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The ABCs of 4TCs - Ryan White HIV/AIDSTechnical Assistanceand Training
Partnerships: Building Cooperation for Action
May 28-30, 2008
Steven Young, MSPH and Lynn Wegman, MPA
Division of Training & Technical Assistance
HIV/AIDS Bureau, HRSA, HHS
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1. Ryan White HIV/AIDS Program
The Program: Federalprogram focused solely ondelivery of health care andsupport services for overhalf a million underservedlow income persons in theU.S. living with HIV/AIDS
TA/Training: Helping RyanWhite HIV/AIDS Programsfunction more effectivelythrough technicalassistance and training
Federal Oversight
HHS
HRSA
HIV/AIDS Bureau
HAB/ DTTA & Service Divisions
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Oversight of Ryan WhiteTraining and TA: DTTA
HRSA/HAB’s DTTA: Division of Training &
Technical Assistance Provides technical assistance (TA) and training activities
that support Ryan White programs
Assists grantees, planning bodies, funded providers,affected communities and individuals living with HIVinfection in designing, implementing and evaluating RyanWhite-supported programs
Administers the national AIDS Education & Training Centers(AETC) HIV care provider training program
Conducts training for HAB staff on HIV/AIDS issues
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2. Vision for TA & Training
More responsive, timely,and cost-effective TA &training resourcesavailable fromHRSA/HAB and moreeffective Ryan White-funded HIV/AIDS careprograms
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Ryan White Reauthorization
Requires adjustment in focus and effort
Training HAB staff, current grantees andnew grantees
Training TA consultants
Technical assistance on specific topics(e.g. core services)
Revising TA & training priorities
2008 All Grantee Meeting
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3. TA/Training for RW Community
Meetings/ConferencesLogistics Contract
TA Products/InitiativesTA Contract
TA Centers on Key TopicsCooperative Agreements
Individualized/On-Site Peer and Expert Consultations
TA Contract
Provider Clinical TrainingAETCs
TARGET CenterCentral Source for Finding
Ryan White TA and Training
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c. TA Partners and Activities
Quality of Care and Treatment Guidelines
Unmet Need
Peer Advocates
Data Use in Planning,
Evaluation, Quality
Cultural Competency and Stigma
Consumer Involvement &
Leadership
Care Delivery Capacity Building
Fiscal ManagementOrganizational Development
ADAP
Ryan White Community
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Cooperative Agreement:Supporting Networks of HIV
CAEAR Foundation in partnership with the Academy forEducational Development and the National Minority AIDSCouncil; Advisory Group and interventions involve AETCs
Grantee
On-site TA, intensive capacity building, and regional meetingsActivities
TA and training to enhance comprehensive HIV primarymedical care and treatment services in racial and ethnicminority communities. TA is targeted to (1) small to mediumcommunity and faith-based organizations serving minoritypopulations, (2) entities planning to expand capacity to provideHIV/AIDS primary medical care services, and (3) non-RyanWhite Program grantees
Focus ofTA
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Overview- Project Activities
Onsite technical assistance- provide 65 episodes of on-site TA, deliver web-based training and offer 20scholarships for conference attendance
Intensive capacity building- increase the capacity of 5 to10 primary care sites and 5 to 10 Ryan White Programfunded primary care sites serving racial/ethnic minoritycommunities severely impacted by HIV/AIDS and the 2005hurricanes
Regional meeting- increase the capacity of 80 to 100participants from at least 50 primary care sites serving racial/ethnicminority communities severely impacted by HIV/AIDS to develop,improve, or expand the delivery of comprehensive HIV primary careand treatment services through regional meetings and ContinuingEducation Units (CEU) web-based trainings
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Value of the SNHC by EPMCto HRSA grantees
Address provider shortage relative to theprovision of HIV/AIDS care and treatment
Encourage Ryan White Program community towork more collaborately with community healthcenters and other AIDS service organizations
Demonstrate importance of making HIV care astandard component of primary care
www.hivta.org
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Ryan White ReauthorizationQuality Management
Ryan White HIV/AIDS Treatment Modernization Act of 2006directs grantees to develop, implement, and monitor clinicalquality management programs to ensure that
service providers adhere to established HIV clinical practices
quality improvement strategies include support services thathelp people receive appropriate HIV health care
demographic, clinical, and health care utilization information isused to monitor trends in the spectrum of HIV-relatedillnesses and the local epidemic.
HAB has defined “quality” as the degree to which a health orsocial service meets or exceeds established professionalstandards and user expectations.
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Cooperative Agreement:National Quality Improvement/Management TACenter (NQC)
Grantee: Health Research, Inc./New YorkState AIDS Institute
Purpose of Cooperative Agreement:
assist grantees of all Parts to build capacityfor quality improvement
focus on the information and technicalassistance needs of programs concerningdeveloping and implementing qualitymanagement programs
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NQC Activities
Three levels of consultation
Information Dissemination
Training and Educational Forums
Intensive consultation on/off-site
Steering Committee
NQC CQI program
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4. Easing Access to Ryan White TATARGET Center: Technical Assistance Resource Guidance Education Training
http://careacttarget.org
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TARGET: What it Offers
DTTA-staffed HELP desk Available 24 hours a day Staffed M-F, 10-4 EST 301-443-0067 Response within 48 hours
TA Library (375+ tools/resources on primary care, planning, otherHIV/AIDS care topics)
Ryan White Community (over 690 grantee and Planning Councilwebsites, State Profiles, contact information)
Links to All HAB TA
Calendar of TA Events
On the Horizon: Virtual Community
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Learn of Upcoming TA/Trainings
Multiple Venues Are Used to Disseminate TA Info
TARGET Center Calendar http://careacttarget.org
HRSA/HAB Project Officers
HAB Email. Sign up athttp://hab.hrsa.gov/subscribe.htm or [email protected]
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Clinical Training for ProvidersAIDS Education and Training Centers: AETCs
The AETC program is the clinicaltraining component of the RyanWhite program, providing ongoingeducation to clinicians in rural,suburban and urban areas acrossUS
The goal is to increase the numberof providers who are educated andmotivated to counsel, diagnoseand treat people living with HIV
From July 2006 – June 2007,AETCs devoted 46,896 hours totrain 128,528 healthcare providers
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AETC’s: Target Population
Healthcare providers: At least 80 percent of funds or training programs must be
targeted at training: Physicians, Nurses,Advanced Practice Nurses, Physician Assistants,Pharmacists, Oral Health Professionals
Up to 20 percent of funds or programs can be targeted toallied health professionals involved in HIV care
Providers caring for the medically underserved: HRSA funded Providers: Ryan White programs,
Community Health Centers, and Maternal and Child Healthgrantees
Correctional facilities Others
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AETCs:Regional Network of Centers
11 Regional Centers with morethan 130 local sites servinghealthcare providers nationwidefunded for a 5-year grant cycle
In FY 2007 – Regional AETCs wereawarded approximately $30.75 M
And the 4 National AETC Centerswere awarded a combined total ofapproximately $5.7 M
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AETCs Offer LongitudinalHIV Training Opportunities
Didactic Presentations – Introduction to HIVcare and updates - Classroom style workshopsand seminars - Level I
Interactive Skills Building – includes roleplaying - Level II
Intensive Hands on Clinical Training withpatients – preceptorships, mini-residencies,observation of clinical care - Level III
Educational Patient Specific ClinicalConsultations - Includes one-on-one mentoring -Level IV
Technical Assistance and CapacityBuilding – system and organizational issues as wellas clinical issues -Level V
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AETCs:Most Common Training Topics
Treatment strategies (Antiretroviral Therapy; Mother- to-ChildHIV Transmission; Palliative Care)
Diagnostic tests and disease progression (LaboratoryTesting)
Epidemiology & basic science (Post-exposure Prophylaxis) Adherence Clinical manifestations of HIV (Opportunistic Infections; Oral
Health) Comorbidities (Hepatitis Co-infection; TB/HIV Co-infection) Opportunistic infections Substance Abuse Risk assessment/risk reduction Capacity building Minority providers and CBOs
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AETCs Required to ConductTraining Needs Assessments
AETCs prioritize resources totrain & educate in remoteunderserved areas
AETCs conduct at least onecomprehensive needsassessment during 5-year projectand one needs assessment incollaboration with other HHSTraining Centers (4 TCs)
AETCs collaborate with RTCs,PTCs, ATTCs, and TB Centers on– substance abuse and mental healthneeds, STD issues, familyplanning/reproductive health, HIVtesting, TB issues, etc.
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AETCs Focus on TrainingMinority Clinicians and/or MinorityServing Clinicians
OMB Performance Goal for AETCs –Increase the proportion of racial/ethnic minorityhealth care providers participating in AETCtraining programs
Approximately 44% of AETC trainees in2006-2007 were of racial or ethnicbackground
If we include minority serving providers,65% of all AETC training participants metthis definition
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Special Minority AIDSInitiative Projects
Purpose is to expand or support new HIV initiativestargeting African Americans, Latinos, NativeAmericans, Asian Americans, Native Hawaiian andPacific Islanders
AETCs receive additional grant funds to focus ontraining providers to serve these populations:
Along the US Mexico Border (3 AETCs) American Indians and Alaskan Natives (8 AETCs) National Evaluation Center received funds
to focus on evaluating these minority-focused initiatives
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CDC/HRSA InitiativeAETCs Support Training on CDCRecommendations for HIV Testing
In September 2007 CDC provided $1.7M throughan IAA to HRSA to fund AETCs to train clinicianson implementing HIV Testing in Acute Caresettings in Emergency Departments, CHCs, STD clinics,
Labor and Delivery departments, and others.Project will continue into 2009.
Objective is to make HIV Testing a part of routinemedical care for persons ages 13 - 64 years old
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AETC Reporting Requirements
AETCs collect process and performance data atevery training – Participant Information Forms andEvent Records – and submit data annually toHRSA/HAB
AETCs also submit annual continuation grantapplications – includes mid-year progress reporton achievement of goals and objectives Training projections Evaluation and Quality Improvement Plans Identification of key Collaborators/Partners in
upcoming training activities AETCs also submit year-end progress reports
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AETC National Centers
4 National Centers provide supportservices to the AETC Network
National Resource CenterUniversity of Medicine & Dentistry ofNew Jersey
National Minority AETCHoward University
National Clinicians’Consultation CenterUniversity of California, San Francisco
National Evaluation CenterAETCUniversity of California, San Francisco
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AETCs:National Resource Center, NRC
www.aidsetc.org
To provide a central repository for AETCprogram contact information and trainingmaterials developed within the AETCNetwork
To support the AETC mission by offeringtimely, high quality, state-of-the artinformation on HIV
To coordinate the exchange of curriculumand training practices and models and tocollaborate to share best practices, tools,and resources on a national level
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AETCs:National Minority AETC
www.nmaetc.org
Builds Capacity of Racial/Ethnic MinorityClinicians to Provide HIV Care
The NMAETC communicates best practices anddisseminates program tools related to clinicalcare and cultural competency in HIV/AIDS
Alliance of Historically Black Colleges andUniversities with MD programs
Hispanic Serving Institutions
Tribal Colleges and Universities
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AETCs:NCCC: National Clinicians’Consultation Center
(www.nccc.ucsf.edu)Warmline PEPline Perinatal HotlineFREE confidential consultative services for clinicians
1-888-448-876524/7
Perinatal HotlineHIV consultation and referral
1-888-448-491124/7
PEPline HotlinePost-exposure prophylaxis
1-800-933-34138AM-8PM EST M-F
WarmlineConsultation regarding HIV managementquestions for clinicians
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AETCs:NCCC
Line/Date Established Calls to Date Calls Per MonthWarmline - 1993 46,000 200+PEPline - 1997 52,000 750+Perinatal Line - 2004 500 30+
TOTAL 98,500 1,000
Warmline calls - 85% from medically underserved areasHRSA is principal funderCDC provides supplemental funds
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AETCs:National Evaluation Center, NEC
www.ucsf.edu/aetcnec
Helps AETCs develop, test and implementeffective evaluation models and strategieswhich lead to
Measuring outcomes
Determining clinician behavior change
Improving patient care
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Thanks!
Steven R Young, MSPHDirector, Division of Training and Technical [email protected] 301-443-5761
Lynn Rothberg Wegman, MPAChief, HIV Education BranchDivision of Training and Technical [email protected] 301-443-5658
HIV/AIDS BureauHealth Resources and Services AdministrationDepartment of Health and Human Services
TARGET CenterCentral Source of Ryan White TAhttp://careacttarget.org