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HIV Clinical Capacity Building The Pacific
AIDS Education Training Center/I-TECH
ExperienceOrWhat do you guys on the 5th floor
really do?

• CAPS Town Hall
• March 4, 2005

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The Unfortunate Incident of September 3,2003
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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

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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

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In the Beginning

• HRSA funded in 1987based 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

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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

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Where have we been all your life?

• First round of AETCsfocused on health
  professions schools
• Western AETC merged with AETC for Southern
  California
• Move to UCSF Campusintegration 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 siterecognized as local leaders
  in HIV care

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National AETC Program

• 11 regional centers
• More than 130 associated sites

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National AETC Programs contd

• 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

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National AETC Programs contd

• National HIV/AIDS Clinicians 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 [phone]

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National AETC Programs contd
National HIV/AIDS Clinicians 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
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National AETC Programs contd
National HIV/AIDS Clinicians 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
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California Sites

• 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

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Nevada Sites

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

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Arizona Site

• University of Arizona
• Training faculty in both Tucson Phoenix

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Hawai'i Site

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

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Pacific Jurisdictions
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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

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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

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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/resistanceca
  ses/

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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

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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

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Special Focus Areas contd

• 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
• CDCs Advancing HIV Prevention
• Prevention with Positives
• Rapid HIV Testing
• Perinatal Transmission

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Special Focus Areas contd

• US-Mexico Border AETC
• Linkages with Border Special Projects of National
  Significance (SPNS)
• Link with the CAPS TIE Core

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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

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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

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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)

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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 CDCs Advancing HIV Prevention
• Rapid Testing Training
• IDSA Guidelines on Prevention with Positives

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• 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
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Evaluation of Clinical Training

• UCSF AIDS Policy Research Center
• Local Performance Site profilesincluding
  Warmline data
• Pacific Jurisdiction capacity building evaluation
• Level III Vignette project with the National AETC
  Evaluation Center
• Online clinician training needs assessment

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Warmline Calls in our Region
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Lessons from the Pacific

• Respect the hierarchy
• Were here as long as you need us
• Respect the cultural values

• 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

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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
  experiencebringing 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

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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

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The I-TECH Continuum of Care Training
Education Model
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I-TECH Partnerships
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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

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New Training Center in Chennai, India
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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)

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The Future?

• I-TECH UCSF partnership with American
  International Health Alliance on HRSA Twinning
  Center
• Volunteer Health Corps

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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

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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