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| Delta Region AETC/Rural Mississippi Trainee Quote |
"In the far-flung rural areas of Mississippi, it is rare to find an infectious disease specialist on a hospital staff, or an infectious disease clinic within a two or three hour drive. The AETC program offers on-going training to local doctors, nurse practitioners, nurses, case managers, and others, so they are prepared to become a link in the Mississippi HIV Rural Area Network, a statewide collaborative of HIV care sites, providing a much needed service to HIV-infected patients who have nowhere else to turn. During my eight years serving as a family practice doc in the rural town of Marks, I availed myself of the services provided by the AETC on many occasions for workshops and in-service training for myself, a nurse practitioner, and another doctor who joined our practice, as well as our case manager and nurses. The staff of the AETC also visited our clinic to do presentations for the entire staff and provided education about HIV and patient care to the nurses in our local hospital. Without support from the AETC, many of us would not have been able to keep up with the ongoing education needed to be proficient in the care of HIV/AIDS patients. It is important for their work to continue."
- Andrea Balconis, MD, FAAFP
After accessing off- and on-site training provided by the local AETC |
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| Louisiana AETC Trainee Quote |
"We saw a pregnant patient in clinic today for the first time. She was referred to us from the E.D. where she'd just received a positive HIV test result. She was very upset, frightened for herself and her baby. Thanks to what I'd learned over these last few months in training with you, I was able to initiate a plan of care for her that included collaborative medical management with an OB/GYN and case management and supportive services from the RWCA Title IV agency. Thanks for all of your help! I look forward to continuing my training with you."
- Niki Pierce, RN Case Manager
After accessing AETC training |
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The Louisiana AETC (LA AETC) has instituted an intensive longitudinal program designed to increase the capacity of clinicians to provide state-of-the-art HIV care. Focusing on individual clinicians, it is a comprehensive education and skill-building program for educating HIV clinicians in underserved communities. These clinicians usually practice in communities of color or in rural areas with limited HIV services. Participants are community-identified clinicians (advanced practice nurses, dental professionals, pharmacists, physician assistants, physicians, and nurses) who are committed to learning more about HIV/AIDS, willing to expand their HIV practices and to become local resources for HIV care. By providing state-of-the-art training for health care providers in these communities, the LA AETC bridges the gap between the need for effective HIV services and the availability of those services.
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| By providing state-of-the-art training, the AETC bridges the gap between the need for effective HIV services and availability of those services. |
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Illustration: Longitudinal Training at a Small, Rural Public Hospital in Louisiana
In Louisiana, 81% of the state's 14,000 HIV-infected individuals receive care through a network of 10 public hospitals. One hospital serves two rural parishes in Louisiana. In November 2002, this small rural hospital hired a registered nurse to provide case management services for 60 HIV-infected ambulatory care patients. The nurse was inexperienced in HIV care as well as in case management. Local physicians were also inexperienced in HIV care and there were no infectious disease physicians available for consultation or referral, leaving a significant gap in clinical expertise.
Recognizing the difficulty of providing HIV care in this rural area, the LA AETC approached the registered nurse and offered assistance in designing and implementing a longitudinal training plan. Working together, a program was developed that would meet the nurse's education needs, enhance her knowledge, and help her develop the case management skills that her patients needed.
As a result of this individualized training program, the registered nurse increased her HIV case management knowledge and skills. Initially, the LA AETC provided technical assistance in setting up a case management program, as well as consultative services in identifying appropriate patient service needs. With additional in-depth didactic education and skills building training, the registered nurse grew confident in providing HIV case management services to her clients. The collaborative relationship resulted in unlimited and ongoing access to expert HIV care consultation services. The LA AETC also provided HIV training and education to an LPN in the area who worked with HIV patients; she attended a 3-day nursing clinical preceptorship.
The LA AETC forged new relationships and collaborations with the hospital during the course of educating these providers. Currently, the LA AETC has a strong relationship with an HIV-experienced infectious disease physician who sees HIV-infected patients at the hospital twice a week. This physician uses AETC clinical consultation services and attends clinical preceptorships and other training sessions. Working in collaboration with this small, rural hospital, the LA AETC provides a skills-building training series via telemedicine to 20-30 nurses, social workers, and physicians.
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| The collaborative relationship resulted in unlimited and ongoing access to expert HIV care consultation services. |
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Outcomes
Immediate/Short-term:
 | Developed knowledge and skills of the RN to provide case management services. |
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| Strengthened knowledge and skills of the LPN to provide direct patient care to HIV-infected patients. |
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| Built strong relationships between the LA AETC and providers at a small, rural Louisiana public hospital. |
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| Established LA AETC/hospital telemedicine training collaboration. |
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Mid-term/Long-term:
| Increased professional development of HIV-experienced infectious disease physician. |
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| Increased knowledge and ability of 20-30 hospital providers to care for HIV-infected patients. |
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| Formalized relationship with the hospital so that it was not dependent on any one individual. |
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| Continued longitudinal training. |
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Mississippi AETC
| Mississippi HIV Discharge Planning/Prison Release Program Primary Care Provider Quote |
When the HIV Discharge Planning Program/Prison Release Program was in its infancy, Judith Dial, FNP, was the primary care provider at the men's prison. She later transferred to the Title III-funded Adult Infectious Disease Clinic. She sees the successful transition of HIV-infected inmates from the prison health system to HIV primary care settings in the community. She provided the quote below:
"A few days ago I received a call from one of the patients I treated while at the Mississippi Department of Corrections. He needed a refill on one of his medications, as he would run out before his next scheduled clinic appointment. He told me he was able to get an infectious disease clinic appointment, housing, and a job as a result of the discharge planning made on his behalf prior to his release from prison. The AETC does a great job of teaching us how to work with incarcerated people with HIV to see that they get the health care and social services they need. Since I began to work at the Special Care Clinic, I have seen two former inmates who are getting HIV health care as a result of the HIV Rural Area Network and the AETC. Thanks for the great job you all do."
- Judith Dial, FNP
Primary care provider in the Mississippi Corrections System |
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The Mississippi AETC (MS AETC) has instituted longitudinal training and technical assistance programs in the Mississippi prison system. The MS AETC has a long history of working with the Mississippi Department of Corrections. This collaboration resulted from participation in a statewide task force convened by the state commissioner in response to the American Civil Liberties Union's interest in equitable treatment for HIV-infected inmates.
The MS AETC observed that HIV-infected inmates were not being appropriately referred for follow-up care and services upon release from prison. As a result, they were not receiving the care and treatment they required after their release. The MS AETC was instrumental in linking HIV-infected releasees to local health care providers through the Mississippi-based HIV Rural Area Network (HIVRAN). HIVRAN provides referral and consultation support to Ryan White CARE Act funded providers and other agencies delivering HIV services in rural Mississippi.
Illustration: Longitudinal Training and Technical Assistance in the Mississippi Prison System
In order to link HIV-infected former inmates to local health care providers, the MS AETC worked with prison officials, providers, and HIVRAN organizations to implement the newly-created HIV Discharge Planning Program. This new program, which uses a multidisciplinary medical discharge planning committee, facilitates continuity of care for HIV-infected inmates who are released from prison to return home.
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| Through the educational efforts, discharge planning for HIV-infected inmates increased from 0% to 100%. |
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The MS AETC developed policies and procedures within the prison system that now support monthly discharge planning meetings. Additionally, the MS AETC provided training and education to the prison case manager and other providers. It also provided logistical support and technical assistance to assure accuracy in patient acuity assessment, to identify client needs and appropriate provider and service agencies to participate in discharge planning and to enhance the flow of patient information.
Multidisciplinary discharge planning teams include an AETC registered nurse clinical trainer, providers from RWCA Titles II, III, and IV programs, and other HIV care programs as appropriate. The HIV Discharge Planning Program is a key part of a system of referral and care that effectively connects released HIV-infected inmates to HIV primary care.
Outcomes
Immediate/Short-term:
| Increased knowledge and skills of prison providers. |
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| Established policies and procedures for providing transitional services for HIV-infected inmates leaving prison. |
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| Implemented a multidisciplinary medical discharge planning committee. |
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| Enhanced clinical information flow from prison to Special Care Clinic providers. |
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| Expanded the network of services through linkage with service agencies. |
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Mid-term/Long-term:
| Increased discharge planning for HIV-infected inmates from 0% to 100%. |
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| Reduced duplication of baseline diagnostic blood work. |
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| Sixty percent (60%) of HIV-infected inmates have been referred for follow-up care in Special Care Clinic. |
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Arkansas AETC
| Rural Arkansas Trainee Quote |
"Jon Allen, PA, as the point person for the AIDS Education and Training Center, has been instrumental in the development and distribution of Antenatal and Neonatal Guidelines Education and Learning System (ANGELS) guidelines for the management of HIV disease during pregnancy. In addition to the hours of time devoted to the development of the guidelines, the AR AETC has participated in two state-wide teleconferences to discuss the guidelines and current treatment recommendations. Because the guidelines and teleconferences are designed for all providers of obstetrical care in Arkansas, the advice and recommendations offered have an impact far beyond the confines of UAMS Medical Center."
-Barbara Smith, RN
After accessing several LPS-sponsored activities |
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Recognizing the dichotomy of obstetrical care delivery between urban and rural systems, the Department of Obstetrics and Gynecology at the University of Arkansas, Campus for Medical Sciences (UAMS), in conjunction with Medicaid, created and developed the Antenatal and Neonatal Guidelines Education and Learning System (ANGELS) program. The ANGELS program provides a system of clinical guidelines, 24-hour/7-day-a-week case management, and aggressive outreach education programs that are designed to improve healthcare outcomes and reduce healthcare expenditures across the state of Arkansas.
ANGELS has the potential to reduce the number of babies born in Arkansas with severe medical problems, including HIV, and save the state millions of dollars in long-term care for those children. Arkansas AETC (AR AETC) faculty members serve as HIV Specialists and provide clinical consultation on high-risk HIV pregnancies.
Illustration: Utilization of Clinical Consultation in Rural Arkansas
Children born with serious health complications represent a significant financial responsibility for the state. Many of those health complications come from diseases present at birth such as HIV infection. The AR AETC collaborates with other RWCA programs in Arkansas with the shared interest in improving the quality of HIV care for women and children, especially those in rural areas with limited access to health care.
ANGELS provides guidelines for diagnosing and treating high-risk pregnancies, including HIV; continuing medical education for Arkansas obstetricians and family practice physicians; and procedures for referring pregnant women with severe medical complications to UAMS for specialized care. Obstetrical and neonatal health care providers have around-the-clock access to experts in high-risk pregnancy at UAMS.
AR AETC faculty provides HIV case consultation by e-mail, and telephone. When consultation is not sufficient to resolve the issue, AR AETC faculty accepts high-risk HIV patients into their practices where they provide excellent care. Faculty use experiences from the consultations to provide case-based and interactive learning experiences for other providers.
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| Faculty use experiences from the consultations to provide case-based and interactive learning experiences for other providers. |
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The AR AETC faculty at UAMS works closely with maternal-fetal medicine specialists in the UAMS College of Medicine. This is proving to be a valuable partnership for the AR AETC because UAMS provides assistance to Arkansas obstetricians through a network of interactive video connections that allow physicians in nine Arkansas communities to consult UAMS specialists. AR AETC is now a partner in providing HIV clinical consultation through this network and consultations have doubled in a short period of time.
Outcomes
Immediate/Short-term:
| Increased knowledge of HIV treatment guidelines for obstetricians and family practice providers who perform perinatal care. |
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| Established stronger relationships among the AR AETC, rural providers, and obstetrical and community-based clinics. |
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| Improved care for the individuals referred to the AR AETC faculty for high-risk pregnancy care related to HIV. |
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Mid-term/Long-term:
| Increased knowledge and skills of Arkansas obstetricians and family practice providers in HIV through an interactive video network. |
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| Further increased knowledge and skills of rural obstetricians and primary care providers. |
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