Circle of Care HIVAIDS Project

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Circle of Care HIV/AIDS Project

• Yukon Kuskokwim Health Corporation
• Bethel, Alaska
• Andrea Savage, MPH, MSW
• Mark Anaruk, M.Ed.

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Camai, Cangacit ernerpak-llu?

• Elitnauryuqtuten Western Alaska-ami,
  Mamterilleq, Yupiit Kuigpak-Kuskowaq-ami-llu!!

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Welcome! How are you today?

• I want to teach you about Western Alaska, Bethel,
  and the Yupik Eskimo people of the Yukon and
  Kuskokwim Rivers.

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Alaskas Road System
 
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Our Alaska Native Cultures
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Social Issues

• Unemployment is over 50 in most villages
• Substance Abuse rates are very high, leading to
  high rates of STIs
• Our regions Chlamydia rates are the highest in
  Alaska
• A very young population (median age is 23.8)

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Legal Issues

• Our tribes compacted
• 48 of the 227 Federally-recognized tribes in
  Alaska
• Government to government relationship with
  the federal government
• Local sovereign control and self-determination is
  important to the villages

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Cultural Issues

• 97 of the village pop. is Alaska Native
• The native language, Yupik, is spoken in most
  homes
• Success is defined differently
• Yuuyaraq
• Subsistence is a way of life here, really.

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Geographical Issues

• There are no trucking companies delivering
  freight here!
• Travel is by airplane,
• boat or snow machine
• 48 villages that cover
• 75,000 square miles
• Climateannual mean
• temperature is 29.9 degrees

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Complexity of Care Coordination

• Distance Factor
• Several systems involved in providing care,
  i.e. state, tribal and city programs, all need to
  be coordinated in a persons care
• YKHC is a large organization, it can be difficult
  to steer through all the programs
• 48 village clinics
• Hospital
• Specialty clinics and programs

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Target Population

• High risk Alaska Native/ American Indian
  individuals with suspected or known
  co-morbidities, such as substance abuse, STIs and
  mental illness, between 18-64

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• The Problem
• HIV individuals, who are AN/AI, has increased
  from 17 to 21 of state's population between
  '97-'01. (Native population in Alaska 103,000,
  or 16 of the population)
• A lack of surveillance exists among AN/AI
  populations.
• Tremendous Barriers
• -Community Stigma
• -Lack of testing services
• -Lack of concern among AN/AI populations

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Introducing the Circle of Care Staff

• Andrea Savage, MSW,MPH Project Coordinator

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Introducing the Circle of Care Staff

• Carl Evans Case Manager, Outreach Worker

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Goals of the Project

• Increase number of individuals with suspected or
  known co-morbidities, such as substance abuse,
  STIs and mental illness, who know their HIV
  status
• Increase knowledge of the need for testing
• Create community advocacy for HIV/AIDS in order
  to de-stigmatize the disease

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The Intervention

• HIV Training / Education for Community Leaders
  and Advocates
• HIV Training / Education
• in Risk Assessment
• Pre-Post Test Counseling
• for Village-based
• Health Care Providers

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The Intervention

• Outreach to High-Risk
• Individuals
• Village-based Testing
• Clinics by the
• Circle of Care staff,
• including pre and post
• test counseling services

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Challenges to Implementation
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Initial Stakeholder

• The hospitals buy-in had to be obtained
• Key individuals from the hospital met with staff
  from the Chugachmiut Project.
• Final project evaluations conclusions were that
  native health organizations must continue to seek
  creative methods of increasing HIV testing in
  rural Alaska

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Community Health and Wellness

• Buy-in obtained by the CHW department.
• The department of Community Health and Wellness
  addresses the health education needs of Bethel
  and the surrounding villages.

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Stakeholder Buy-In
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Time line Year 1 (July 2002-June
2003)

• Grant Awarded
• Logic Model developed
• Project planning, program development,
  collaborations agencies
• Recruitment and hiring of staff
• Seek IRB approval
• Meet with tribal councils, recruit Community
  Advocacy Board
• Collaborating departments and agencies

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Time line Year 1 (July 2002-June
2003)

• Present to Tribal Medicine Gathering for feedback
  
• Create individual community action plans
• Pre- and Post-Test Counseling training
• Establish medical provider advisory board
• Establish most effective HIV testing methods with
  lab
• Semi-annual progress reports to funding agency
• Alaska Area IRB and Human Subjects Committee
  reviews

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Challenges to Implementations
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Hiring Staff

• Bethel, Alaska is considered a manpower shortage
  area.
• Cost of living is one of the highest in Alaska
• Interviewing requires expensive travel
• Remote harsh climate
• Staff hiring was completed in Jan 03

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IRB and Human Subjects

• IRB
• (Alaska Area IRB)
• Jan 03 proposal is submitted to IRB
• IRB meets once a month
• Final IRB approval was given in May 03

• Human Subjects
• (YKHC)
• Feb 03 proposal submitted
• HSC meets quarterly
• Final HSC approval was given in June 03

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A year in the Delta
J F M A M J
J A S O
N D

• Moose Hunting, Aug-Sept
• River Freezes Up, Oct
• Winter Travel, Nov-Mar
• Spring Bird Hunting, Apr
• Fishing/Fish Camp, May-Aug

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Providers and Community

• Providers feel that the prevalence of HIV in the
  Delta is low even though there is a high
  prevalence of co-morbidities. They are reluctant
  to offer testing to anyone other than prenatal
  patients.

• All community surveys reflect that people of the
  Delta feel there is a need for HIV testing and an
  expansion of HIV education in the villages.
• 1 1 ?

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Challenges to obtaining provider buy-in

• Hospital is severely under staffed
• Health indicators are poor in the Delta making
  concern about HIV of low importance
• Behavioral Health may lack the resources needed
  to be able to focus on the mental health issues
  associated with HIV

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Tribal Gathering Survey, Apr 03
N 69
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Tribal Gathering Survey, Apr 03
N 69
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Testing

• One goal of the project is to increase the number
  of individuals in the Delta who know their HIV
  status

• State testing takes 2-3 weeks
• Results are entered into RPMS
• OraQuick test can not be exposed to temp. below
  35 F.

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Steps taken to obtain buy-in
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Providers Support

• Presentations and updates at Grand Rounds
• Recruiting for Medical Advisory Committee
• Project staff available for pre and posttest
  counseling

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Village Support

• Letters to Tribal Councils
• Meetings with Tribal Councils
• Attending Community
• Council meetings

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Community Outreach

• Meeting with Community Agencies
• Presentations made to.
• Prison
• Tundra Center
• Public Health Nursing
• Tundra Womens Coalition
• PATC

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Publicity Campaign
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National HIV Testing Day

• Radio PSA
• Scanner Channel announcement
• Posters
• Newspaper articles
• Presentation to Providers

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• Take care of
• Yourself
• Your family
• Your community
• HIV testing is available at
• Bethel Health Center - No cost, by appointment or
  walk-in 1-4 p.m. Mon. Fri. 1-800-478-2110 or
  543-2110
• YKDR Hospital see your group practice provider
  543-6442.
• Bethel Family Clinic fee for service, by
  appointment 543-3773

Walk-in testing available at YKDRH on June 27th
from 930 am to 4 pm. For more information, call
543-6486
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Data Collection

• Tools have been developed with involvement from
  YKHC staff OU staff
• Community Surveys will be collected beginning
  this fall
• Demographic information to capture co-morbidities
  of clients to be added to survey tools

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Data Collection

• Training of CHRs to administer survey
• Data Collection process has begun with Community
  Survey beta test
• Ready to move forward in this area!

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Quyana!