Brief History Intent & Guidelines Overview of Workplans Strategies

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 CBOs—if 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 skills—both clinical & cultural—among 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. 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 Specific Project OutcomesSelected Local Performance SitesSouthern California Cluster

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 • Training–of–trainers workshops including activities on cross–training & 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 Hawai’iCapacity-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 Department—Yuma County Health Department—Mariposa Community Health Center—Chiricahua County Health Center—Border 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 County—Family Health Center, Central San Diego—Vista 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