HRSA SPNS Ryan White Care Act

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HRSA SPNS Ryan White Care Act

• Demonstration and Evaluation Models that Advance
  Service Innovation Along the U.S. Mexico
  Border, 2000 2005.

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GOALS

• Reduce barriers to care
• Increase early detection of persons with HIV
• Increase access to comprehensive HIV/AIDS care
• Enhance capacity of Community and Migrant Health
  Centers to provide HIV/AIDS care

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The US Mexico Border
The geographic region 100 kilometers/62 miles
north and south of the US Mexico geopolitical
border The US/Mexico Border extends for almost
2,000 miles from the Gulf of Mexico in the East
to the Pacific Ocean in the west.
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The Border
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Where do HIV/AIDS patients get care along the
border?
Demonstration Sites San Ysidro San Ysidro
Health Center Tucson El Rio Health Center,
Arizona Border HIV/AIDS Care Project Las Cruces
Camino de Vida Center for HIV Services El Paso
Centro de Salud Familiar La Fe Harlingen Valley
AIDS Council
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How many HIV/AIDS patients were included in the
SPNS evaluation?

• 1200 study participants
• 353 in California
• 126 in Arizona
• 94 in New Mexico
• 345 in El Paso, TX
• 282 in Harlingen, TX
• This does not include the thousands of clients
  whose lives have been touched through this
  initiative

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Who are the border health HIV SPNS evaluation
participants?
Male Hispanic
Female Non-Hispanic
Female Hispanic
Male Non-Hispanic
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Who are the border health HIV SPNS evaluation
participants?

• 81 are identifying themselves as Hispanics
• 77 Mexicans / Mexican Americans
• Live average of 22 miles from care
• Average of 11 years living in the agency area
• Average of 38 border crossing per person-year
• Median of 5
• 65 of the population no US insurance
• 36 are working
• 6 are migrant farm workers

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Who are the border health HIV SPNS evaluation
participants?

• 26 of men declared having had sex with other men
  in the past year
• 15 of patients declared having had sex with a
  HIV person in the past year
• 15 are disabled
• 43 with mental health issues

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In what exposure group did the patients classify
themselves?
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Were patients perceptions of their barriers
reduced?
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Increase early detection and access to care

• Outreach models and links to care
• Promotora model
• Lay health care workers from the communities they
  serve
• Promote health using education, prevention
  messages, prevention materials
• House parties to discuss issues and promote
  education in a safe environment

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Increase early detection and access to care

• Outreach models and links to care
• Peer advocate model
• HIV individuals used to test high risk groups
• Promotora/street outreach hybrid
• evolved to include peer advocates
• Urban street outreach

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Increase early detection and access to care

• Social marketing
• Tu no me conoces
• Radio / printed material
• Targets transborder latinos/as, sex workers,
  migrant farm workers, latino MSM
• www.tunomeconoces.org
• Proyecto Juntos
• Radio / TV / posters / print material
• Targets 13-45 years old LEP females
• www.valleyaids.org

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Increase early detection and access to care El
Paso

• Multidisciplinary team care management
• Increased service hours from 16 to 28 per week
• Decreased ER visits
• Improved self-reported adherence
• Decreased proportion of No shows

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Increase early detection and access to care New
Mexico

• Initiated HIV testing outside of the clinic
• Increased awareness of the importance of knowing
  ones status and early detection
• Improved patient understanding of HIV disease
  management

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Increase early detection and access to care
California

• Increased availability of clinical hours in HIV
  primary care
• Imperial county from 2 hrs to 16 hrs per week
• San Ysidro Health Center from 8 hrs to 40 hrs
  per week
• Increased HIV related services specific to border
  needs
• Nutrition counseling
• Treatment adherence
• HIV testing

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Increase early detection and access to care
Arizona

• Increased HIV testing outside of the clinic
• House parties and in the field
• Reduction of time interval between HIV testing
  and entry into care

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Increase early detection and access to care
Harlingen

• Increased service delivery hours from 40 to 80
  per week
• Expanded clinical sites from 1 to 4
• Decreased no shows
• Decreased ER visits

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Growth in HIV primary care case loads, 2000-2004
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Enhance capacity of Community and Migrant Health
Centers to provide HIV/AIDS care

• Hired and trained bilingual staff for providing
  HIV care
• Trained community health providers on HIV primary
  care
• Increased self-reported provider knowledge and
  skills (New Mexico)
• Increased availability of overall HIV care
  services

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Enhance capacity of Community and Migrant Health
Centers to provide HIV/AIDS care

• Increased collaborations between CHC, ASO and
  AETC
• Use on-site co-management model to train rural
  physicians (Harlingen)
• Development of self-pace training curriculum for
  use in the CHC to address high turn-over
  (Arizona)
• Cross-border training of physicians (Harlingen,
  California)

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Other successes

• Provided financial resources for medical care for
  CHCs Care Act Grantees
• Formed on-going collaborations among the 5 SPNS
  sites
• Although funding stays here, education efforts
  cross the border
• Increased organizations capacity for evaluation

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• POLICY RECOMMENDATIONS

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The US-Mexico Border is Unique

• Characteristics of the population
• Overwhelmingly Mexican-origin Hispanics
• Poor
• Uninsured
• Significant patterns of migration between the
  United States and Mexico
• Characteristics of place
• The border is a geopolitical construct an
  imaginary line
• Communities behave as though this border does not
  exist
• Both sides of the border experience
• Pronounced poverty
• Fragile and poorly funded public health
  infrastructure
• A perfect storm
• Anticipatory and bi-national policy responses are
  needed
• National/state resource capacities and
  limitations need to be recognized
• Tan lejos de Dios y tan cerca a los Estados
  Unidos/So far from God and so close to the United
  States

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Policy recommendations

• Enhance CHC capacity for HIV services through
  the
• Addition of HIV primary care as required services
• Continuation of BPHC funding
• Offering of one time expansion to base funding
  for border CHC HIV services

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Policy recommendations

• Address border funding inequities
• Designate the border as its own Federal region
• Designate border as an EMA under Ryan White CARE
  Act
• Encourage and fund collaborations amongst border
  HIV care providers

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Policy recommendations

• Continue to address workforce issues
• Increase the number of providers trained to care
  for HIV patients
• Create better incentives to keep providers
  working along the border

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Recommendations for future HRSA initiatives

• Collaborate with other agencies to fund health
  services and epidemiological studies such as
• Identification of treatment models for
  communicable diseases that spans both sides of
  the border
• prevalence of HIV on both sides of the border
• Develop and fund evidence-based bi-national
  service delivery models for HIV/AIDS

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Discussion