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The ABCs of 4TCs - Ryan White HIV/AIDSTechnical Assistanceand Training

Partnerships: Building Cooperation for Action

May 28-30, 2008

Steven Young, MSPH and Lynn Wegman, MPA

Division of Training & Technical Assistance

HIV/AIDS Bureau, HRSA, HHS

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1. Ryan White HIV/AIDS Program

The Program: Federalprogram focused solely ondelivery of health care andsupport services for overhalf a million underservedlow income persons in theU.S. living with HIV/AIDS

TA/Training: Helping RyanWhite HIV/AIDS Programsfunction more effectivelythrough technicalassistance and training

Federal Oversight

HHS

HRSA

HIV/AIDS Bureau

HAB/ DTTA & Service Divisions

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Oversight of Ryan WhiteTraining and TA: DTTA

HRSA/HAB’s DTTA: Division of Training &

Technical Assistance Provides technical assistance (TA) and training activities

that support Ryan White programs

Assists grantees, planning bodies, funded providers,affected communities and individuals living with HIVinfection in designing, implementing and evaluating RyanWhite-supported programs

Administers the national AIDS Education & Training Centers(AETC) HIV care provider training program

Conducts training for HAB staff on HIV/AIDS issues

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2. Vision for TA & Training

More responsive, timely,and cost-effective TA &training resourcesavailable fromHRSA/HAB and moreeffective Ryan White-funded HIV/AIDS careprograms

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Ryan White Reauthorization

Requires adjustment in focus and effort

Training HAB staff, current grantees andnew grantees

Training TA consultants

Technical assistance on specific topics(e.g. core services)

Revising TA & training priorities

2008 All Grantee Meeting

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3. TA/Training for RW Community

Meetings/ConferencesLogistics Contract

TA Products/InitiativesTA Contract

TA Centers on Key TopicsCooperative Agreements

Individualized/On-Site Peer and Expert Consultations

TA Contract

Provider Clinical TrainingAETCs

TARGET CenterCentral Source for Finding

Ryan White TA and Training

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c. TA Partners and Activities

Quality of Care and Treatment Guidelines

Unmet Need

Peer Advocates

Data Use in Planning,

Evaluation, Quality

Cultural Competency and Stigma

Consumer Involvement &

Leadership

Care Delivery Capacity Building

Fiscal ManagementOrganizational Development

ADAP

Ryan White Community

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Cooperative Agreement:Supporting Networks of HIV

CAEAR Foundation in partnership with the Academy forEducational Development and the National Minority AIDSCouncil; Advisory Group and interventions involve AETCs

Grantee

On-site TA, intensive capacity building, and regional meetingsActivities

TA and training to enhance comprehensive HIV primarymedical care and treatment services in racial and ethnicminority communities. TA is targeted to (1) small to mediumcommunity and faith-based organizations serving minoritypopulations, (2) entities planning to expand capacity to provideHIV/AIDS primary medical care services, and (3) non-RyanWhite Program grantees

Focus ofTA

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Overview- Project Activities

Onsite technical assistance- provide 65 episodes of on-site TA, deliver web-based training and offer 20scholarships for conference attendance

Intensive capacity building- increase the capacity of 5 to10 primary care sites and 5 to 10 Ryan White Programfunded primary care sites serving racial/ethnic minoritycommunities severely impacted by HIV/AIDS and the 2005hurricanes

Regional meeting- increase the capacity of 80 to 100participants from at least 50 primary care sites serving racial/ethnicminority communities severely impacted by HIV/AIDS to develop,improve, or expand the delivery of comprehensive HIV primary careand treatment services through regional meetings and ContinuingEducation Units (CEU) web-based trainings

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Value of the SNHC by EPMCto HRSA grantees

Address provider shortage relative to theprovision of HIV/AIDS care and treatment

Encourage Ryan White Program community towork more collaborately with community healthcenters and other AIDS service organizations

Demonstrate importance of making HIV care astandard component of primary care

www.hivta.org

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Ryan White ReauthorizationQuality Management

Ryan White HIV/AIDS Treatment Modernization Act of 2006directs grantees to develop, implement, and monitor clinicalquality management programs to ensure that

service providers adhere to established HIV clinical practices

quality improvement strategies include support services thathelp people receive appropriate HIV health care

demographic, clinical, and health care utilization information isused to monitor trends in the spectrum of HIV-relatedillnesses and the local epidemic.

HAB has defined “quality” as the degree to which a health orsocial service meets or exceeds established professionalstandards and user expectations.

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Cooperative Agreement:National Quality Improvement/Management TACenter (NQC)

Grantee: Health Research, Inc./New YorkState AIDS Institute

Purpose of Cooperative Agreement:

assist grantees of all Parts to build capacityfor quality improvement

focus on the information and technicalassistance needs of programs concerningdeveloping and implementing qualitymanagement programs

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NQC Activities

Three levels of consultation

Information Dissemination

Training and Educational Forums

Intensive consultation on/off-site

Steering Committee

NQC CQI program

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Resources for Quality

• NQC- www.NationalQualityCenter.org

• HIVQUAL- www.HIVQUAL.org

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4. Easing Access to Ryan White TATARGET Center: Technical Assistance Resource Guidance Education Training

http://careacttarget.org

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TARGET: What it Offers

DTTA-staffed HELP desk Available 24 hours a day Staffed M-F, 10-4 EST 301-443-0067 Response within 48 hours

TA Library (375+ tools/resources on primary care, planning, otherHIV/AIDS care topics)

Ryan White Community (over 690 grantee and Planning Councilwebsites, State Profiles, contact information)

Links to All HAB TA

Calendar of TA Events

On the Horizon: Virtual Community

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Learn of Upcoming TA/Trainings

Multiple Venues Are Used to Disseminate TA Info

TARGET Center Calendar http://careacttarget.org

HRSA/HAB Project Officers

HAB Email. Sign up athttp://hab.hrsa.gov/subscribe.htm or emailpjones1@hrsa.gov

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Clinical Training for ProvidersAIDS Education and Training Centers: AETCs

The AETC program is the clinicaltraining component of the RyanWhite program, providing ongoingeducation to clinicians in rural,suburban and urban areas acrossUS

The goal is to increase the numberof providers who are educated andmotivated to counsel, diagnoseand treat people living with HIV

From July 2006 – June 2007,AETCs devoted 46,896 hours totrain 128,528 healthcare providers

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AETC’s: Target Population

Healthcare providers: At least 80 percent of funds or training programs must be

targeted at training: Physicians, Nurses,Advanced Practice Nurses, Physician Assistants,Pharmacists, Oral Health Professionals

Up to 20 percent of funds or programs can be targeted toallied health professionals involved in HIV care

Providers caring for the medically underserved: HRSA funded Providers: Ryan White programs,

Community Health Centers, and Maternal and Child Healthgrantees

Correctional facilities Others

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AETCs:Regional Network of Centers

11 Regional Centers with morethan 130 local sites servinghealthcare providers nationwidefunded for a 5-year grant cycle

In FY 2007 – Regional AETCs wereawarded approximately $30.75 M

And the 4 National AETC Centerswere awarded a combined total ofapproximately $5.7 M

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AETCs Train In Every StateAnd Territory

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AETCs Offer LongitudinalHIV Training Opportunities

Didactic Presentations – Introduction to HIVcare and updates - Classroom style workshopsand seminars - Level I

Interactive Skills Building – includes roleplaying - Level II

Intensive Hands on Clinical Training withpatients – preceptorships, mini-residencies,observation of clinical care - Level III

Educational Patient Specific ClinicalConsultations - Includes one-on-one mentoring -Level IV

Technical Assistance and CapacityBuilding – system and organizational issues as wellas clinical issues -Level V

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AETCs:Most Common Training Topics

Treatment strategies (Antiretroviral Therapy; Mother- to-ChildHIV Transmission; Palliative Care)

Diagnostic tests and disease progression (LaboratoryTesting)

Epidemiology & basic science (Post-exposure Prophylaxis) Adherence Clinical manifestations of HIV (Opportunistic Infections; Oral

Health) Comorbidities (Hepatitis Co-infection; TB/HIV Co-infection) Opportunistic infections Substance Abuse Risk assessment/risk reduction Capacity building Minority providers and CBOs

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AETCs Required to ConductTraining Needs Assessments

AETCs prioritize resources totrain & educate in remoteunderserved areas

AETCs conduct at least onecomprehensive needsassessment during 5-year projectand one needs assessment incollaboration with other HHSTraining Centers (4 TCs)

AETCs collaborate with RTCs,PTCs, ATTCs, and TB Centers on– substance abuse and mental healthneeds, STD issues, familyplanning/reproductive health, HIVtesting, TB issues, etc.

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AETCs Focus on TrainingMinority Clinicians and/or MinorityServing Clinicians

OMB Performance Goal for AETCs –Increase the proportion of racial/ethnic minorityhealth care providers participating in AETCtraining programs

Approximately 44% of AETC trainees in2006-2007 were of racial or ethnicbackground

If we include minority serving providers,65% of all AETC training participants metthis definition

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Special Minority AIDSInitiative Projects

Purpose is to expand or support new HIV initiativestargeting African Americans, Latinos, NativeAmericans, Asian Americans, Native Hawaiian andPacific Islanders

AETCs receive additional grant funds to focus ontraining providers to serve these populations:

Along the US Mexico Border (3 AETCs) American Indians and Alaskan Natives (8 AETCs) National Evaluation Center received funds

to focus on evaluating these minority-focused initiatives

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CDC/HRSA InitiativeAETCs Support Training on CDCRecommendations for HIV Testing

In September 2007 CDC provided $1.7M throughan IAA to HRSA to fund AETCs to train clinicianson implementing HIV Testing in Acute Caresettings in Emergency Departments, CHCs, STD clinics,

Labor and Delivery departments, and others.Project will continue into 2009.

Objective is to make HIV Testing a part of routinemedical care for persons ages 13 - 64 years old

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AETC Reporting Requirements

AETCs collect process and performance data atevery training – Participant Information Forms andEvent Records – and submit data annually toHRSA/HAB

AETCs also submit annual continuation grantapplications – includes mid-year progress reporton achievement of goals and objectives Training projections Evaluation and Quality Improvement Plans Identification of key Collaborators/Partners in

upcoming training activities AETCs also submit year-end progress reports

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AETC National Centers

4 National Centers provide supportservices to the AETC Network

National Resource CenterUniversity of Medicine & Dentistry ofNew Jersey

National Minority AETCHoward University

National Clinicians’Consultation CenterUniversity of California, San Francisco

National Evaluation CenterAETCUniversity of California, San Francisco

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AETCs:National Resource Center, NRC

www.aidsetc.org

To provide a central repository for AETCprogram contact information and trainingmaterials developed within the AETCNetwork

To support the AETC mission by offeringtimely, high quality, state-of-the artinformation on HIV

To coordinate the exchange of curriculumand training practices and models and tocollaborate to share best practices, tools,and resources on a national level

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AETCs:National Minority AETC

www.nmaetc.org

Builds Capacity of Racial/Ethnic MinorityClinicians to Provide HIV Care

The NMAETC communicates best practices anddisseminates program tools related to clinicalcare and cultural competency in HIV/AIDS

Alliance of Historically Black Colleges andUniversities with MD programs

Hispanic Serving Institutions

Tribal Colleges and Universities

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AETCs:NCCC: National Clinicians’Consultation Center

(www.nccc.ucsf.edu)Warmline PEPline Perinatal HotlineFREE confidential consultative services for clinicians

1-888-448-876524/7

Perinatal HotlineHIV consultation and referral

1-888-448-491124/7

PEPline HotlinePost-exposure prophylaxis

1-800-933-34138AM-8PM EST M-F

WarmlineConsultation regarding HIV managementquestions for clinicians

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AETCs:NCCC

Line/Date Established Calls to Date Calls Per MonthWarmline - 1993 46,000 200+PEPline - 1997 52,000 750+Perinatal Line - 2004 500 30+

TOTAL 98,500 1,000

Warmline calls - 85% from medically underserved areasHRSA is principal funderCDC provides supplemental funds

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AETCs:National Evaluation Center, NEC

www.ucsf.edu/aetcnec

Helps AETCs develop, test and implementeffective evaluation models and strategieswhich lead to

Measuring outcomes

Determining clinician behavior change

Improving patient care

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Thanks!

Steven R Young, MSPHDirector, Division of Training and Technical Assistancesyoung@hrsa.gov 301-443-5761

Lynn Rothberg Wegman, MPAChief, HIV Education BranchDivision of Training and Technical Assistancelwegman@hrsa.gov 301-443-5658

HIV/AIDS BureauHealth Resources and Services AdministrationDepartment of Health and Human Services

TARGET CenterCentral Source of Ryan White TAhttp://careacttarget.org