CFAR Symposium: Egagig commuity orgaizatios i academic HIV research Sa Ysidro Health Ceter May 4th, 2016 Jeaette L. Aldous, MD Cliical Director of Ifectious Disease Sa Ysidro Health Ceter
SYHC: Humble Begiigs Fouded 1969-45 years Local Wome s Orgaizatio Foudig Mothers Grat i partership with The Medical Society of SD ad UCSD Casita First Cliic Site 2
SYHC Today SYHC is ow a Federally Qualified Health Ceter (FQHC) providig comprehesive primary care services ad family support programs to more tha 89,000 registered patiets residig i the South ad Cetral/Southeaster Regios of Sa Diego Couty aually. SYHC s patiet populatio profile is predomiately Latio with high rates of poverty, uisured idividuals ad families, low educatio levels, ad o-eglish speakig heads of households. The Missio of Sa Ysidro Health Ceter is to improve the health ad well beig of our commuity s traditioally uderserved ad culturally diverse people. 3
SYHC Patiet Demographics 2015 Total patiets: 89,662 39% 0-19 yrs 52% 20-64 9% 65 & over Demographics: 83% Latio, 5% AA, 4% API, 8% White Icome: 91% of SYHC patiets live at or below 200% of FPL Isurace: 31% Uisured 57% Medi-Cal 8% Medicare 4% Private (mostly Covered Califoria) 4
SYHC FQHC Programs ad Services Comprehesive Primary Care Urget Care Itegrated Behavioral Health Services Itegrated Wome s Health Services Health Educatio Pharmacy Primary Care specialties (Podiatry, Eye cliic, Chiropractic ) Comprehesive Detal Services 5
SYHC Services Overview OB-GYN Primary Care (10 Sites) Mi Clíica Behavioral Health Pharmacy (2) Mobile Cliics (2) Oral Health (4 Sites) Materal Child Health Ceter ADHC PACE School Based Cliics (3) WIC (5 Sites) HIV/AIDS (2) 6
History- SYHC HIV Services 1990s South Bay AIDS Project - HIV Case Maagemet Services i the South Bay area 1999 HIV Specialty Care itegrated at Sa Ysidro Health Ceter oce a week for 4 hours 2001 UCSD Owe Cliic ad SYHC collaborate to provide full-time HIV Medical Specialists at Sa Ysidro Health Ceter 2008, SYHC acquired Comprehesive Health Ceters icludig 2 HIV cliics (Elm St. & Euclid St.) HIV Departmet curretly has 50 staff members ad multiple programs across Souther Sa Diego Couty Our Missio To provide a cotiuum of culturally sesitive medical, social ad supportive services free of charge that ehace the health ad erich the quality of life of people livig with HIV/AIDS ad their families 7
SYHC HIV SERVICES: ONE DEPARTMENT, TWO REGIONS, FOUR SITES SOUTH BAY Cliic: MX Border 650+ HIV+ patiets CASA drop i ceter SOUTHEAST: Kig-Chavez Health Ceter (KCHC) 350+ HIV patiets OUR PLACE drop i ceter
SYHC HIV Services Overview Medical ( 1200) Traiig Research Case Maagemet ( 1323) HIV Prevetio ( 3303) Outreach ad Testig ( 7368)
SYHC HIV Departmet Cliic Services Ø Comprehesive HIV specialty ad Primary Care Ø Treatmet ad Adherece Couselig Ø Medical Case Maagemet Ø Prevetio Couselig Ø Pre-exposure Prophylaxis Cliic 10
SYHC HIV Departmet Coordiated Services at CASA ad Our Place Case Maagemet Peer Advocacy Support Groups Art Therapy (oly at CASA) New Cliet Orietatios ADAP Erollmet Evets & Activities Lik to care to all social ad medical services Referrals Metal Health Services Legal Services Food Assistace Housig Assistace Treatmet Educatio ad Adherece Couselig Substace & Addictio Couselig Trasportatio Services 11
Medical Educatio: Commuity-Based HIV Medicie 1) Family Medicie Residets 6 week cliic rotatio for R2s at two sites 2-4 week advaced rotatio for R3s 2) SYHC Primary Care Providers 12
Curret research activities: Special Projects of Natioal Sigificace demostratio project q HRSA RW Part F fuded demostratio projects to improve HIV service delivery (oe of 15 sites atiowide) q Evaluatio parter: Mari Zuiga, PhD q Secod SYHC SPNS project i 12 years q Prior study documeted socio-demographics ad HIV care access behavior of Latios livig with HIV i the U.S.-Mexico border regio q Purpose of curret fudig: q Further the overall uderstadig of system-level structural chages withi the HIV workforce that will optimize huma resources while improvig health outcomes. 13
KEY COMPONENTS OF OUR SPNS DEMONSTRATION PROJECT Practice Trasformatio Ø Improvemets to our HIV Care Teams Project Coect Ø Icreasig access to SYHC o-hiv services for HIV positive patiets through Patiet Navigatio, traiig, ad outreach withi SYHC Workforce Capacity Buildig Ø Ø Expadig HIV workforce capacity through traiig residets ad o-hiv providers Partership with SYHC Family Practice Residecy
OUR UNIQUE CHALLENGES 15
Border health issues (AIDS, TB, STDs) Sicker populatio Preset later stage disease Biatioal patiets Use of services i Tijuaa (commuicatio limitatios) Social life o both sides of border ( Southbay does ot have a gay commuity like i Hillcrest, may patiets will travel to Tijuaa for the ight life ) Deportatio/migratio 16
Curret priorities ad Future goals Itegratio ad de-stigmatizig HIV across the orgaizatio. Icreasig access to iteral services Behavioral health/substace abuse services Closer relatioship with Behavioral Health Dept Targetig Youth (focus: youg MSM of color) Expadig access to PrEP Hep C treatmet TB treatmet cascade (cliic-wide) 17
RESEARCH IN THE COMMUNITY, OUR FQHC PERSPECTIVE 18
Traditioal paradigm for commuity-based research 1. Researcher develops idea, cotacts commuity agecies to collaborate 5. Data dissemiated: Cofereces Jourals, Reports Advocacy, Cliical practice COMMUNITY 2. Commuity with characteristic or health coditio of iterest is ivited to participate 4. Data aalyzed 3. Data collected by research team Slide c/o María Luisa Zúñiga, PhD
Academic Research Collaboratios: Commets from HIV Departmet staff The few studies we have bee ivolved i defiitely iterrupted the patiet flow. PI [wated to be] o site... Havig the PI aroud the cliic was ot part of what was agreed o which resulted i problems with patiets ad staff. 20
Academic Research Collaboratios: Commets from HIV Departmet staff We had a study i which participats were expected to use a laptop for the questioaire. Staff could ot assist with the laptop ad may cliets eded up with a icomplete questioaire, lost data, etc.may patiets were ot comfortable with electroics. Spaish traslatio was ot appropriate. Participats ofte skipped questios because they did ot uderstad what was beig asked. 21
Academic Research Collaboratios: Commets from HIV Departmet staff [study] thought that what worked with the MSM commuity i Hillcrest would also work for SYHC s populatio. 22
Academic Research Collaboratios: Commets from HIV Departmet staff I would say before eve implemetig a study, the PI should kow well where they would like to implemet the study. Ask about the agecy/staff about the patiet populatio, demographics, educatioal level of, potetial barriers to erollmet, retetio, etc. 23
Research i the Commuity: Lessos Leared.commuity cliic leaders ad providers also recogize the importace ad potetial cotributios of research coducted withi a commuity cliic settig give the patiet populatios, etc. Take home message for academic folks is: as log as your research does t get i the way of busy cliic operatios, the yep we re happy to let you [i] 24
Traditioal paradigm for commuity-based research 1. Researcher develops idea, cotacts commuity agecies to collaborate 5. Data dissemiated: Cofereces Jourals, Reports Advocacy, Cliical practice COMMUNITY 2. Commuity with characteristic or health coditio of iterest is ivited to participate 4. Data aalyzed 3. Data collected by research team Slide c/o María Luisa Zúñiga, PhD
Opportuities for commuity-egaged research Validatio of fidigs, access to data, advocacy, coauthorship? Discuss priority aalyses Commuity mobilizatio Data dissemiated: Cofereces Jourals Reports Advocacy Cliical practice Data aalyzed Researcher develops idea, cotacts commuity agecies to collaborate COMMUNITY Data collected by research team Co-geerate idea, iform o uderlyig resources ad challeges Commuity with characteristic or health coditio of iterest is cotacted ad ivited to participate Trai members of commuity to support data collectio, provide critical feedback Commuity support i locatig study populatio Slide c/o María Luisa Zúñiga, PhD
Ackowledgemets Mgmt ad research team: Sara Kig, MPH Karla Torres Katie Paella Breda Huerta María Luisa Zúñiga, PhD Cliical staff: Virgiia Sachez, RN Jua Delgado Cecilia Navarrete Simo Ramirez Rob Kiera, PA-C Mayu Witers, RN Bill Grimes Herma Magaa
THANK YOU 28