1. 1 Partnership for Health Experience at AIDS Care Roberto B Corales, DO, AAHIVS Medical Director & Principal Investigator September 15, 2011

2. 2 Introduction Partnership for Health is an intervention aimed at every ACHC patient. It is to promote safer sex practices condom negotiation skills) and to identify referrals for individual with high risk sex practice Other DEBI* include: voces/voices, mental health Unique DEBI intervention: ACHC uses peer educators and outreach workers to engage patients during their clinic visits. They encourage and engage patients to review PfH materials that are available in the waiting rooms and re-inforce the prevention messages. ACHC has also re-designed education materials to be more visible and portable (PfH content was NOT changed) ACHC has also made available 3 safer sex education kits, which are located in clinic interview rooms, to assist inproviding hands-on learning (male and female condoms) *DEBI: diffusion of effective behavioral intevention

3. 3 Trainings First training in 2005 AETC (AIDS Education Training Center) – Ask Screen Intervene (ASI) 4 modules I: Risk screening II: Universal Prevention III: Tailored Behavioral Intervention IV: Partner services Re-training in October 2008

4. 4 7/05: sticker

5. 5 2/06: incorporated in our progress note template

6. 6 12/07: added in the EMR template (EHS)

7. 7 sticker 12/07: added in the EMR template (EHS)

8. 8 Annual Reporting to the CDC (7/08-7/09) (excerpt) Agency name Intervention /Program model Target Population Recruitment locations Number of sessions, waves, cycles, Activities, Encouters, etc.. Number of clients enrolled during the reporting period Number of clients successfully completing required sessions Key core activities Number clients completing key core activities ACHCPartnership for Health HIV/AIDS positive men and women engaged in high risk sex practices and behaviors ACHC patients 2,125649560Not requested 560 Approximately 10 pages with narrative and graphs.

9. 9 DEBI program Models SMART Process Objectives Agency NameDEBI Program modelList your SMART Process Objectives Discuss progress made toward each stated process objective for the reporting period ACHCPartnership for Health1.By June 30, 2008, 100% of ACHC staff will be retrained in the PfH Interventions 2.By June 30, 2008, 90% of ACHC clinical staff will be actively participating in the Partnership for Health Intervention 3.By June 30, 2008 new patient education materials will be introduced and incorporated into the Partnership for Health intervention 1.Objective met 9/19/08. In order to assure ongoing maintenance of the integrity of program process and maintenance of staff knowledge, a re-training has been scheduled for 10/08 2.Objective previously met, but due to recent clinical turnover, re-training is scheduled 3.Objective met. PfH education materials are widely incorporated in PfH process by clinical staff, displays and brochures throughout the clinic

10. 10 DEBI program Models SMART Outcomes Objectives Agency NameDEBI Program ModelList your SMART Outcome Objectives Discuss progress made toward each stated outcome objective for the reporting period ACHCPartnership for Health1.By June 30, 2008, 55% of HIV-positive patients seen in follow up visits will receive PfH intervention 2.By June 30, 2008, 85% of new HIV-positive patients seen will receive the PfH intervention 3.By June 30, 2008, 20% of HIV-positive patient will receive condom demonstrations 4.By June 30, 2008, 50% of HIV positive ACHC patient seen for follow up visit will report using safer sex practices 1.Objectives exceeded. 86% of positive patients follow up visit received the PfH intervention 2.Objective exceeded. 100% of new positive patients received the PfH intervention 3.Objective exceeded. From the last reporting cycle 181 (an increase of over 300%) of positive patients received condom demonstrations 4.Objective exceeded. >90% of patients seen during follow up visit reported using safer sex practices If an outcome objective was not met, explain and discuss strategy for improvement

11. 11 So, how do these process, outcomes and intervention change the STD transmission?

12. 12 STD cases YearCTGCSyphilisTOTAL 200409110 200503710 200657719 200743411 200865617 200985013 2010133016

13. 13 Need county-wide clinics initiative and buy in PfH should be at every clinic Patient reporting accuracy (underreporting of % condom use) Patient reporting fatigue (“just say yes to all”) Providers intervention at every follow up visit (clinical staff buy in) Thoughts from this experience

14. 14 Re-design templates Re-assign questioning role to Medical Assistants Need to easily “query” the data Bi-annual audits to track and trend PDSA Changes and modifications

15. 15 PfH eMDs template (draft) 9/11: added in the new EMR template (eMDs)

16. 16 The End