Brief History Intent & Guidelines Overview of Workplans Strategies MAI Consultation Meeting March 10, 2004 Presented by Robert Tagalicod, MA, PhL Minority Programs Manager Minority AIDS Initiatives

HRSA Guidelines Program Guidance for AETC Funding Brief History of MAI 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 Aim of Current Funding Outcome: Improving clinical practices (behaviors) of health providers Impact: Improved access to & quality of care

HRSA Guidelines Program Guidance for AETC Funding Improved quality of life for PLWHA Improved access to & quality of services Improved clinical practices Training & Education Program Logic Deliverables & Outcomes

HRSA Guidelines Program Guidance for AETC Funding Training Priority Training 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 Guidelines Program 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 counselors Medical service sites, or HBCUs, HSIs, TCs & minority CBOsif 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

Overview of Project Outcomes Improved knowledge & attitudes Improved clinical practice

Specific Project Outcomes Selected Local Performance Sites Northern California Cluster University of California, Davis 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) San Francisco Area (UCSF) Improved skills among pharmacists & other targeted providers in correctional settings to ensure adherence to antiretroviral therapies

Specific Project Outcomes Selected Local Performance Sites Southern California Cluster University of California, Los Angeles University of California, Los Angeles Improved bilingual, community-based services for mental health, substance use & HIV & referrals among them University of Southern California University of Southern California Improved skillsboth clinical & culturalamong minority providers & those who serve minorities Drew University Drew University Improved clinical knowledge & skills including training skills among targeted South & East Los Angeles community-based clinics

University of California, San Diego University of California, San Diego Improved clinical knowledge & skills among low-volume clinicians in minority neighborhoods in greater San Diego University of California, Irvine University of California, Irvine Improved clinical knowledge & skills among Native American providers regionally & at remote tribal facilities Specific Project Outcomes Selected Local Performance Sites Southern California Cluster

Specific Project Outcomes Selected Local Performance Sites Hawaii, Arizona & Nevada University of Hawaii University of Hawaii Improved clinical management skills among Pacific providers Establishment/expansion of local performance site(s) among Pacific Island jurisdictions Upcoming Planned Projects Upcoming Planned Projects University of Arizona University of Nevada

Specific Project Outcomes SPNS Arizona Border HIV/AIDS Care Project El Rio Health Center 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

Specific Project Outcomes SPNS Southern California Border HIV/AIDS Project San Ysidro Health Center 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

Overview of Local Performance Sites Target Audiences Program Methodologies Evaluation Types

Program Overviews UC Davis Modified Direct Observed Therapy Within Harm Reduction Framework Target Audience Target Audience Case managers & outreach workers Physicians & nurses Methodology Methodology Modified Direct Observed Therapies (DOT) employing Motivational Interviewing Evaluation 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

Program Overviews San Francisco Area HIV Pharmacotherapy for Correctional Health Care Providers Target Audience Target Audience Pharmacists & other targeted providers in correctional settings including juvenile facilities Methodology Methodology All-day clinical training workshops Regional distribution of curriculum Evaluation Evaluation Immediate post-training evaluations followed by short- & long-term surveys (including qualitative assessments via phone interviews)

Program Overviews UC Los Angeles Bilingual Referral Networking Among Mental Health & HIV/AIDS Providers Target Audience Target Audience Mental health workers including counselors Case managers Methodology Methodology On-site/off-site intensive all-day workshops & Train-the- Trainer workshops Evaluation Evaluation Process evaluation by participants via pre/post event surveys & open-ended interviews Project evaluation, e.g., number of successful referrals

Program Overviews University of Southern California Standardized Patients Target Audience Target Audience Physicians, nurses, & nurse practitioners Social workers, case managers & counselors Methodology Methodology Facilitated small group to practice patient interviewing & counseling skills with minority Standardized Patients Evaluation Evaluation Standardized Patients feedback to the participants Trainee self-assessment surveys

Program Overviews Drew University Capacity Building Among South & East Los Angeles Community Clinics Target Audience Target Audience Physicians, physician assistants & nurses Pharmacists, dentists & dental assistants Methodology Methodology Training–of–trainers workshops including activities on cross–training & cross-referral Interactive workshops focusing on dual/multiple diagnoses & treatment issues Evaluation Evaluation Formative evaluation Project evaluation, e.g., increased number of patients showing greater adherence to treatment

Program Overviews UC San Diego Outreach to & Training of Low-Volume African American Providers Target Audience Target Audience Low volume clinicians practicing in minority neighborhoods, i.e., African American physicians & providers in greater San Diego Methodology Methodology Full day & half-day clinical conferences Mentoring by recognized experts Evaluation 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

Program Overviews UC Irvine Capacity-Building Among Native American Providers Target Audience Target Audience Native American nurses at remote tribal centers Regional Native American health providers Methodology Methodology 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 Overviews University of Hawaii Capacity-Building Among the Pacific Island Jurisdictions Target Audience Target Audience Doctors, nurses & health educators in Hawaii & Pacific Island jurisdictions (PIJ) Methodology Methodology Intensive 5-day training Follow-up satellite case conferencing Strategically planned site visits & as needed Evaluation Evaluation Semi-longitudinal: post-training evaluations & follow-up evaluations Follow-up interviews of sampled PIJ providers

Program Overviews SPNS: El Rio Health Center Capacity-Building Among Arizona Border Primary Care Providers Target Audience Target Audience Primary Care Providers in Various Settings Cochise County Health DepartmentYuma County Health DepartmentMariposa Community Health CenterChiricahua County Health CenterBorder Health Foundation Methodology Methodology Outreach, e.g., promotores Eight core training modules Evaluation Evaluation Centro de Evaluación, Oklahoma Matrix design; multi-site analysis

Program Overviews SPNS: San Ysidro Health Center Capacity-Building Among Southern California Border Health Centers Target Audience Target Audience Community Health Centers Clinicas de Salud del Pueblo, Imperial CountyFamily Health Center, Central San DiegoVista Community Clinic, Northern San Diego-- Comprehensive Health Centers Methodology Methodology Outreach, e.g., promotores Core primary care services at partner sites Evaluation Evaluation Centro de Evaluación, Oklahoma Matrix design; multi-site analysis

Where Do We Go From Here? Strategies Toward Successful Outcomes

Strategies Assuring Outcomes Continuous & Refined Needs Assessments Continuous & Refined Needs Assessments Collaborative Efforts Collaborative Efforts Complementary, non-duplicative & coordinated with other LPS & Central Office & with national AETCs Partnered with recognized clinical centers of excellence Targeted Programs 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 Evaluation Continuous & focused on outcomes & impact