25.2 HIV on the USMexico Border: The USMexico Border AETC Steering Team UMBAST Part II: Models of Bi

1
25.2 HIV on the US/Mexico Border The US/Mexico
Border AETC Steering Team (UMBAST) Part II
Models of Binational Cooperation
US/Mexico Border Institute All Grantees
Meeting Washington, D.C. Wednesday, August 30,
2006

• TX/OK AETC Border Project
• Oscar Gonzalez, MS
• Border Coordinator TX/OK AETC
• Laura Armas-Kolostroubis MD
• Clinical Director TX/OK AETC

2
What is Needed?

• The people
• The will
• The funding

3
People Highly Active

• Massive numbers border crossings daily
• PLWHA also cross the border as needed
• Haphazard continuity of care including ARV
  regimen, leading to resistance and poor outcomes
• Co-infections differ from region to region
  complicating clinical care
• Different HIV/AIDS clinical prevention
  protocols in each side of border
• In general, border clinicians doing what they can
  with what they have

4
(No Transcript)
5
(No Transcript)
6
Funds Limited in US/MX Border Crossing

• US Federal funds are mostly for domestic use
• Agencies such as USAID, Gates Foundation and
  others provide significant funding, but are
  generally directed to high prevalence countries,
  which Mexico is not
• Private funding (Pharmaceutical Industry, etc) is
  usually limited by country or region

7
Where We Started

• Clinician network development
• Local
• Regional
• National
• Mutual understanding of the healthcare systems
• Mexico Public system, IMSS, ISSSTE, etc
• US Medicaid, Ryan White, uninsured
• Private
• Political/public health leadership, key
  informants and gate keepers

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
1.1 M people Cross the Border Daily282 M people
crossings per year
12
Some Objectives

• Focus medical management
• Border clinicians knowledgeable in the care for
  migrant/ mobile populations and their families
• Involvement of State representatives and local
  authorities
• Involvement of Federal government and agencies
  that provide access to ARVT
• CENSIDA
• Other state agencies COESIDA

13
Texas, US
Tamaulipas, Mexico
14
Important Elements

• Sought the buy-in of our own Institution Parkland
  Health and Hospital System and highlighting the
  potential positive impact on our own patient
  population
• Sought private funding
• Ortho Biotech
• Merck Corp.
• Took advantage of existing venues to secure
  additional resources, promote our ideas among
  other providers, seek support and thrust

15
(No Transcript)
16
Parkland Hospital HIV Services Model

• 2001 PHHS clinicians train border physicians on
  HIV 101 (Ortho funding)
• 2001 Border clinicians visit Parkland for 3-day
  preceptorship
• 2002 Collaboration is presented at a Mexican
  National Conference
• CENSIDA becomes interested
• 2003 Parkland staff meet with CENSIDA Technical
  director (Mexico City)
• Twinning project is born

17
(No Transcript)
18
Progress

• 2003, new CENSIDA General Director, twinning
  Project formalized, agreement to do pilot project
  with 3 states
• Continued quest for funding
• Continued clinician/ trainers good will
• 2003 Border Summit at the Texas HIV/STD update in
  Austin
• Brainstorming/strategizing session with state
  agencies and needs assessment
• 2004 Meeting Parkland meeting with CENSIDA in San
  Francisco during CROI Conference
• Tamaulipas identified as target state by CENSIDA

19
(No Transcript)
20
Texas, US
Tamaulipas, Mexico
21
Funds and Goodwill

• 2004 Merck Corp. offers to fund project, but will
  need to limit project to Tamaulipas
• 2004 Border Summit Binational Health week
• Policy Forum and Clinical Update
• Border White Paper (El Paso)
• Multi-sectorial Group (South Padre Island)

22
Model for Training and Technical Assistance

• 2004
• Meeting with Tamaulipas State Health Secretariat,
  Tamaulipas State University and other state
  agencies to present the training and Capacity
  Building Model
• The AETC model is chosen as most practical and
  cost effective

23
Modelo de AETC

• Construcción de Capacidad
• De tener regiones sin recursos a experto local
• Aplica teorías de Aprendizaje para Adultos
• Proveé Consulta Clínica
• Proveé Desarrollo de Entrenadores
• Utiliza el Modelo de Entrena-al-Entrenador
• Crea Redes de comunicación inter-disciplinaria

24
Modelo de AETC
V
IV
III
II
I
Lecciones Didácticas
Talleres
Tutoría Clinica
Consulta Clínica
Asistencia Técnica
25
Modelo de AETC
Desarrollo de Curriculum
Valoración de Necesidades
Entrenamiento
Evaluación
26
Implementing Model

• 2004
• Focus Groups with state clinicians, nurses,
  healthcare professionals and patients for needs
  assessment (Reynosa, Tamps)
• Seven Nurses mini-preceptorship at Parkland
• 2005
• First Clinical Update Training in Reynosa with
  state-wide broadcast

27
Valoración de Necesidades Reynosa Diciembre 14,
2004
28
Valoración de Necesidades Reynosa Diciembre 14,
2004
29
Fase I Valoración de NecesidadesReynosa,Tamaulip
as14 de Diciembre 2004
30
Progress and Growth

• 2005
• Meeting with CENSIDA
• follow up on needs assessment, and
• Implementation of AETC model
• Dr. Jorge Saavedra, Director of CENSIDA
  participates in UMBAST meeting, San Francisco
• Three clinical preceptorships at Parkland for
  HIV/AIDS clinicians from Tamaulipas
• State HIV Coordinator
• 2 Epidemiologist
• 2 ID specialist
• 1 Ob-Gyn
• 2 General Practitioners

31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
28-29 de Enero 2005 Primer Adiestramiento para
Capacitar los Profesionales Cuidad de Reynosa,
Tamaulipas
35
28-29 de Enero 2005 Primer Adiestramiento para
Capacitar los Profesionales Cuidad de Reynosa,
Tamaulipas
36
23-25 de Mayo 2005Preceptoria en la Clinica de
VIH de Parkland en Dallas
37
8-10 de Junio 2005 Preceptoria en la Clinica de
VIH de Parkland en Dallas
38
(No Transcript)
39
8-10 de Junio 2005 Preceptoria en la Clinica de
VIH de Parkland en Dallas
40
Continued 2005

• Dr. Saavedra visits Parkland/ UT Southwestern
• 2005 Second Clinical Update in Reynosa
• Clinicians who had participated in TOTs make
  their own presentations

41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
11-12 de Noviembre 2005Segundo Adiestramiento
para Capacitar los Profesionales Ciudad de
Reynosa, Tamaulipas
48
11-12 de Noviembre 2005Segundo Adiestramiento
para Capacitar los Profesionales Cuidad de
Reynosa, Tamaulipas
49
(No Transcript)
50
(No Transcript)
51
2006 Progress

• Dr. Griselda Hernandez, CENSIDA visits Parkland
  Hospital and participates as a speaker in TX/OK
  AETC Women and HIV International Clinical
  Conference

52
(No Transcript)
53
Fruits of Collaboration

• Technical assistance for development of
  nationwide CAPASIT centers (Centers for STD and
  HIV Care) modeled after Parkland HIV Clinic
  services and patient care
• T/A to develop clinical tools and charts
• T/A to implement HIV prevention guidelines
• TA to develop HIV Prevention Case Management
  Programs

54
Resultados

• Valoración de Necesidades
• 14 de Diciembre 2004 Cuidad de Reynosa
• 30 participantes
• Primera Capacitación de Personal
• 28-29 Enero 2005 en Cuidad de Reynosa
• 33 participantes Día uno
• 43 participantes Día dos
• Preceptorias
• 23-25 Mayo 2005 4 Médicos
• 8 -10 Junio 2005 4 Médicos
• Segunda Capacitación de Personal
• 11-12 Noviembre 2005 en Cuidad de Reynosa
• 40 participantes Día uno
• 30 participantes Día dos
• En Total, 984 horas de entrenamiento

55
Highlighting our Collaboration

• Conference and Poster Presentations
• 2004 HIV Prevention Conference Mexico City
• 2004 Machismo Conference Mexico City
• 2004 Enkidu Conference Mexico City
• 2005 National Nurses Conference, Tampico, Tamps
• National HIV Conference Oaxaca, Mexico
• US-Mexico Border Binational HIV Conference,
  Monterrey, Mexico
• 2005 HIV Prevention Conference, Atlanta GA
• 2006 All Titles Conference
• 2006 HRSA Border Summit, Tucson AZ

56
OUTCOMES

• Planning meeting for Tamaulipas HIV Statewide
  Conference and future plans
• Mexican program trainees now planning their own
  programs
• Mexican Institutions now seeking their own
  resources to make it this a continuous and
  sustainable effort

57
Celebrating our Success

• Clinical consultations are taking place
• Texas providers ask for referrals when migrant
  patients or their partners return to Mexico
• Mexican clinicians contact us if they have a
  patient who was seen at Parkland
• Education in border region now includes
  information on ARVs in Mexico
• Mexican clinicians attend US border activities
  and network with local providers
• Parkland Pocket Guide To HIV Care Spanish
  translation, adaptation and publication by
  December 2006

58
Tips for Successful Binational Collaboration

• Peer to peer relationship
• Keep the patient at the center of the activities
• Strong relationship with the authorities
• Put it in writing
• Plan to implement, but be patientMUY patient
• Clear, consistent communication
• Recognize each others efforts and challenges

59

• Questions?