Brief History

Intent & Guidelines

Overview of Workplans

Strategies

MAI Consultation MeetingMarch 10, 2004

Presented by Robert Tagalicod, MA, PhL Minority Programs Manager

Minority AIDS InitiativesMinority AIDS Initiatives

HRSA GuidelinesProgram Guidance for AETC Funding

Brief History of MAIBrief 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 FundingAim of Current Funding• Outcome: Improving clinical practices (behaviors) of

health providers

• Impact: Improved access to & quality of care

HRSA GuidelinesProgram Guidance for AETC Funding

Improved quality of life for Improved quality of life for PLWHAPLWHA

Improved quality of life for Improved quality of life for PLWHAPLWHA

Improved access to & Improved access to & quality of servicesquality of services

Improved access to & Improved access to & quality of servicesquality of services

Improved clinical practicesImproved clinical practicesImproved clinical practicesImproved clinical practices

Training & EducationTraining & EducationTraining & EducationTraining & Education

Program Program LogicLogicDeliverables & Deliverables & OutcomesOutcomes

HRSA GuidelinesProgram Guidance for AETC Funding

Training PriorityTraining Priority Level 2: Workshops, seminars & hands-on clinical

experience Level 3: Intensive clinical rotations, preceptorships &mini-

residencies

Specific MAI Features 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)

HRSA GuidelinesProgram Guidance for AETC Funding

Role of Healthcare Support Services Providers Role of Healthcare Support Services Providers • Case managers, social workers, mental health workers &

substance abuse counselorsMedical service sites, or

HBCUs, HSIs, TCs & minority CBOs—if part of a structured program to expand their ability for such training

• Training of HSSPMust be ’carefully justified’ based on needs assessment

Should result in improved access to &/or quality of care

Overview of Project OutcomesOverview of Project Outcomes

Improved knowledge & attitudes

Improved clinical practice

Specific Project OutcomesSelected Local Performance SitesNorthern California Cluster

University of California, DavisUniversity of California, Davis• Improved multidisciplinary skills among HSSPs working

with homeless, substance users & parolees to ensure adherence to antiretroviral therapies

San Francisco Area (UCSF)San Francisco Area (UCSF)• Improved skills among pharmacists & other targeted

providers in correctional settings to ensure adherence to antiretroviral therapies

Specific Project OutcomesSelected Local Performance SitesSouthern California Cluster

University of California, Los AngelesUniversity of California, Los Angeles• Improved bilingual, community-based services for mental

health, substance use & HIV & referrals among them

University of Southern CaliforniaUniversity of Southern California• Improved skills—both clinical & cultural—among minority

providers & those who serve minorities

Drew UniversityDrew University• Improved clinical knowledge & skills including training

skills among targeted South & East Los Angeles community-based clinics

University of California, San DiegoUniversity of California, San Diego• Improved clinical knowledge & skills among low-volume

clinicians in minority neighborhoods in greater San Diego

University of California, IrvineUniversity of California, Irvine• Improved clinical knowledge & skills among Native

American providers regionally & at remote tribal facilities

Specific Project OutcomesSelected Local Performance SitesSouthern California Cluster

Specific Project OutcomesSelected Local Performance SitesHawaii, Arizona & Nevada

University of HawaiiUniversity of Hawaii• Improved clinical management skills among Pacific

providers

• Establishment/expansion of local performance site(s) among Pacific Island jurisdictions

Upcoming Planned ProjectsUpcoming Planned Projects• University of Arizona

• University of Nevada

Specific Project OutcomesSPNSArizona Border HIV/AIDS Care Project

El Rio Health CenterEl 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

Specific Project OutcomesSPNSSouthern California Border HIV/AIDS Project

San Ysidro Health CenterSan 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

Overview of Local Performance SitesOverview of Local Performance Sites

Target Audiences

Program Methodologies

Evaluation Types

Program OverviewsUC DavisModified Direct Observed Therapy Within Harm Reduction Framework

Target AudienceTarget Audience• Case managers & outreach workers

• Physicians & nurses

MethodologyMethodology• Modified Direct Observed Therapies (DOT) employing

Motivational Interviewing

EvaluationEvaluation• 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

Program OverviewsSan Francisco AreaHIV Pharmacotherapy for Correctional Health Care Providers

Target AudienceTarget Audience• Pharmacists & other targeted providers in correctional

settings including juvenile facilities

MethodologyMethodology• All-day clinical training workshops

• Regional distribution of curriculum

EvaluationEvaluation• Immediate post-training evaluations followed by short- &

long-term surveys (including qualitative assessments via phone interviews)

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

Target AudienceTarget Audience• Mental health workers including counselors

• Case managers

MethodologyMethodology• On-site/off-site intensive all-day workshops & Train-the-

Trainer workshops

EvaluationEvaluation• Process evaluation by participants via pre/post event

surveys & open-ended ‘interviews’

• Project evaluation, e.g., number of successful referrals

Program OverviewsUniversity of Southern CaliforniaStandardized Patients

Target AudienceTarget Audience• Physicians, nurses, & nurse practitioners

• Social workers, case managers & counselors

MethodologyMethodology• Facilitated small group to practice patient interviewing &

counseling skills with minority Standardized Patients

EvaluationEvaluation• Standardized Patients feedback to the participants

• Trainee self-assessment surveys

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

Target AudienceTarget Audience• Physicians, physician assistants & nurses

• Pharmacists, dentists & dental assistants

MethodologyMethodology• Training–of–trainers workshops including activities on cross–

training & cross-referral

• Interactive workshops focusing on dual/multiple diagnoses & treatment issues

EvaluationEvaluation• Formative evaluation

• Project evaluation, e.g., increased number of patients showing greater adherence to treatment

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

Target AudienceTarget Audience• Low volume clinicians practicing in minority neighborhoods,

i.e., African American physicians & providers in greater San Diego

MethodologyMethodology• Full day & half-day clinical conferences

• Mentoring by recognized experts

EvaluationEvaluation• 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

Program OverviewsUC IrvineCapacity-Building Among Native American Providers

Target AudienceTarget Audience• Native American nurses at remote tribal centers

• Regional Native American health providers

MethodologyMethodology• Intensive on-site visits with follow-up consultations

• Three-day clinical training workshops at UCI

Evaluation Evaluation • Semi-longitudinal review of clinical outcomes: pre-/post-

ELISA, pre-/post-training surveys

Program OverviewsUniversity of Hawai’iCapacity-Building Among the Pacific Island Jurisdictions

Target AudienceTarget Audience• Doctors, nurses & health educators in Hawaii & Pacific

Island jurisdictions (PIJ)

MethodologyMethodology• Intensive 5-day training

• Follow-up satellite case conferencing

• Strategically planned site visits & as needed

EvaluationEvaluation• Semi-longitudinal: post-training evaluations & follow-up

e-mail evaluations

• Follow-up interviews of sampled PIJ providers

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

Target AudienceTarget 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

MethodologyMethodology• Outreach, e.g., ‘promotores’

• Eight core training modules

EvaluationEvaluation• Centro de Evaluación, Oklahoma

• Matrix design; multi-site analysis

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

Target AudienceTarget AudienceCommunity Health Centers

Clinicas de Salud del Pueblo, Imperial County—Family Health Center, Central San Diego—Vista Community Clinic, Northern San Diego-- Comprehensive Health Centers

MethodologyMethodology• Outreach, e.g., ‘promotores’

• Core primary care services at partner sites

EvaluationEvaluation• Centro de Evaluación, Oklahoma

• Matrix design; multi-site analysis

Where Do We Go From Here?Where Do We Go From Here?

Strategies Toward Successful Outcomes

StrategiesAssuring Outcomes

Continuous & Refined Needs AssessmentsContinuous & Refined Needs Assessments Collaborative EffortsCollaborative Efforts

• Complementary, non-duplicative & coordinated with other LPS & Central Office & with national AETCs

• Partnered with recognized clinical centers of excellence

Targeted ProgramsTargeted 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

EvaluationEvaluation• Continuous & focused on outcomes & impact