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Assisting PLWHAs Returning to Mexico and other Latin American Countries: A Pilot Project

Assisting PLWHAs Returning to Mexico and other Latin American Countries: A Pilot Project. Oscar Gonzalez, PhD Texas/Oklahoma AETC Tracy Tessmann, MA Texas/Oklahoma AETC. Overview. Project Summary Establishing Continuity of Care Referral Process for HIV Providers Serving Migrant Patients

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Assisting PLWHAs Returning to Mexico and other Latin American Countries: A Pilot Project

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  1. Assisting PLWHAs Returning to Mexico and other Latin American Countries: A Pilot Project Oscar Gonzalez, PhD Texas/Oklahoma AETC Tracy Tessmann, MATexas/Oklahoma AETC

  2. Overview • Project Summary • Establishing Continuity of Care • Referral Process for HIV Providers Serving Migrant Patients • Program Challenges • Navigating HIV Services in Latin America • Other Social Challenges • Conclusions

  3. Project Summary • International Continuum of CarePilot project of Parkland Health & Hospital System & Texas/Oklahoma AETC • HIV infected migrant patients returning to their countries of origin are assisted in linking to HIV clinical care

  4. Project Summary - cont’d • Linkage to clinical care: • Ensures continuity of treatment • Reduces the development of resistance • Encourages adherence to treatment • Improves/promotes HIV prevention • Reduces the spread of HIV • Helps people to establish and maintain relationships with HIV providers and the health care systems in Mexico and Latin America

  5. Establishing Continuity of Care The target population is providers serving HIV-infected Latino migrant populations in the U.S. The process involves: • Dissemination of project information to HIV clinicians • Providers contact the project via e-mail or telephone • Response is generally 48 hours or less • Situations are assessed individually • Referrals are handled in a culturally appropriate manner

  6. Information Needed for Linkage • Who? • Why? • When? • Where? • Regimen? • How long?

  7. Destination Referral Includes Providing Information about: • Requirements for accessing care in the destination country • HIV clinic location and contact person • Availability of HIV treatment and services • Physician’s name and credentials • Intake appointment date and time • Tips for navigating the health care system(s)

  8. Successful Patient Linkage Information Includes: • Diagnosis letter • CD4 count and viral load test results • Genotype and phenotype test results • List of HIV/AIDS and other medications • Medications for 3 months • Immunization history • Opportunistic infections history Other information needed: • U.S. physician’s contact information • Photo ID • Proof of residence

  9. Challenges • Fragmentation/lack of a national health care system for HIV • Patients often rural, clinics mostly urban • Clinical capacity often limited • HIV medications available but access is limited • Cost of international phone calls • Lack of pre-travel planning by patients • Referral follow-up • Non-Mexican citizens do not qualify for HIV care in Mexico

  10. Scenarios are different Epidemic profiles vary by country and are changing Mexico had 1 HIV clinic in 2005, in 2008: 56 ARV treatment access gaps & limitations Medications: universal access is not reality Lack of support services Funds and resources are still an issue Processes are different Different treatment guidelines and standards Access to clinical charts from U.S. is a challenge Navigating HIV Services in Latin America and Mexico

  11. Navigating HIV Services- cont’d • Populations at risk are different • Newly vulnerable populations vary by country* • Ex-military • Migrants • Sex workers • MSM • Transgender • Sex tourists • Young people and children • Pregnant women • Feminization of the epidemic • Large clinician turnover * Kaiser Family Reporting Manual on HIV*AIDS , July 2008

  12. Other Social Challenges • Social taboos • Stigma • Discrimination • Homophobia • Criminalization of sex work • Lack of social justice laws • No integration between sex education, HIV prevention/services and reproductive health services • Human rights issues * Kaiser Family Reporting Manual on HIV/AIDS , July 2008

  13. Conclusion • More than 200 referrals • Processes being formalized • Marketing to be expanded • Limited funding • Evidence of demand

  14. Questions? Oscar Gonzalez, PhD HIV/AIDS US/MX Border Coordinator Texas/Oklahoma AIDS Education & Training Center 1936 Amelia Court, Second Floor Dallas, TX 75235 (214) 590-2834 PH (214) 590-2184 FAX o1gonz@parknet.pmh.org www.aidseducation.org

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