).
There are numerous pedagogical benefits to service learning for non-traditional students (Astin et al., 2000;Peters et al., 2006), and these benefits extend to the online classroom.According to Helms, Rutti, Hervani, LaBonte, and Sarkarat, (2015), "Technology facilitates information exchange and enables virtually any class to transition into online service-based learning." In an online classroom, it is important to conduct activities that facilitate engagement.For this online legal studies course, the incorporation of service learning was designed to extend opportunities for increased student/faculty, student/student and student/content engagement.
For the online Wills, Trusts, and Probate Law course, I created a project to offer pro bono legal services to members of the local community.What makes the course unique is that in addition to the usual class activities, the students and I work in teams on a semester-long project that involves using the knowledge and skills they gain traditionally to assist real-life individuals.Through the community engagement experience, students learn about interviewing skills, ethical considerations, the basics of estate planning, and how to draft and execute estate planning documents properly.Typically, I include projects in each of my classes, so there was no extra work involved for the students as they participate in this project.
All parties that are involved reap benefits from the community engagement project.The community residents are thankful to receive pro bono legal help.Moreover, they enjoy interacting with and offering a learning opportunity to the students.In their evaluations of the class, students customarily cite the community engagement component as the course highlight.For many students, the servicelearning project is the first time that they have used their specialized legal knowledge to assist actual individuals with real needs.The community residents teach the students the importance of effective and continuous communication, confidentiality, and sensitivity.As a result of the experience, some students decide to have difficult conversations with their own family members concerning estate planning upon the project's completion.Still other students remark that the community engagement project makes the online class more engaging and they welcome the added classmate and instructor interactions.
The challenges related to this service-learning class are typical of other online courses and group projects.There may be students who are unwilling or slow to do their fair share, or who may have communication challenges.From the instructional perspective, it takes more effort to establish a partnership, to confirm that the project is running smoothly, to manage group dynamics, and to ensure that the client is satisfied.However, overall, the pros far outweigh the cons.
Writing for nonprofits, upper division English course (Sipai Klein).Writing for Nonprofits is a face-to-face, service-learning course that introduces undergraduate English majors to writing and communication activities that take place at nonprofit organizations.The course was offered during both spring 2014 and fall 2015 and contextualized the writing needs of these organizations by collaborating local partners to implement an eight-week long project.Students were given the opportunity to specialize in the type of communication that interests them by applying for one of four tracks within which they participated in the project: project manager, managing editor, graphic designer, or writer/ researcher.These tracks mimic the positions found at a small nonprofit.Once students were "hired" for a track, they met with their community partner to discuss potential projects and subsequently submitted a project proposal to be approved by both the partner and instructor.While not all projects require fieldwork, students were expected to engage with the project as determined in the project proposal.Throughout the semester, students repeatedly met with the community partner and submitted update reports.The deliverables created for the projects had to be tested for usability on target audiences.The semester concluded with a presentation that was open to the public; additionally, each team submitted a portfolio that included a final recommendation report to the community partner.
An example of a successful project included a legislative luncheon that was designed, as students stated, "[to] raise awareness within the county community about the increasing number of teens age 16-19 not in school and not working." This project supported a nonprofit with a mission to serve as a collaborative that connects resources from across the county.The student team identified published empirical research, analyzed data from the county, and interviewed community stakeholders related to high school dropout causes and prevention.They presented their findings at a luncheon that included multiple community activists and local political figures.The project was successful because students addressed a community partner's specific needs, collaborated throughout the iterative research process, and, lastly, developed problem-solving communication skills within the context of a nonprofit organization.
An intriguing feature of teamwork in this course was the way a nonprofit's mission encouraged non-traditional and traditional students to contribute and share.For example, when partnering with a nonprofit that worked with therapy animals, students from diverse generations vied for the project manager position-this included students who were separated in age by several decades.The team found ways for shared grounds and contributed their unique knowledgethe younger members created instructional material for using social media platforms and the more seasoned members prepared content.The intersection of skills and knowledge created a robust repository with which to serve the nonprofit's communication needs and helped the team create a successful social media marketing campaign.This collaboration illustrates how traditional and non-traditional students can work together when they both value community engagement.
Writing for Nonprofits required a degree of flexibility and problem-solving that I did not encounter in my other courses.In their course reflections, students identified the following challenges: the additional time it took to travel to a community partner; the amount of labor required for the project; team-internal issues (e.g., communication, and the low-contributing team member); and community-partner communication (e.g., vision of the final deliverables).These challenges are natural consequences of collaborative learning that includes stakeholders outside of the classroom and make the course rewarding to students in the end.Still, the following suggestions did help address some of these challenges: 1) holding a kickoff meeting on campus with the community partner to clarify needs and expectation, 2) prototyping and receiving feedback from the target audience during the design phase (allowing students to experience the iterative process of negotiating deliverables with the community partner), and 3) investing in teambuilding activities to strengthen each team's internal communication.
Literatura infantil, upper division Spanish language elective (Rosario Vickery).Literatura infantil, an upper division Spanish-language and culture course in children's literature during fall 2016, connected students to the community in a dynamic relationship with our community partner, the county public library.Throughout the semester, students applied what they learned in class to a situation outside of the classroom with a librarian specializing in children's literature serving as the students' mentor.Although I had previously integrated service learning into many of my language and culture courses, I structured this course with community engagement as the driving pedagogy.The pedagogy worked as currency in learning the material for both non-traditional and traditional students since it offered a platform for performance and immediate feedback from the a learning path especially appreciated when career goals are driving factors.The course objectives of engaging in critical thinking and continuing the development of advanced oral and written Spanish-language skills from topics in Spanish and Latin American culture in children's books coincided with the library's goal to significantly increase the number of bilingual story hours offered for the children and families in the community.I chose the community partner partly through the public library's previous engagements with PACE and also because I had previously worked as a scholar for a national reading program for Latino children offered at that system.
In class, the students analyzed children's literature through discussions and written assignments.They acquired new vocabulary, practiced reading aloud, and furthered oral proficiency skills by presenting a mock story hour to the class.As convenient to their schedules, students volunteered several hours at the public library.This approach enabled them to check out books to read and become acquainted with the library's resources for children's literature in Spanish.Students also worked side by side with their librarian mentor to prepare a story hour for the public library, the final project of the course.This story hour, conducted by each student for children at the public library, took place during the last month of the semester.Some students conducted a story hour with a student partner and others alongside the librarian.Every student was able to choose the activities for the story hour and the books to read to the children.
Some children who attended a story hour were fluent in Spanish while others had little or no previous exposure to Spanish language or the Latino culture.The college students knew to keep every child engaged, an important element that they addressed with youthful energy enjoyed by all.Each student was mentored by a children's librarian who worked one on one with the student during the planning, preparation, and performance of the bilingual story time for the children.Parents who attended a story hour were from the community at large, a multicultural population including Latinos.All parents were excited about the exposure to Spanish and noted its importance for their children.The Latino parents particularly appreciated their children experiencing Spanish at a public space and noted the value of reinforcing the home language at the library.
Approximately 30% of the students in the class were heritage learners or immigrants whose first language is Spanish.The remainder were learning Spanish as a secondary language.Although there was a traditional mid-term exam, the course was primarily project-driven.This approach presented two challenges, which though resolved, are worth noting here.A logistical issue was that due to a disability, one student in the class needed help in arranging transportation to and from the library multiple times throughout the semester.This was especially challenging since library visits comprised 25% of the participation in the course.As the instructor for the course, I frequented the library regularly so the student who did not drive coordinated her visits with mine.A challenge related to communicating learning outcomes became evident from the first reflection on the service experience.I noted that a student who had emigrated as an adult was interpreting her role at the library solely from a collective perspective of social benefits to the community at large, and did not express any personal gain from the experience.In her final reflection, however, she noted that she had discovered new abilities within herself, like creativity, and that, "Cada etapa de este proyecto de clase fue una sorpresa para mí." [Each stage of this class project was a surprise for me].

Lessons Learned and Suggestions for Practitioners
PACE experienced both successes and failures during its first four years.Reflection has been a driving force throughout the development and execution of the QEP, both at the stakeholder level and at the individual, course-based level.Based on ongoing reflection, we can summarize our lessons learned into four broad themes: Communication with community partners is essential.Bringle and Hatcher (1996) emphasize the importance of the community partner's involvement in the identification of service opportunities, both at a macro (program) and a micro (course) level.However, in our experience staff or leadership turnover at the community partner organization, or a misunderstanding regarding the expectations of all stakeholders (faculty, students, and community partner), can derail a project.Memoranda of understanding and regularly scheduled project updates help avoid these issues.Our most successful projects have been designed by faculty who: 1) directly communicate with the community partner in the needs assessment and project design, and regularly throughout the project; and 2) proactively engage with the director with project updates.These principles are emphasized throughout the faculty training, and reinforced by the program director during memoranda of understanding development and submission, periodic check-ins during the term of implementation, and end-of-term faculty reflections and community partner evaluations.
Faculty preparation, support, and communication are critical.Providing a faculty-focused community engagement course is a preparation.Having a "Plan B" is part of preparation, too; in the event that an unresolvable issue comes up during a project, student learning, and where feasible fulfilling the spirit of the project, must take priority over an individual project deliverable.The course faculty member and program manager need to remain flexible and ready to adjust the course project for any number of reasons, including changes in community partner staffing or leadership.During the project/course development, faculty members and, where needed, the program director discuss the course, the community partner's needs and goals, and the student learning goals in detail and the agreement document is used to structure and clearly delineate the roles and responsibilities of all parties.In the very rare instance where a PACE project was terminated early (usually because of changes in the community partner staffing or leadership), students' efforts may be redirected to an alternative partner with similar needs, if available, or, if not, to an on-campus deliverable that supports the university mission.However, more typically adjustments can be made in the nature of the deliverable or the timing of the project completion, while still supporting both the student learning and the community partner goals.
Student preparation and engagement are essential.Students come to the course with different levels of academic preparation, community experience, and volunteerism.The instructor must provide students with adequate preparation in the skills or information needed for the project, a sufficient description of the project plan and deliverables, and a clear understanding of how the project ties to the community partner's needs.Communication with student teams should be frequent, and faculty should be prepared to serve as a project consultant as well as an instructor.
Leadership of the initiative matters.While every institution is different, campus culture and leadership investment can make or break an academic community engagement initiative.Bringle and Hatcher (1996) note that along with the initial self-assessment and strategic planning activities, a person should be identified to assume the leadership and administrative responsibility for the subsequent implementation and operation of the initiative.Given the curricular nature of our academic community engagement (embedded within courses), a senior faculty member was a natural fit; selecting someone who has already advanced through promotion and tenure, and therefore is more established in his or her career path, with a good grasp of the institutional culture, experience in working across campus and engaging with the university leadership on matters of policy and procedure has worked well.

Future Directions
We are in the last year of our initial five-year implementation, and have identified several actions to sustain our momentum.These actions include streamlining our data collection procedures, examining longitudinal effects, creating capstone or independent study community engagement courses, and constructing a dynamic community partner database.As PACE moves from QEP to permanent university program, additional success measures, including student retention and effects on graduation rates, can be examined.We also hope to transition our networking event to a more formalized conference and extend our reach to more partners such that our institution continues to grow its presence as a stakeholder to help address community interests and needs.

Figure 1 .
Figure 1.Quality Enhancement Plan Flow Chart Brown et al.: Using Community-Based Participatory Research to Assess the Needs Published by Nighthawks Open Institutional Repository, 2019 Brown et al.: Using Community-Based Participatory Research to Assess the Needs Published by Nighthawks Open Institutional Repository, 2019 also notes the importance of balancing and Brown et al.: Using Community-Based Participatory Research to Assess the Needs Published by Nighthawks Open Institutional Repository, 2019 Brown et al.: Using Community-Based Participatory Research to Assess the Needs Published by Nighthawks Open Institutional Repository, 2019

Table 2 .
Demographic Characteristics and HIV Routes of PLWHA Survey Respondents

Table 4 .
Identified Gaps in Care and Services Brown et al.: Using Community-Based Participatory Research to Assess the Needs Published by Nighthawks Open Institutional Repository, 2019

About the Authors All
Department of Health and Human Services.Office of Disease Prevention and Health Promotion 2020 (2015).Topics and objectives: Access to health services.Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services. Health Resources and Services Administration.(n.d.-a).U.S. Department of Health and Human Services.HIV/AIDS in rural America.Retrieved from http://narhc.org/wp-content/uploads/2013/12/Rural-HIV-AIDs-Handout.pdf.Health Resources and Services Administration.(n.d.-b).HIV/AIDS in rural America: HRSA's Response to the Challenge.Retrieved from https:// hab.hrsa.gov/livinghistory/issues/rural_1.htm.Iyer, M. (2015).Understanding the health care needs of persons living with HIV/AIDS in rural communities.Retrieved from http://www.apa.org/pi/aids/resources/exchange/2015/01/health-hivaids.aspx. of the authors are with the Department of Public Health, Health Administration, and Health Sciences at Tennessee State University.Elizabeth Brown, Owen Johnson, Wendelyn Inman, Revlon Briggs, and Elizabeth Williams are associate professors and Charles Brown and Wanda Burrell are assistant professors.Rosemary Theriot is professor and chair of the department, and Alexis Heaston is an adjunct professor and program manager of the master of public health degree program.

Table 1 .
PACE Projects by Service Type and Project Type

Table 3 .
Summary of Project Descriptions for Sample Course Vignettes Brown et al.: Using Community-Based Participatory Research to Assess the Needs Published by Nighthawks Open Institutional Repository, 2019 encounter (Jacoby