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| Clinical Training of a Dental Hygienist Trainee Quote |
"After I got back from the clinical training in Denver, I started doing risk assessments on my dental patients and I knew better what to do when I found problems. For instance, when one of my patients presented with oral candidiasis, I referred him to the Community Health Center for an evaluation. I always knew thrush was a sign of immune compromise, but in Denver I learned that it was a significant finding for HIV and that I needed to refer him for additional care. And then I saw another patient with oral candidiasis. He already had a diagnosis of HIV, so I asked about his care and found out he had not seen his primary care provider in over a year! I encouraged him to get an appointment and to get his CD4 cell count done since I had learned that candidiasis can indicate a deteriorating immune status."
- Lonna Jones, RDH, from Sioux Falls, SD,
After attending an AETC-sponsored clinical training in Denver |
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Nebraska AETC
Illustration: Corrections Education in Nebraska
Education often provides the impetus to make small changes that can have a significant impact on patient care. The Nebraska AETC educated nurses and physicians at a county corrections facility with the goal of increasing knowledge about HIV. A nurse practitioner from the AETC taught the medical staff about signs and symptoms of HIV, laboratory testing used to diagnose and monitor HIV care, and prevention issues. An unanticipated outcome from this class was that jail staff started sending copies of appropriate lab results (which had been requested but never sent) to the HIV clinic prior to each patient's scheduled appointment. This small change allowed clinic staff to quickly review lab values, complete patient assessment and care planning more efficiently, and provide a higher quality of care to inmates with HIV.
Outcomes
Immediate/Short-term:
 | Increased knowledge of providers regarding signs and symptoms, laboratory testing, and prevention. |
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| Increased access to laboratory reports prior to each patient's appointment. |
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Mid-term/Long-term:
| Developed a system to handle patient care more efficiently due to receipt of laboratory results. |
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| Regional MPAETC, Native American Education Initiative Trainee Quote |
"Bringing the Indian Health Service (IHS) and the Tribal Health Program together for this conference was a great idea. It created a bridge between prevention/wellness and care/treatment. The training helped to put HIV on the radar screen for a lot of clinicians and it changed the way we do business. HIV testing is now being tracked to address inconsistencies in how tests had been offered, information provided by clinicians is more accurate, and there has been a measurable increase in Native community members coming in for HIV tests.
One of the most exciting results of the conference is that our supervising midwife is now treating a Native American patient with HIV. She incorporated things she learned at the conference to develop a better way to assess and treat Native people based on the model of the Medicine Wheel. Most importantly, she is pioneering a monthly HIV clinic on the reservation to meet increasing care need and is creating a team of professionals to provide HIV care and treatment services. This is an innovative program and one of few reservation-based HIV clinics to create linkages between IHS and Tribal health."
-Ella Richards, RN
Tribal member and nurse educator at the Pine Ridge Indian Health Service Hospital, reporting on an HIV Conference sponsored by the National Native American AIDS Prevention Center as a sub-contractor of the Mountain Plains AETC |
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South Dakota AETC
Illustration: Quality Assurance for AETC Education in South Dakota
The Sioux Falls Health Department (SFHD) is a multi-service health agency and a RWCA Title III-funded Early Intervention/Primary Care site. The SFHD has established a network to provide a full array of care services for HIV-infected patients. The South Dakota AETC works closely with the Title III program to educate clinicians, offering a combination of on-site presentations, audio-conferences, grand rounds, and clinical training. Between February 2002 and June 2003, the South Dakota AETC had over 90 education interactions with clinic staff. Table 1 shows the results of a chart review process that was initiated prior to this education with a follow up 16 months after education had started.
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Table 1. Chart Review Results Prior to and After AETC Education for Clinicians in the South Dakota Title III Clinic"
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| Clinical Activity | Feb 02 | Jun 03 |
| CD4 cell count ordered within the last 6 months | 83% | 90% |
| Viral Load ordered within the last 4 months | 83% | 90% |
| Pneumovax within the past 7 months or 2 within lifetime | 67% | 70% |
| PPD placed within the last 12 months if patient is PPD negative | 9% | 39% |
| Ophthalmology referral as appropriate within last 12 months | 0% | 75% |
| PCP preventive therapy in patients with CD4 counts < 200 | 80% | 100% |
| MAC preventive therapy in patients with CD4 counts > 50 | 67% | 100% |
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The table demonstrates positive improvements in clinical care on all measures and, most essentially, the initiation of eye care for these clients. Because of AETC education, HIV-infected patients received better monitoring, consultation, and preventive care in this rural clinic.
Outcomes
Immediate/Short-term:
| Established collaborative relationship between the AETC and the Title III clinic. |
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| Increased knowledge and skills of providers. |
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| Provided access to quality improvement data. |
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Mid-term/Long-term:
| Improved quality of care as noted through clinical care measures. |
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New Mexico AETC
Illustration: Needs Assessment and Information Sharing
In addition to providing education about HIV, the AIDS Education and Training Centers also provide services such as problem solving, needs assessment, evaluation, technical assistance, and collaboration coordination to clinicians. During a face-to-face needs assessment facilitated by the New Mexico AETC, for instance, a representative from a clinic in southern New Mexico stated that HIV Counseling, Testing, and Risk Assessments were completed with close to 100% of their pregnant clients. A clinician from another clinic responded that very few women in his practice had agreed to the test. Although this was not the intent of the meeting, the AETC facilitator moderated further discussion which lead to information sharing about confidentiality, cultural competency, and quick testing methods. By the end of the meeting, clinicians from the low-testing clinic stated they were better informed and equipped to educate their clients. They were confident that they could increase the number of voluntary HIV tests for pregnant women.
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| By the end of the meeting, clinicians stated they were better informed and equipped to educate their pregnant clients about HIV testing. |
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During a second face-to-face needs assessment meeting, the New Mexico AETC worked with providers from Las Cruces in an effort to better understand the HIV information needs of clinicians in the US-Mexico Border area. Findings from this assessment provided input into education needs, including the desire for hands-on clinical instruction. As a result, the New Mexico AETC worked with the regional office of the Mountain Plains AETC in Denver to arrange for clinicians from the Camino de Vida SPNS project to attend clinical preceptorships in Denver. On-site classes suggested by the needs assessment were also provided. Attendance at these trainings has been excellent and feedback has been positive in terms of participant satisfaction and self-perceived increases in knowledge. A follow-up telephone survey to determine how attendees use AETC information to improve practice is being implemented.
Outcomes
Immediate/Short-term:
| Facilitated opportunities for peer-to-peer learning and sharing of information. |
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| Increased knowledge regarding HIV counseling and testing. |
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| Developed training programs that met the needs of participants. |
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Mid-term/Long-term:
| Established access to clinicians for assessment of training outcomes. |
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| Increased probability that area clinicians will continue cooperative interactions to improve HIV services. |
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