Evidence of Success -Midwest ATEC (MATEC) Service Area: Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Wisconsin

Midwest ATEC (MATEC)

Service Area: Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Wisconsin

The Midwest ATEC (MATEC) has instituted two intensive longitudinal education programs designed to increase capacity to provide state-of-the-art HIV care. The Individualized Clinician Training Program (ICTP) is a comprehensive education and skill-building program to develop HIV clinicians in underserved communities. These clinicians usually practice in communities of color or in rural areas with limited HIV services. Participants in the ICTP are community-identified clinicians (advanced practice nurses, clinical pharmacists, dental professionals, physicians, physician assistants, and registered nurses) who commit to learning more about HIV, expanding their practices in HIV management, and becoming local resources for HIV-infected patients in their communities. By providing state-of-the-art training for medical and dental providers in these communities, MATEC bridges the gap between the need for effective HIV services and the availability of those services. The program requires an initial 40-hour commitment from the clinician over the course of one to two years depending on practitioner availability.

The Targeted Clinic Model is an outreach tool focused on building capacity in clinics that do not yet provide HIV care to a large number of clients. Most of the enrolled clinics are community/migrant health centers that do not have HIV-specific funding or clinics that have received Title III planning grants, are interested in pursuing Title III funding, or are newly funded Title III clinics. MATEC forms partnerships with these clinics, offering training, technical assistance, and consultation. In return, clinic leadership makes a commitment to expand HIV care in the clinic. MATEC works with clinic leadership to assess needs and develop goals and objectives for interventions that will expand and improve care.

MATEC-Illinois Site

Illustration: Developing a Local HIV Expert through the Individualized Clinician Training Program

One Illinois ICTP participant is an internal medicine physician who is the medical director of an HIV clinic in a predominantly African American community on the south side of Chicago. He came into this position several years ago after the unexpected death of the previous director. Immediately upon assumption of this position, he was charged with refining his skills and running an agency. Though he had great enthusiasm, he had very limited experience in the clinical management of HIV-infected patients when MATEC enrolled him as an ICTP participant. After a thorough needs assessment, MATEC designed a training intervention to expand the physician's knowledge of the pathogenesis of HIV infection, HIV disease progression, and opportunistic diseases common to HIV. In addition, he received training and consultation on current antiretroviral medications, appropriate dosing, and proper administration of opportunistic disease prophylaxis. His training plan included opportunities to attend national conferences and preceptorships with experienced HIV treaters.

At the end of the year-long program, this clinician was not only a highly regarded provider and leader within the clinic, but had also assumed leadership in the provider community. With MATEC support, he expanded a local physician forum to include educational opportunities in HIV for healthcare professionals from the highly HIV-affected south side of Chicago. In addition, he was instrumental in working with MATEC and the local society of the National Medical Association to develop an HIV conference for African American clinicians in the spring of 2001. The conference, called Ujima, was repeated in 2003, and recruited two new African American ICTP participants. He is a frequent lecturer and preceptor for MATEC programs and continues to provide HIV education for consumers and providers.

Outcomes

Immediate/Short-term:

	Provided structured process to increase knowledge and skill of provider.
	Developed the knowledge and skills of the physician.

Mid-term/Long-term:

	Moved physician from novice to expert HIV care provider.
	Established venue for peer-to-peer consultation and dialogue.

MATEC-Indiana Site

Illustration: Expanding a Clinical Infrastructure and Clinical Practice

The Indiana MATEC engaged a community health center applying for Title III funding in the targeted clinic program. A family nurse practitioner in the clinic committed to increasing her expertise and practice and to participation in the ICTP. The Community Health Center (CHC), located in a severely marginalized area for healthcare, jobs, and other resources, serves African American and Hispanic patients in a county that has the second largest number of HIV cases in Indiana. At the beginning of the program, only one infectious disease physician and one internal medicine practitioner (both private practice) in the county were providing HIV care. People either had to travel to Chicago for HIV care or go without. The nurse practitioner saw three HIV-infected patients for primary care only. Once the clinic received Title III funding, her goal was to increase the number of patients she was seeing and to expand the ability to provide complex HIV care at the clinic. During a targeted assessment process, she identified several areas of need including: lab work assessment; opportunistic infection (oi) identification, prophylaxis, treatment; and ARV initiation, monitoring, and side effect management. The Indiana MATEC provided her with many didactic training experiences, clinical observations, and consultation opportunities. She is currently focusing on the initiation of treatment, resistance testing, monitoring regimens, dealing with side effects, treatment and monitoring of co-morbidities, adherence, and treatment failure management. Within a year of working with the Indiana MATEC, she had expanded her practice from 3 patients to 75 and her practice has now grown to 250 patients. The most important aspect of this work was the relationship that the Indiana MATEC forged with the NP, as she explained, "I could not have done all this without MATEC for the support and training. I know I can call MATEC anytime with any kind of question and can get the answers I need."

The Indiana MATEC has also helped develop policies and procedures for the HIV clinic and provided linkages to additional resources such as other Title III programs and local AIDS service organizations (ASOs) through the Targeted Clinic relationship. The Indiana MATEC provided training to the entire clinic staff to help them understand HIV screening. The rapid growth of the HIV program was primarily based on the desperate need for care. With MATEC support, a community network for referral was established and patients were able to access care in a clinic that was already recognized as a legitimate service provider for other healthcare needs. In addition, patients had fewer concerns about confidentiality in the community health center and were able to easily access referrals to other programs in the clinic.

Even though the year-long program has been completed, MATEC continues to provide support to the NP and additional training to all CHC staff. One critical piece of success was the Indiana MATEC's ability to establish a trusting relationship and a reputation for responsiveness and quality services.

Outcomes

Immediate/Short-term:

	Provided structured process to increase knowledge and skill of provider.
	Strengthened knowledge and skill of HIV care provider.
	Developed clinical policies and procedures.
	Established linkages with other service agencies.
	Established community network for referrals.

Mid-term/Long-term:

	Established a new point of service for HIV-infected patients.
	Increased number of patients from 3 to 250.
	Increased understanding of staff role in HIV screening.
	Strengthened relationship between Indiana MATEC and community health center.

MATEC-Minnesota Site

Illustration: Developing Mentors through Targeted Clinic Model

In 2000, MATEC-Minnesota (MATEC-MN) began working with a community health center serving the Latino community of St. Paul. MATEC's targeted clinic model, in partnership with other community resources, increased the number of clients served by the clinic and the capacity of the clinic to serve people infected with HIV. The HIV specialty clinic, within the CHC, began in 1997 with four clients. In 2000, when the targeted clinic program began, they were seeing 55 patients. By 2002, that number was up to 84 patients and continues to rise. Since 2000, the program has hired six new staff: a health educator, social worker, program manager, nutritionist, psychiatrist, and case manager. MATEC works with the clinic to conduct yearly all-staff in-service trainings. The clinic is currently working on making services more accessible for patients by coordinating appointments with different specialists on the same day and limiting the number of non-HIV specialty clinicians in the clinic to protect patient confidentiality.

Although the formal targeted clinic program with this clinic ended in 2002, the partnership between MATEC-MN and the clinic continues. In 2003, MATEC-MN enrolled another clinic that serves the African American community of Minneapolis/St. Paul in the targeted clinic program. In addition to providing training, consultation and technical assistance, MATEC-MN has facilitated a relationship between this clinic and the "graduate" targeted clinic. The HIV Program Manager of the graduate clinic has conducted training for the new clinic staff on culturally-specific care. The presentation was geared toward all staff and drew on lessons learned while building the first program. In addition, the graduate clinic opened its doors to providers from the new clinic for clinical observation. This opportunity will remain available to foster mentoring relationships between the two clinics.

Relationships with targeted clinics evolve over time. The process begins with needs assessments and obtaining support from key stakeholders. A training plan is created in collaboration with clinic staff who meet with MATEC-MN staff to identify goals and objectives for the program and to create training calendars. Trainings are provided for all employees on various topics including basic HIV education, stigma, and panels of people living with HIV. Specific trainings are provided for specialized areas as requested. Several clinical staff are enrolled in the ICTP program and receive intensive training and mentoring. These experiences provide clinicians with the skills to become leaders in their clinics during the targeted clinic process and into the future. By encouraging past targeted clinics to develop training capacity, MATEC-MN is able to expand faculty and provide support to current targeted clinics. In turn, targeted clinics are able to support one another while providing high quality HIV care. The clinics are becoming known in their communities as places offering excellent services for people living with HIV.

Outcomes

Immediate/Short-term:

	Explored models for delivery of HIV care.
	Developed plans to implement new clinical care model.
	Identified staff and resources for implementation phase.
	Increased knowledge and skills of providers.

Mid-term/Long-term:

	Forged relationship between MATEC-MN and community health center.
	Developed mentor at the "graduated" clinic.
	Established the "graduated" clinic as a site for clinical observation for other providers.
	Expanded MATEC-MN faculty and enhanced support between the clinics.