Evidence of Success - Pacific AETC Service Area: Arizona, California, Hawai'i, Nevada and the six US-affiliated Pacific Jurisdictions

Pacific AETC

Service Area: Arizona, California, Hawai'i, Nevada and the six US-affiliated Pacific Jurisdictions

The central office of the Pacific AETC (PAETC) works with three other Federally-funded training centers in a collaborative process to assure that local training programs are complementary, not duplicative, and better meet the training needs of similar audiences. For the past two years, representatives from PAETC and the F.J. Curry National TB Center (CNTC), the California STD/HIV Prevention Training Center (CA PTC) and the Center for Health Training (CHT), the Regional Training Center, have met to develop and update a joint strategic training plan. The plan is distributed to 15 local sites, discussed at meetings with LPSs, and posted on the PAETC website.

Illustration: U.S.-Mexico Border Health Care Providers in Arizona and California

One example of the collaborative training efforts is a program that targets healthcare providers serving rural communities living at the U.S.-Mexico border in Arizona and California. By partnering with sister training organizations, the PA AETC is able to efficiently and effectively address training needs of border clinicians for infectious diseases including HIV/AIDS, STDs, tuberculosis, and hepatitis. Clinicians in border areas see patients at risk for all of these infections.

Didactic and interactive methods are used to train participants to better screen for and diagnose HIV, STDs, tuberculosis, and hepatitis, as well as to treat and/or refer patients living in border communities. Rural healthcare providers who attend border trainings are appreciative and enthusiastic audiences. They indicate that they would not otherwise have the opportunity to access such high quality information. Through participation in the training, the participants increased their ability to screen for syphilis, conduct risk reduction counseling, improved sexual history taking and increased knowledge regarding HIV testing practices. Based on the success of the training and participant response, the training will be replicated for a third time in Nogales, AZ.

Outcomes

Immediate/Short-term:

	Increased ability of providers to screen for syphilis, conduct risk reduction counseling, improve sexual history taking, and HIV testing practices.

University of California at Irvine AETC

Illustration: Clinical Preceptorship for Native American Clinicians

For the past four years the University of California at Irvine (UC-Irvine) AETC has provided a specialized clinical preceptorship for Native American clinicians or those who primarily care for Native Americans at the HIV clinical facilities in Orange County, California. The preceptorship includes a focus on cultural competency issues as well as clinical skills. Each of the quarterly preceptorships can support four to six clinicians. A waiting list is routinely established for this course.

Participants come from a wide range of Native communities including: Anchorage and Fairbanks, Alaska; remote tribal villages in Alaska; White River Apache Reservation in Arizona; tribal clinics in North Dakota; urban areas in California such as Los Angeles and Oakland; Gallup, New Mexico; the Cherokee Nation in Oklahoma; and the Rosebud Sioux Reservation in South Dakota.

Results from pre-course needs assessments are used to tailor trainings to the needs of the participants (e.g., sessions on pediatric management issues are added on request). Skills-building sessions are conducted to improve clinicians' screening skills and abilities to diagnose and manage HIV-infected Native Americans. In 2002, a pharmacist from the Alaska Native Medical Center in Anchorage attended the course. He was being trained as a relief HIV pharmacist for a new HIV Clinic. As a result of participation in the Irvine training, the pharmacist's role was enhanced to include direct interactions with patients to explain medications and side effects, thus supporting adherence.

The clinical preceptorship model was successfully replicated at the Phoenix Indian Medical Center in Arizona, with technical assistance and faculty from the Irvine project. This has increased the number of Native American clinicians able to receive skills-focused training.

Outcomes

Immediate/Short-term:

	Developed knowledge and skills of clinicians to screen, diagnose, and manage HIV infection in Native Americans.
	Expanded the role of a clinical pharmacist to include direct interactions with patients.

Mid-term/Long-term:

	Increased number of referrals for clinical preceptorships by past participants.
	Expanded the clinical preceptorship model to Arizona.

Hawai'i AETC

Illustration: Training for the Six U.S.-Affiliated Pacific Island Jurisdictions

The mission of the Hawai'i AETC is to provide health and human service workers with the knowledge and skills necessary to care for people living with HIV. The Hawai'i AETC oversees an Minority AIDS Initiative (MAI)-funded project for the 6 U.S-affiliated Pacific Island Jurisdictions of Guam, American Samoa, Commonwealth of Northern Mariana Islands, Federated States of Micronesia, Republics of the Marshall Islands, and Palau. It provides education and training to physicians, dentists, and nurses practicing in these jurisdictions.

This capacity building project has used training, clinical consultation, and technical assistance to create local training sites for more than five years. Training sites are strategically located and designed for specific sub-regions, given the wide geographic expanse covered and unique cultures involved.

As a result of careful planning, which involved continuous evaluation and needs assessment, many of the islands reported progress toward building regional HIV-related service and training capacity. Needs assessments were conducted for each jurisdiction and training plans were subsequently developed. Various didactic and interactive training sessions were held and clinical preceptorships were implemented. HIV case conferencing was initiated via PEACESAT in July 2002 and has been held every two months. This provides case-based training and clinical consultation to the Pacific jurisdictions. The National HIV/AIDS Clinicians' Consultation Center (NCCC) in San Francisco provides an expert clinician to serve as case discussant and coordinator. Clinicians from Hawai'i also consult and provide technical assistance. To meet the continuing training needs in the Federated States of Micronesia and the Republic of the Marshall Islands, the Chuuk HIV Training Center was established in January 2003.

Outcomes

Immediate/Short-term:

	Improved HIV clinical management skills among providers in the six U.S.-affiliated Pacific Island Jurisdictions.
	Built strong relationships with provider agencies in the six U.S.-affiliated Pacific Island Jurisdictions.

Mid-term/Long-term:

	Improved training capacity among the Pacific Island Jurisdictions by establishing a local LPS.