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Date of Report:
01/2007
Source:
Pennsylvania/MidAtlantic AETC
The Alaska Native Tribal Health Consortium (ANTHC), the Northwest AETC (NWAETC) local performance site (LPS) in Alaska, is the largest, most comprehensive tribal-operated health organization in the United States. The ANTHC mission is to provide high quality health care services for Alaska Natives.
For the past 35 years, trained Community Health Aide/Practitioners (CHA/Ps) have provided p rimary health care to Alaska's villages-in many cases CHA/Ps are the only local health care provider and the first link to care in the Alaska Tribal Health System. In its role as an LPS with Minority AIDS Initiative (MAI) funds, ANTHC developed an HIV/AIDS curriculum to address the educational needs of CHA/Ps.
There are currently 491 CHA/Ps delivering health care in Alaska. Most CHA/Ps are Alaska Native women who practice in their home villages under physician supervision. However, the physician is often located hundreds of miles away so the CHA/Ps are also guided by an extensive field manual entitled
Community Health Aide Manual (CHAM)
and prescribed standing orders. On average, CHA/Ps have a 6th grade literacy level. They are often personally related to many of their patients. As a result, a perceived or actual lack of confidentiality is a barrier to providing health care.
Remote and isolated practice settings contribute to some misinformation among CHA/Ps about HIV transmission, prevention, care and treatment. Isolation also insulates the CHA/Ps, protecting traditional cultural norms and values while also creating barriers to new knowledge that could influence HIV-relatedbeliefs and practices. The HIV/AIDS training curriculum developed by ANTHC aims to address misinformation, reduce stigma, and establish culturally appropriate HIV testing, recognition, and referral guidelines for the CHA/Ps.
The ANTHC HIV Clinical Specialist/Trainer drew from extensive clinical experience with CHA/Ps to develop the curriculum. The development process began with an invitation to review and edit the HIV/AIDS section of the
CHAM
. Additional contributors to the curriculum included staff from the NWAETC and the ANTHC CHA/P training center as well as ANTHC HIV clinicians. Report findings from the seminal Targeted Provider Education Demonstration (TPED) project were also utilized in the development process.
The curriculum was piloted at 2 two-hour training sessions, where participants were asked to provide extensive feedback. This feedback provided key information needed to address the challenge of the amount and level of information needed by CHA/Ps to provide essential services. It was also determined that CHA/Ps need to learn about the STD/HIV transmission risk connection because of the high prevalence of STDs in rural Alaska. The curriculum developers believed that inclusion of this topic in the curriculum may increase buy-in to learning about HIV and HIV testing in the villages despite current low HIV prevalence rates.
The final curriculum included topics such as: recognizing early HIV infection, understanding HIV disease progression, knowing the STD/HIV connection, risk assessment/ reduction, and HIV testing. A typical training with this curriculum is conducted within a time frame of two to five hours. The curriculum is routinely used by the ANTHC LPS to train CHA/Ps. Although trainings have been delivered on-site in rural "hubsites" and via tele- and videoconferencing, training is delivered mostly in person at the Anchorage CHA/P training center. Notably, the use of tele- and videoconferencing technology helped reduce costly travel expenses for CHA/Ps to attend in-person trainings. Overall, evaluations of the HIV/AIDS curriculum demonstrate effectiveness in providing CHA/Ps with information and skills that meet the health care needs of the Alaska Native villages.
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