AIDS Education and Training Center s Response to the National HIV/AIDS Strategy (NHAS) and HIV Care Continuum: FINDINGS FROM FUNDING YEAR 1-15 The mission of the AIDS Education and Training Centers Program (AETC) is to increase the number of health care providers who are effectively educated and motivated to counsel, diagnose, treat, and medically manage people living with HIV (PLWH), and to help prevent high-risk behaviors that lead to HIV transmission. AETCs receive funding through the Health Resources and Services Administration (HRSA) to train health care providers and also receive Minority AIDS Initiative (MAI) funding, to support capacity development activities and programs targeting minority and minority-serving providers. The AETC Program supports the goals of the National HIV/AIDS Strategy (NHAS) 1 by providing training, education, and technical assistance to strengthen the delivery of services and quality of care along the HIV Care Continuum. The HIV Care Continuum includes the diagnosis of HIV, linkage to HIV medical care, lifelong retention in HIV medical care, effective HIV medication management (prescription of ART), and ultimately, HIV viral load suppression. Well-trained health care providers are needed to provide high quality HIV care to ensure system capacity for the increases of PLWH in care that are expected to occur due to improved survival and increased number of patients linked and retained in care. 3 High-quality HIV care is associated with viral suppression, which reduces the likelihood that PLWH will transmit the virus to others; expert clinical training is imperative to ensure the delivery of high-quality HIV care. NHAS GOALS: GOAL1 GOAL GOAL 3 GOAL Reducing new HIV infections Improving access to care and health outcomes for PLWH HIV CARE : STAGE 1 STAGE Reducing HIV-related health disparities and inequities STAGE 3 STAGE Achieving a more coordinated national response to HIV epidemic STAGE 5 Overall, the AETC Program is charged with improving the knowledge and skills of providers and the capacity of organizations in order to increase access to and delivery of high quality care. The AETC regions work in collaboration with the AETC National Evaluation Center to evaluate their programs for quality and effectiveness. This document highlights process and outcome evaluation findings in relation to the NHAS and the HIV Care Continuum for funding year 1-15 (July 1, 1 to August 31, 15). 5 1 White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States: updated to. Washington, DC: White House Office of National AIDS Policy; 15. The White House, Office of the Press Secretary. Executive Order HIV Care Continuum Initiative. http://www.whitehouse.gov/the-press-office/13/7/15/executive-order-hiv-care-continuum-initiative 3 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AID=S Bureau. Workforce Capacity in HIV. CAREAction Newsletter. April 1. Doshi RK, Milberg J, Isenberg D, et al. High rates of retention and viral suppression in the US HIV safety net system: HIV care continuum in the Ryan White HIV Program, 11. Clin Infect Dis. 15; :117 15. 5 AETC National Evaluation Center. (15). National Outcome Evaluation Findings from the AIDS Education and Training Center Program: AETC Funding Year 1-13. Report prepared for the Health Resources and Services Administration s HIV/AIDS Bureau (HRSA/HAB).
NHAS GOAL1 Reducing new HIV infections indings: How AETC Skills-Building Programs Support NHAS Goals NHAS GOAL Increasing access to care and health outcomes for PLWH NHAS GOAL 3 Reducing HIV-related health disparities and inequities NHAS GOAL FY 1-15 Achieving a more coordinated national response to HIV epidemic About EVALUATED AETC TRAININGS: Focus of Training Activities 51% 5% HIV testing Risk reduction / Harm reduction 53% 33% Antiretroviral treatment Co-morbidities 5% 3% Vulnerable populations Racial/ethnic minorities 39% Trainings conducted in collaboration with other agencies and federal training centers 3% % 9% 9% Adherence Risk assessment Pre/Postexposure prophylaxis Pediatric HIV care / Perinatal transmission % % % 1% Community linkages Substance misuse Hepatitis A, B, C Mental health 3% 1% 11% % LGBT individuals Cultural competence Incarcerated individuals Health literacy 99 % of evaluated trainings were relevant to an NHAS goal (39 total AETC trainings were evaluated with a -week follow-up survey) About EVALUATED AETC TRAINEES: Targeted Workforce Development 1% of total participants conducted HIV testing 55% were clinical providers % of total participants shared training information with patients/clients 9% of total participants discussed training information with colleagues 15% of total participants tested all patients annually 3% 1% 1% of medical provider* participants provided primary care to HIV+ patients were new HIV providers (< years experience) were novice HIV providers ( to 3 years experience) % 33% were racial/ethnic minorities of medical provider* participants HIV+ patient population consisted of 5% or more racial/ethnic minorities 3% of total participants distributed training materials to colleagues,7 Unique Follow-up Participants (3,5 total follow-up participants; 1,1 medical provider* participants) *Medical providers include advanced nurses, dentists, other dental professionals, nurses, pharmacists, physicians, and physician assistants
indings: AETC TRAINING IMPACT ON HIV SERVICE S FY 1-15 Outcomes of AETC SKILLS-BUILDING TRAINING in support of NHAS Goals and the HIV Care Continuum Knowledge Gain 7 % of evaluation participants gains in knowledge across all programs* 7% in Diagnosis Skills % in Linkage to Care Skills 3% using skills DIAGNOSED DIAGNOSED WITH HIV WITH HIV 1 LINKED TO CARE 7% using skills ACHIEVED VIRAL SUPRESSION 5 79% in HIV Medication Management Skills 5% using skills PRESCRIBED ANTIRETROVIRAL THERAPY ENGAGED OR RETAINED IN CARE 3 7% in Engagment/ Retention Skills % using skills *n=,91 trainees from 3, AETC trainings completed an evaluation immediately after training 3
indings: SKILL IMPROVEMENT AND IMPLEMENTATION AFTER ATTENDING AETC SKILLS-BUILDING TRAINING FY 1-15 A Great Deal A Great Deal 1 1 Diagnostic Skills Not At All Not At All All AETC Programs: p<.5 All AETC Programs: Not Significant All AETC Programs: Reference Rating* Skill Improvement: p<.5 MAI Programs: p<.5 MAI Programs: Not Significant MAI Programs: Reference Rating* Skill Implementation: p<.5 SEES providers, newer HIV providers, and those with fewer patients with HIV significant gains in skills related to HIV diagnosis. providers and newer HIV providers significant use of the HIV diagnosis skills acquired from training in their clinical. A Great Deal 1 Not At All Linkage to Care Skills 1 Skill Improvement: p<.5 Skill Implementation: p<.5 SEES providers, newer HIV providers, and those with fewer patients with HIV significant gains in skills related to linkage to care. providers and novice HIV providers significant use of the linkage to care skills acquired from training in their clinical. *Reference Rating - Regression models controlled for the following variables: Ryan White funded, White/Caucasian providers, has -9% clients who are racial/ethnic minorities, has + years of HIV experience, sees + HIV-infected patients per month, and has at least 75% of patients with HIV on ART
indings: SKILL IMPROVEMENT AND IMPLEMENTATION AFTER ATTENDING AETC SKILLS-BUILDING TRAINING FY 1-15 A Great Deal 1 Not At All Engagement / Retention in Care Skills** 1 Skill Improvement: p<.5 Skill Implementation: p<.5 SEES providers, newer HIV providers, and those with fewer patients with HIV significant gains in skills related to engagement/ retention in care. providers and novice HIV providers significant use of the engagement/ retention in care skills acquired from training in their clinical. **Engagement / Retention in Care includes the following three skill categories: Patient education skills, skills for working with culturally diverse patients, and diagnostic skills. A Great Deal 1 Not At All 1 HIV Medication Management Skills*** Skill Improvement: p<.5 Skill Implementation: p<.5 SEES providers and newer HIV providers significant gains in skills related to HIV medication management. providers and new HIV providers significant use of the HIV medication management skills acquired from training in their clinical. *Reference Rating - Regression models controlled for the following variables: Ryan White funded, White/Caucasian providers, has -9% clients who are racial/ethnic minorities, has + years of HIV experience, sees + HIV-infected patients per month, and has at least 75% of patients with HIV on ART ***HIV Medication Management includes the following skill categories: HIV lab interpretation skills and medication management skills. 5
Summary of FY 1-15 Findings: A total of 39 AETC skills-building trainings were evaluated with a -week follow-up survey. 3,5 trainees attended at least one of these trainings and completed the survey. Of these trainees,,7 were unique participants and 1,1 were medical providers. The majority (99%) of AETC trainings were delivered in support of an NHAS goal, 53% of trainings were on antiretroviral treatment, 5% were on a clinical topic relevant to vulnerable populations, and 39% were conducted in collaboration with other federal training centers and/or agencies. A large proportion of trainees (7%) gaining knowledge as a result of AETC training. Our analyses indicate the strongest levels of both improvement and implementation were observed for linkage to care skills, meaning AETCs support linkage efforts made by providers. Minority HIV providers benefiting the most from AETC training, as they statistically significant in skills and implementation of newly acquired skills across most of the skills measured. New and novice providers, as well as providers seeing fewer patients with HIV per month, also statistically significant in skills and implementation of newly acquired skills across most of the skills measured. Trainees sharing information from the training with both their colleagues and patients thus reaching a larger audience than those that attended training. Approximately 7% of trainees sharing information from the training with their patients/clients/ colleagues, which increases the overall reach of AETC training. The AETC Program is critical to developing the HIV workforce by building the skills of HIV service providers to deliver high quality care to PLWH. These results illustrate that the AETCs are effective in helping improve the knowledge and skills of AETC trainees on core constructs related to care delivered along the HIV care continuum. Outcomes demonstrate that AETC trainees are adopting the skills and evidence-based s they learned during AETC training in their settings, thereby improving quality of care for PLWH. The important work conducted by the AETCs is responsive to the NHAS and will continue to address knowledge gaps as HIV systems of care continue to change. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UAHA755, AETC National Evaluation Center. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.