Brief History

1
Minority AIDS Initiatives

• Brief History
• Intent Guidelines
• Overview of Workplans
• Strategies

MAI Consultation Meeting March 10,
2004 Presented by Robert Tagalicod, MA, PhL
Minority Programs Manager
2
HRSA GuidelinesProgram Guidance for AETC Funding

• Brief History of MAI
• HIV/AIDS in minority communities declared a
  "severe ongoing health crisis (1998)
• MAI created (2000)
• Funding for MAI reflected in allocations under
  Reauthorized Ryan White CARE Act (2000)
• Aim of Current Funding
• Outcome Improving clinical practices (behaviors)
  of health providers
• Impact Improved access to quality of care

3
HRSA GuidelinesProgram Guidance for AETC Funding
Improved quality of life for PLWHA
Improved access to quality of services
Program Logic Deliverables Outcomes
Improved clinical practices
Training Education
4
HRSA GuidelinesProgram Guidance for AETC Funding

• Training Priority
• Level 2 Workshops, seminars hands-on clinical
  experience
• Level 3 Intensive clinical rotations,
  preceptorships mini-residencies
• Specific MAI Features
• Capacity-building based on gap analysis
• Training-of-trainers other mentoring models
• Trainee travel for MAI providers
• Training primary care clinics on US/Mexico border
  (SPNS)

5
HRSA GuidelinesProgram Guidance for AETC Funding

• Role of Healthcare Support Services Providers
• Case managers, social workers, mental health
  workers substance abuse counselors
• Medical service sites, or
• HBCUs, HSIs, TCs minority CBOsif part of a
  structured program to expand their ability for
  such training
• Training of HSSP
• Must be carefully justified based on needs
  assessment
• Should result in improved access to /or quality
  of care

6
Overview of Project Outcomes

• Improved knowledge attitudes
• Improved clinical practice

7
Specific Project OutcomesSelected Local
Performance SitesNorthern California Cluster

• University of California, Davis
• Improved multidisciplinary skills among HSSPs
  working with homeless, substance users parolees
  to ensure adherence to antiretroviral therapies
• San Francisco Area (UCSF)
• Improved skills among pharmacists other
  targeted providers in correctional settings to
  ensure adherence to antiretroviral therapies

8
Specific Project OutcomesSelected Local
Performance SitesSouthern California Cluster

• University of California, Los Angeles
• Improved bilingual, community-based services for
  mental health, substance use HIV referrals
  among them
• University of Southern California
• Improved skillsboth clinical culturalamong
  minority providers those who serve minorities
• Drew University
• Improved clinical knowledge skills including
  training skills among targeted South East Los
  Angeles community-based clinics

9
Specific Project OutcomesSelected Local
Performance SitesSouthern California Cluster

• University of California, San Diego
• Improved clinical knowledge skills among
  low-volume clinicians in minority neighborhoods
  in greater San Diego
• University of California, Irvine
• Improved clinical knowledge skills among Native
  American providers regionally at remote tribal
  facilities

10
Specific Project OutcomesSelected Local
Performance SitesHawaii, Arizona Nevada

• University of Hawaii
• Improved clinical management skills among Pacific
  providers
• Establishment/expansion of local performance
  site(s) among Pacific Island jurisdictions
• Upcoming Planned Projects
• University of Arizona
• University of Nevada

11
Specific Project OutcomesSPNSArizona Border
HIV/AIDS Care Project

• El Rio Health Center
• Improved capacity to provide outreach
  counseling for at-risk border populations ?
  Increased testing numbers
• Link PLWHA to primary health care
• Enhanced capacity of primary care providers in
  rural border communities to provide HIV care

12
Specific Project OutcomesSPNSSouthern
California Border HIV/AIDS Project

• San Ysidro Health Center
• Increased rates of early detection of underserved
  Latinos living with HIV
• Increased access to HIV/AIDS primary care
  services
• Enhanced capacity of Community Health Centers to
  provide culturally competent care core HIV
  services

13
Overview of Local Performance Sites

• Target Audiences
• Program Methodologies
• Evaluation Types

14
Program OverviewsUC DavisModified Direct
Observed Therapy Within Harm Reduction Framework

• Target Audience
• Case managers outreach workers
• Physicians nurses
• Methodology
• Modified Direct Observed Therapies (DOT)
  employing Motivational Interviewing
• Evaluation
• Formative evaluation with on-going participation
  of experienced outreach workers case managers
• Project evaluation, e.g., increased number of
  patients showing greater adherence to therapy
  harm reduction protocols

15
Program OverviewsSan Francisco AreaHIV
Pharmacotherapy for Correctional Health Care
Providers

• Target Audience
• Pharmacists other targeted providers in
  correctional settings including juvenile
  facilities
• Methodology
• All-day clinical training workshops
• Regional distribution of curriculum
• Evaluation
• Immediate post-training evaluations followed by
  short- long-term surveys (including qualitative
  assessments via phone interviews)

16
Program OverviewsUC Los AngelesBilingual
Referral Networking Among Mental Health
HIV/AIDS Providers

• Target Audience
• Mental health workers including counselors
• Case managers
• Methodology
• On-site/off-site intensive all-day workshops
  Train-the-Trainer workshops
• Evaluation
• Process evaluation by participants via pre/post
  event surveys open-ended interviews
• Project evaluation, e.g., number of successful
  referrals

17
Program OverviewsUniversity of Southern
CaliforniaStandardized Patients

• Target Audience
• Physicians, nurses, nurse practitioners
• Social workers, case managers counselors
• Methodology
• Facilitated small group to practice patient
  interviewing counseling skills with minority
  Standardized Patients
• Evaluation
• Standardized Patients feedback to the
  participants
• Trainee self-assessment surveys

18
Program OverviewsDrew UniversityCapacity
Building Among South East Los Angeles Community
Clinics

• Target Audience
• Physicians, physician assistants nurses
• Pharmacists, dentists dental assistants
• Methodology
• Trainingoftrainers workshops including
  activities on crosstraining cross-referral
• Interactive workshops focusing on dual/multiple
  diagnoses treatment issues
• Evaluation
• Formative evaluation
• Project evaluation, e.g., increased number of
  patients showing greater adherence to treatment

19
Program OverviewsUC San DiegoOutreach to
Training of Low-Volume African American Providers

• Target Audience
• Low volume clinicians practicing in minority
  neighborhoods, i.e., African American physicians
  providers in greater San Diego
• Methodology
• Full day half-day clinical conferences
• Mentoring by recognized experts
• Evaluation
• Post-conference evaluations
• Project evaluation, e.g., geo-tracking number of
  consults by experts with minority providers
  tracking HIV patient volume of trained minority
  providers

20
Program OverviewsUC IrvineCapacity-Building
Among Native American Providers

• Target Audience
• Native American nurses at remote tribal centers
• Regional Native American health providers
• Methodology
• Intensive on-site visits with follow-up
  consultations
• Three-day clinical training workshops at UCI
• Evaluation
• Semi-longitudinal review of clinical outcomes
  pre-/post-ELISA, pre-/post-training surveys

21
Program OverviewsUniversity of
HawaiiCapacity-Building Among the Pacific
Island Jurisdictions

• Target Audience
• Doctors, nurses health educators in Hawaii
  Pacific Island jurisdictions (PIJ)
• Methodology
• Intensive 5-day training
• Follow-up satellite case conferencing
• Strategically planned site visits as needed
• Evaluation
• Semi-longitudinal post-training evaluations
  follow-up e-mail evaluations
• Follow-up interviews of sampled PIJ providers

22
Program OverviewsSPNS El Rio Health
CenterCapacity-Building Among Arizona Border
Primary Care Providers

• Target Audience
• Primary Care Providers in Various Settings
• Cochise County Health DepartmentYuma County
  Health DepartmentMariposa Community Health
  CenterChiricahua County Health CenterBorder
  Health Foundation
• Methodology
• Outreach, e.g., promotores
• Eight core training modules
• Evaluation
• Centro de Evaluación, Oklahoma
• Matrix design multi-site analysis

23
Program OverviewsSPNS San Ysidro Health
CenterCapacity-Building Among Southern
California Border Health Centers

• Target Audience
• Community Health Centers
• Clinicas de Salud del Pueblo, Imperial
  CountyFamily Health Center, Central San
  DiegoVista Community Clinic, Northern San
  Diego-- Comprehensive Health Centers
• Methodology
• Outreach, e.g., promotores
• Core primary care services at partner sites
• Evaluation
• Centro de Evaluación, Oklahoma
• Matrix design multi-site analysis

24
Where Do We Go From Here?

• Strategies Toward Successful Outcomes

25
StrategiesAssuring Outcomes

• Continuous Refined Needs Assessments
• Collaborative Efforts
• Complementary, non-duplicative coordinated with
  other LPS Central Office with national AETCs
• Partnered with recognized clinical centers of
  excellence
• Targeted Programs
• Aimed at low/mid-volume providers HSSPs
• Methodologically sound curricula that result in
  measurable improvements in quality of care or
  increased access to care
• Evaluation
• Continuous focused on outcomes impact