HRSA SPNS Border Health Initiative
Participants: : Steve, Tony, Rosana, Alisa, John Wiebe, Joaqim, Veronica, Michelle, Yolanda, Sandi, Robyn, Ledia, Barney, Betty, Tim, Herman, Saleem.
Project Reports:
El Paso:
• Chris Johnson will be representing El Paso at APHA meeting in Atlanta.
Evaluation (John): We have been informed that our paper submission to the November Texas/Mexico health conference has been accepted, along with that from the South Texas project. We will work with Yolanda and Sandi to coordinate the presentations.
We have collected some new data, but efforts have been centered on data entry during the past two weeks. We had planned training for home visits. However, when informed of the training, administrative officials at La Fe expressed concern that our data collection personnel had not undergone the full orientation required of all employees. They have asked that our
personnel undergo orientation, have Hepatitis vaccinations, etc., before working with patients. Tony is discussing these requirements with the administration to arrive at an agreement and get data collection back on track.
We still need the scoring directions for the Estrada acculturation measure. We have multiple analyses planned that involve acculturation, but do not know the validated scoring procedure.
New Mexico:
q Updates/Changes (Veronica):
o Meeting with Tommy Thompson on 10/14/01 (present were Joe O’Neal, Mr. Cantu, Governor of Chihuahua, Mexico and Mexican Secretary of Health).
o Satellite CDC update on Testing, Counseling, Referral on 11/15/01
o Conference call Farmworkers Justice Fund 10/12/01
o CHC Capacity Building
§ Scheduled to re-assess provider needs on 10/31/01 (BAHC)
§ BAHC Dental services for our clients
§ Meeting with medical provider Dr. Carla Eagan on 10/10/01 (LCDF)
§ Working closely with our Clinical Director who is monitoring the Title III funding.
§ Discussing risk-assessment training with Lucy Bradley-Springer of Mountain/Plains AETC
§ Status of local providers and support mechanisms (Dr. Steve Jennison)
q Local Evaluation (Michelle):
o Overview
o Specific activities
§ Adjunct status acquired/IRB application almost complete/modifying consent form
§ SPSS training & technical assistance with David and Tim on 10/01 & 10/02
§ Continuing to formalize the data collection and entry protocols
§ Tim and Yvonne are almost done cleaning up the outreach data (123 to date tested)
§ Data is being collected from the Pre/Post SPNS HIV+ clients (16 entered to date)
§ Preparing for APHA Conference
q Technical Assistance Needs:
o Will
be reviewing Logic Model during site visit on 11/09/01
Data Collection to Date:
Outreach HIV tests = 90 in FY-01 and 33 in FY-02. Data collected on HIV+ clients = 16.
Valley AIDS Council (Sandi
& Yolanda):
·
October 11, Clinical
Precepting (Dr. Sinclair and Dr. Barboza) saw 4 patients. Clinically, three are doing well. One CRITICAL INCIDENT, in that
this male presented very ill, late stage HIV (AIDS). He was misdiagnosed and released from Val Verde Hospital in Del
Rio (approximately 50 miles from Eagle Pass).
Consequently, Dr. Terrence Doran, SA Title IV Medical Director and
infectious disease specialist, will conduct a series of HIV presentations to
the hospital clinical and ancillary staff in order to increase awareness in
recognizing the signs and symptoms associated with HIV.
·
Clinical Precepting
with Dr. Sinclair is scheduled for October 18th and 19th in the
Brownsville and McAllen Texas. Status
regarding turnover in McAllen is that Dr. Jain, interim Project physician
taking Dr. Reyna’s position (originally designated Project physician) will be
replaced by Dr. D’Lima. Dr. D’Lima will
be provided an overview of SPNS Project and her role in the system level
intervention. Dr. Sinclair will
provide beginning and intermediate lectures, and she will participate in
reviewing case studies and Precepting with Project physicians in the Valley.
·
Evaluation team is
collaborating with Dr. Sinclair to write a report/White Paper that will discuss
the Juntos experience in providing clinical training to physicians in low
seroprevalence urban areas.
Paper/report will include how the SPNS project in collaboration with Dr.
Sinclair, Medical Education Director of Texas Oklahoma AETC has adapted the
traditional AETC model to fit the needs of the Project physicians in
Brownsville, McAllen and Eagle Pass areas and will include pieces from
qualitative interviews that speak to our experience regarding lack of support
(administrative) given to physicians, including lack of protected time, adverse
consequence to physician employer evaluations, high turnover and how there are
few physicians willing to do HIV work in the lower Rio Grande Valley
areas. The report will also include
recommendations for successful implementation of such a Project…for example,
necessity of including clinical training that is specific to nurses with rationale
being that nurses appear to lend some level of continuity to medical care
versus physicians who appear to have a higher rate of turnover.
·
Project data
collection activities continue at a steady pace. The Project Data Manager (Gina
Holt) has been assuming the Case Profile Developer role in addition to her data
management role. The Case Profile
Developer is on sick leave of absence until October 22, 01.
·
The Social Support
Module and the Medical Health Form were implemented October 1, 01.
·
The local evaluation
team is developing a ‘tickler’ system that will be used to alert Project staff
when client level data is due.
·
Quarterly Data
Training and Evaluation Planning Sessions continue. Action items are generated at each meeting and systematic follow
up on progress made are documented in process notes that are included in
reports forwarded to the lead agency and HRSA.
·
Local Evaluation Team
achieved a milestone/deliverable in September 2001. The Project Data Quality Assurance and Procedures Manual is
complete and manuals were distributed to Project data staff, National
Evaluators and HRSA, early October 2001.
Arizona Border HIV/AIDS
(Steve):
Trainings: Dr. Carmichael conducted the CME training for physicians and health care professionals on “Ambulatory Care of the HIV Patient”, County-Wide Grand Rounds on September 25th in Bisbee, AZ. Forty-five health care professionals were in attendance. Physicians were approached and informed of the ABHAC Project those interested were told that they would be contacted in the near future.
Dr. Carmichael was in Yuma on 10/11-10/12 to work with the staff of Sunset Clinic and the Yuma County Health Department. He met with the new Infectious Disease physician in Yuma to introduce himself and the project.
AZ AIDS ETC trainings for dentists in Nogales and Sierra Vista for October 18th are scheduled. The trainings are to be provided by faculty members from the UCLA ETC.
Out Reach Activities: Yuma County – Puentes de Amistad scheduled a meeting on 10/5 to address concerns that the promotoras may have concerning the changes in the management of Puentes de Amistad. None of the promotoras attended the meeting. Their plan is to send out letters (10/12) to the promotoras asking if they plan to continue with Puentes de Amistad. The plan is to replace those who are not returning or those who do not respond to the letter. A new promotoras program has formed, Campesinos sin Fronteras. Flor Redondo and the Yuma County Health Department staff are continuing outreach but at a smaller scale. Steve will follow the situation in Yuma and remain in contact with Albert Moreno of the Border Health Foundation.
Santa Cruz County – Community event Haunted House October 29th.
Cochise County – The Cochise County Health Department is training the promotoras (2) at the Chiricahua Community Health Center on outreach skills to the targeted populations of the project. CCHD continues their outreach from their outlying counseling and testing sites.
ADHS Funds: The project has identified three individuals to attend the CDC TOT for counseling and testing. The training is scheduled for December 4-7, 2001 in Portland, OR. The plan is that these individuals will train the curriculum in Spanish to project promotoras who then would be able to conduct the pre-counseling in the fields. The plan for the additional use of CBC funds will hire part time staff at the counseling and testing sites to educate individuals testing positive for HIV on primary care, medications, medication adherence
Project Enrollment: Five new enrollments entered from Yuma with two additional enrollments needing to be entered from Yuma. Total enrollment of patients to date is 41 of which 10 are post baseline.
Local Evaluation (Tony): The project developed a form to document medical referrals made by SIA staff on behalf of ABHAC Project patients.
Announcement The SIA office has move to suite 160 the address and telephone numbers remain the same. Ken Burton has relocated his office at the SIA location his fax number remains the same office number is (520) 628-8287.
San Ysidro Health Center
(Rosana & Alisa):
·
Services identified
with rollover funding
◄ Add two full time testers (1 @ Imperial County and 1 @ Vista), hire part-time at San Ysidro
◄Hire ½ staff person for evaluation team
◄ Hire ½ time treatment educator (pending)
◄ Develop a Bi-national resource guide
◄ Develop a Social Marketing Campaign
·
Progress on the
development of the local social marketing campaign
·
Data
Collection Update/current outreach and multi site module numbers
As
of the end of September 2001:
Total number of
individuals who have consented to participate in SPNS: 236
Module A 236
Module B 234
Module D 235
Module E 50, Module E time 2 = 16
Module G 41
HIV Positive preSPNS
(June 30 2001) = 53
HIV Positive postSPNS
(July 1 –September 2001) =18 Positives from testing = 3
Total Positives = 71
Total individual
outreach contacts to date: 1855
·
Evaluation data
collection training update
Multi-site Evaluation Issues
(David):
● Spanish Barriers module is completed and available on the Evaluation Center web page
● The location of the SPNS Grantees Meeting will be held in San Diego, CA on January 7-9, 2002
● John Wiebe requested scale for Acculturation Module – Tony Estrada advised he had previously provided the scale to David. David will forward the scale to all project sites.
Dissemination (David):
● APHA conference will be held in Atlanta, GA and the SPNS presentation is scheduled for October 24, 2001 from 2:30 – 4:00 pm. Projects were reminded to review the protocol posted on the web page.
HRSA Issues:
● Ledia advised that AETC is looking at developing a model for measuring their training efforts and have entered into discussion with local SPNS projects. Sandi has been asked to coordinate follow-up conference calls between SPNS grantees, the Centro de Evaluacion, and AETC local evaluators. She advised that concerns was expressed by BPHC that many of the 330 clinics did not have enough registered nurses to provide services. Steve advised that in Arizona, most RNs supervise other nurses. Joaquin sated they have three RNs on staff. San Ysidro said one RN is providing case management and providing services. VAC advised that 330’s have historically have encountered problems in hiring and retaining RNs. Yolanda said she understood that issue to be that SPNS does not have RNs hired under the HRSA grant. David mentioned that at the onset of the multi-site evaluation, Barbara Aranda-Naranjo had advised the Centro de Evaluaciόn that there was a national AETC evaluation center that would address measurement of local training effectiveness and should not be a part of the SPNS Grantees multi-site evaluation. Local projects were encouraged to work with their regional AETC to determine local measurement issues. Arizona has worked with their AETC and developed instruments for evaluating the training efforts as a local evaluation issue.
Another issue was that translators at the 330 clinics are not qualified or able to adequately translate HIV medical information. Alisa said Mari had raised the issue that bi-lingual staff were translating and wanted to know if this was true for all projects. Joaquin said their staff are also bi-lingual and translate using local jargon understood by their border population.
Steve said a request was made by the projects to be allowed to review the evaluation instrument being used by the AETC to determine of any of the data collected by the AETC is useful for local evaluation. Ledia advised that follow-up discussions will include participation of the Centro de Evaluacion.