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CAPS Town Hall March 4, 2005

“HIV Clinical Capacity Building: The Pacific AIDS Education & Training Center/I-TECH Experience” Or…What do you guys on the 5 th floor really do?. CAPS Town Hall March 4, 2005. The Unfortunate Incident of September 3, 2003. Mission. Knowledge & skills development

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CAPS Town Hall March 4, 2005

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  1. “HIV Clinical Capacity Building: The Pacific AIDS Education & Training Center/I-TECH Experience”Or…What do you guys on the 5th floor really do? CAPS Town Hall March 4, 2005

  2. The Unfortunate Incident of September 3,2003

  3. Mission • Knowledge & skills development • Enable health care professionals to care for HIV+ patients in underserved & vulnerable populations • Increase number of well-trained health care professionals working with HIV+ patients in the community • Respond to the needs of emerging populations & to changing face of the epidemic • Assist remove barriers to primary care access

  4. Target Audience • Primary Target • Physicians, including psychiatrists & other subspecialists • Nurses • Physician assistants • Advanced practice nurses • Pharmacists • Oral health professionals • Secondary Target ( 20%) • Other allied health professionals • Paraprofessionals

  5. In the Beginning… • HRSA funded in 1987—based out of Fresno • Conceived of as a way to build the HIV clinical workforce • Pre-ARV focus of training • Palliative approaches • Reducing stigma • Mainstreaming of care • Much of the focus was on classroom training • Minor emphasis on quality • Physician focused

  6. Over time… • Multidisciplinary focus to include pharmacists • Emphasis on improving quality of both training and actual patient care • Recognition of the role of HIV clinical consultation • Focus on “treaters” • Focus on the impact of our efforts

  7. Where have we been all your life? • First round of AETCs—focused on health professions schools • Western AETC merged with AETC for Southern California • Move to UCSF Campus—integration into the Ryan White CARE Act • Move to CAPS 2003 Office burns to the ground Today • Serving CA, AZ, NV, HI the 6 US Affiliated Pacific Jurisdictions • Decentralized model with 16 local performance sites • LPS located in health professions schools and CBOs • Physician, nurse, dentist & pharmacist expert faculty at each site—recognized as local leaders in HIV care

  8. National AETC Program • 11 regional centers • More than 130 associated sites

  9. National AETC Programs cont’d • AETC National Resource Center http://www.aids-ed.org/ Affiliated with the UCSF Center for HIV Information • AETC National Evaluation Center http://www.ucsf.edu/aetcnec/ UCSF AIDS Policy Research Center • National Minority AETC http://www.nmaetc.org/ • International Training & Education Center http://www. go2itech.com/ Affiliated with the UCSF Center for HIV Information

  10. National AETC Programs cont’d National HIV/AIDS Clinician’s Consultation Center San Francisco General Hospital Warmline Hours: Monday – Friday, 6 AM - 5 PM, PST Voice mail available 24 hours/7 days Up-to-the-minute HIV clinical information Individualized expert case consultation on clinical HIV/AIDS problems 1 (800) 933-3413

  11. National AETC Programs cont’d National HIV/AIDS Clinician’s Consultation Center Post-Exposure Prophylaxis Hotline (PEPLine) Hours: 24 hours / 7 days a week Questions about occupational exposure to HIV & other blood-borne pathogens Phones answered by clinicians with expertise in occupational exposures 1 (888) HIV-4911

  12. National AETC Programs cont’d National HIV/AIDS Clinician’s Consultation Center Perinatal HIV Hotline Hours: 24 hours / 7 days a week Free clinical consultation & advice on treating HIV-infected pregnant women & their infants Questions regarding indications & interpretations of rapid & standard HIV testing in pregnancy 1 (888) HIV-8765

  13. “Nor Cal” North Coast UC Davis UC San Francisco San Jose San Joaquin Valley East Bay “So Cal” Drew University UC Los Angeles UC Irvine USC UC San Diego California Sites

  14. Nevada Sites • University of Nevada at Reno • Southern Nevada Area Health Education Center (AHEC)

  15. Arizona Site • University of Arizona • Training faculty in both Tucson & Phoenix

  16. Hawai'i Site • University of Hawai'i, Manoa • Primary site for work with the Pacific Jurisdictions

  17. Pacific Jurisdictions

  18. Training Methods Level I Lectures & didactic seminars Level II Skills building workshops & seminars Level III Hands on clinical training; mini-residencies Level IV HIV clinical consultation Level V TA, capacity building & referral

  19. HIV Care in 2005 • HIV a complex chronic disease • Varying rates of HIV infection Stable or increasing in some communities • Therapy guidelines continuously changing (ACTG 076) • New drug approvals • Multiple lab testing modalities • Toxicity management e.g. increased use of statins, fat accumulation, diabetes • Complexities of adherence

  20. Information Dissemination • Treatment guidelines, slides, videos & landmark journal articles • Teaching aides, e.g., curricula • Abstracts & Conference Presentations • Monthly PAETC Faculty Newsbrief • Fourth Level newsletter • NCCC Bulletin http://www.ucsf.edu/hivcntr/Bulletin/ • HIV Resistance Testing Panel Consultation Reports http://www.ucsf.edu/hivcntr/resources/resistancecases/

  21. Special Focus Areas • Minority AIDS Initiative (MAI) Capacity Building Increase number of community based MAI clinicians that: • Routinely perform HIV risk assessments, screening, diagnosis on high risk populations • Are trained in the clinical management of HIV disease • Receive longitudinal training experiences • Demonstrate increasing levels of HIV clinical care treatment skills, individually or through co-management with HIV/AIDS treatment experts • Provide expert quality HIV direct clinical care services in minority communities highly impacted by HIV/AIDS

  22. PAETC MAI Projects • Asian/Pacific Islander • Collaboration to build HIV clinician capacity with AAPCHO member clinics • Capacity building in US-affiliated Pacific Jurisdictions • African American • San Diego HIV clinician support for AfAm providers • Latino/a • CBO collaboration in Los Angeles with LA Department of Mental Health • Native American • Level III ‘hands on’ clinical training • Capacity building with the California Rural Indian Health Board

  23. Special Focus Areas cont’d • Training of corrections health care providers • Now with a chart review component at 5 correctional facilities with the highest HIV population • ‘TC’ Coordination • Francis J. Curry Tuberculosis Training Center • CDC-funded California HIV/STD Prevention Training Center • OPA-funded Center for Health Training • SAMHSA-funded Addiction Technology Transfer Centers • CDC’s Advancing HIV Prevention • Prevention with Positives • Rapid HIV Testing • Perinatal Transmission

  24. Special Focus Areas cont’d • US-Mexico Border AETC • Linkages with Border Special Projects of National Significance (SPNS) • Link with the CAPS TIE Core

  25. California State Office of AIDS Contracted to… • Provide medical, nursing and pharmacy consultation for Care Branch • Provide HIV resistance testing consultation for providers using the State voucher program (in collaboration with the UCSF Positive Health Program) • Provide post-exposure prophylaxis consultation to the California Department of Corrections (PEPline staff) • Proposed quality management program

  26. Annual Faculty Development • Collaborative • Northwest AETC • STD/HIV Prevention Training Center • F.J. Curry TB Training Center • Center for Health Training • Over 100 multidisciplinary faculty • Focus on building skills to improve training

  27. Additional Faculty Development • NCCC-sponsored AETC pharmacist & clinical consultation training • Lead: Ronald Goldschmidt, MD, at SF General Hospital • Nursing Faculty Development • Lead: Carol Dawson Rose, PhD, RN • Dental Steering Committee • Lead: USC School of Dentistry • National Meeting with the STD/HIV Prevention Training Centers • Transgender HIV clinician training • Annual Pacific Clinicians Meeting • Lead: Hawai'i AETC and Amy Kindrick, MD, MPH (UCSF)

  28. Training Directions • Less focus on lectures & grand rounds type of presentations. • More focus on individual clinic HIV capacity building • Minority AIDS Initiatives to focus on training of providers for vulnerable populations • AETC Role in CDC’s Advancing HIV Prevention • Rapid Testing Training • IDSA Guidelines on Prevention with Positives

  29. Co-Sponsored by The National HIV/AIDS Update Conference aims to translate research advances into practical strategies to help end the AIDS pandemic and improve the lives of people living with HIV/AIDS. Free booth for the UCSF ARI Oakland, CA - April 10-13, 2005

  30. Evaluation of Clinical Training UCSF AIDS Policy Research Center • Local Performance Site profiles—including Warmline data • Pacific Jurisdiction capacity building evaluation • Level III Vignette project with the National AETC Evaluation Center • Online clinician training needs assessment

  31. Warmline Calls in our Region

  32. Lessons from the Pacific • Invest in a thoughtful needs assessment • Tailor presentations to your audience • Integrate quality of care and HIV consultation from the beginning • Special attention to issues of infrastructure • Respect the hierarchy • We’re here as long as you need us • Respect the cultural values

  33. International Training and Education Center on HIV (I-TECH) • Awarded to the University of Washington in April 2002: “the International AETC” • UCSF is the primary partner • Tapping into the 15+ year US HIV care experience—bringing lessons, not models. • Employ principles of integrity, teamwork, accountability, respect and sustainability • Utilizes AETC levels of training: Moving quickly to Levels III and IV • Particular emphasis on strengthening the role of nurses

  34. I-TECH Objectives To extend and improve quality of life for persons living with HIV infection by: • Designing sustainable clinical management and workforce training systems • Supporting transfer of learning through individual and organizational change processes • Improving HIV/AIDS care and treatment practices • Measuring access to quality HIV care

  35. The I-TECH Continuum of Care Training & Education Model

  36. I-TECH Partnerships

  37. Partnership Activities • Building infrastructure for improved clinical training and care facilities • Producing instructional materials, including curricula and media • Managing resource databases • Tailoring and delivering training • Evaluating transfer of learning to practice • Designing or improving patient monitoring systems

  38. New Training Center in Chennai, India

  39. UCSF Collaborators • Center for HIV Information (Larry Peiperl, MD) • Positive Health Program at SFGH (Diane Havlir, MD) • Warmline/PEPline (Betty Dong PharmD) • Global Health Sciences (Haile Debas, MD) • Zimbabwe Twinning Initiative (Nancy Padian, PhD) • CAPS (Steve Morin, PhD) • UCSF School of Nursing (Carmen Portillo, PhD, RN)

  40. The Future? • I-TECH UCSF partnership with American International Health Alliance on HRSA Twinning Center • Volunteer Health Corps

  41. Pacific AETC Staff • E. Michael Reyes, MD, MPH Director & Principal Investigator • Mona Bernstein, MPH Deputy Director • To Be Hired • Minority Programs Manager • Catherine Casey Fiscal Coordinator • Carol Dawson Rose, PhD, RN Nurse Director • Susan V. Foster Program Assistant • Gladys Tam Administrative Assistant

  42. I-TECH Staff • E. Michael Reyes, MD, MPH CoDirector • Ann Downer, EdD (UW) CoDirector • Monica Dea, MPH Program Coordinator • Nicolé Mandel CHI Team Coordinator • Carmen Portillo, PhD, RN Nurse Consultant • Betty J. Dong Pharmacist Consultant

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