SPNS Grantees Conference Call

April 1, 2002 @ 10:30 am

Present: Barbara E., Steve, Ken, Herman, David, Tim, Michael T., Sandi, Yolanda, Mari, Veronica, Michelle, Yvonne, America, John, Elias, Robyn, Adan, Kurt, Rosana, Betty

Project Reports:

Arizona Border HIV/AIDS Care:

Trainings: Dr. Carmichael conducted clinic in Bisbee with Dr. Avina and saw four (4) patients. After the clinic Dr. Carmichael spent one (1) hour with Dr. Avina on patient medical care education.

Dr. Carmichael is working with Dr. Arriaga in Douglas, AZ to begin to take ABHAC patients and to complete documentation.

AZ AIDS ETC completed the first training module, AIDS Facts and conducted training to promotoras at Puentes de Amistad. Pam D. continues to develop additional training modules with assistance of Dr. Goldsmith.

Out Reach Activities: Yuma County –Puentes de Amistad participated in a health fair held in Gaston, AZ provided information on HIV and information on where to get tested.

Promotoras participated in the Bi-national Youth Conference in San Luis, MX 250 youth from Mexico and US participated. Outreach to field workers continues to occur at least 3 times per week. On 3/19 Robert Castrillo (AETC) and Gabby Leon (YCHD) conducted AIDS Facts training for the promotoras. Puentes is scheduled to participate on April 20^th at the music festival in Yuma and the 27^th at Dia del Nino in San Luis, AZ. Outreach continues to be coordinated between YCHD, Puentes de Amistad and Campesinos Sin Frontera.

Santa Cruz County – Platicamos Salud completed training of new staff Johnny Galindo. They will contact Enrique Gomez to schedule the in service on targeting at risk populations. Outreach activities continue in Nogales and the surrounding communities. Mariposa Clinic tested 16 individuals as a result of their outreach.

Cochise County – Cochise County Health Department (CCHD) Sharon Schinstock is working with Robert Castrillo and Pam Reid Duffy to schedule trainings in Cochise County for the next quarter. CCHD continues to conduct outreach from their sites

Collaborators are working to identify patients to participate in key informant interviews for April 22^th - 24^th.

Dissemination Activities: Barbara advised that Tony will be in contact with projects to discuss a dissemination project.

Project Enrollment: CCHD has one person scheduled for enrollment. Patient reported on last conference call was not positive and enrollment packet was destroyed. Patient was scheduled to return to clinic for test results and counseling. Dr. Carmichael continues to inform his patients who live in the catchments areas of the project of the option to transfer their care to the CHC in the area.

Local Evaluation: Project continues to collect local evaluation data and submits to Impact Consulting.

Camino de Vida Center for HIV Services:

Programmatic: (Veronica)

Provider Trainings

• Training of providers on April 17^th at La Clinica de Familia
• Dinner sponsored by GlaxoSmithKline is scheduled for April 23^rd, Dr. Steve Jenison
• Providers training April 24^th at Ben Archer Health Center, Dr. Elaine Thomas
• Veronica and Kari presented at the New Mexico Governor’s AIDS Task Force on March 14^th in Alb. NM.
• Kari and Debbie presented at the Social Workers of Southern New Mexico on March 20th.

Local Evaluation: (Michelle)

• Veronica, Kari, and Michelle gave a staff presentation on March 15^th of an overview of project with current data- they are interested in seeing more data; Michelle will be working on this beginning with the barriers data.
• Michelle created the first local data file and entered all of the PIF/evaluation data (NMAETC). Several more data files need to be created.
• The local codebook was finalized and a copy was sent to OU. We're holding off on doing codebooks for the Promotor Training Evaluation until it is finalized. Since we're not sure if we are going to standardize the AETC Provider Evaluation, we are waiting to create the codebook.
• Yvonne and Eddie, the Senior Case Manager, are working on lining up our key informant interviews - it has been difficult.
• We've been monitoring the progress we have been making on our respective work plans (data collection, evaluation, project) and will continue moving forward.
• Data collection efforts for both outreach and in-house slowed down beginning in January 01, 2002 - Veronica and Yvonne have been working on this. Data collection efforts should pick up again - Elizabeth will be conducting interviews beginning in April and we are exploring the possibility of hiring a graduate student to assist. Having the third Promotor should help in terms of outreach.
• Lots of activities are planned for April in terms of provider trainings.

DATA COLLECTION

OUTREACH:	Individual Outreach
	Total Number of Contacts Number of Tests to date Fy1 = 90 Fy2 = 107	302 197
	Group Outreach
	Total number of contacts Number of group outreach sessions Number of appointments made Number tested	89 6 0 20
	Total number of contacts (individual & group)	371
IN-HOUSE:	Number of interviews and data collected on HIV+ Clients:	57

Centro de Salud Familiar La Fe:

• Data collection is progressing without incident. 
• Christopher Johnson will be presenting data on depression in our sample at

the annual meeting of the Society of Behavioral Medicine in Washington D.C.

this week.  His findings will point up the difficulty of measuring

depression in this population because of its confound with somatic symptoms.

• We have arranged for the collection of qualitative data from key informant

interviews

• We are continuing to work on an appointment attendance tracking and

promotion system.

• We have spoken by telephone with Adan Cajina, our new project officer, and

tentatively discussed him coming for a site visit.

San Ysidro Health Center:

Programmatic/Dissemination (Rosana)

· Social Marketing Campaign plan provided to Robyn Schulhof for review. Focus group to obtain feedback on marketing messages is planned for April/May. Mari will contact Yolanda & Sandi (UT, San Antonio) regarding evaluation plans for marketing campaign.

· Follow-up information was obtained on the epidemiological study: “HIV Prevalence, Risk Behaviors, and Acccess to Care Among Young Latino MSM in San Diego, CA and Tijuana, BC, Mexico” . A copy of preliminary study findings has been provided to Centro for dissemination to our border sister sites.

· We are experiencing communication problems with our partner site in Imperial County, Clinicas de Salud del Pueblo. Information is not getting to me on the current situation with the promotoras. CSP is having problems with the promotoras that may have a direct impact on SPNS outreach in that area in the future. I will conduct monthly site visits until the situation at CSP is more stable.

· I attended the 14^th annual AmFAR National HIV/AIDS update conference from March 19-22. Participated in a workshop on HIV along the border where I met up with a local SPNS partner site coordinator from Vista Community Clinic as well as Bob Smith from Valley AIDS Council who were presenting.

· There was an HIV/AIDS update information presentation at SYHC in Spanish on March 28, 2002 by Dr Octavio Vallejo (UCLA) and Nelson Virgil sponsored by pharmaceutical companies. Both presenters were great, fluent in Spanish, and were very impressed on how savvy and informed our Spanish speaking Latino population is on the latest issues regarding HIV/AIDS.

· 2 people tested positive at SYHC within the last 2 weeks. The two are white MSM, one, a25 year-old MSM and the other a 30-year-old MSM male prostitute. Both South Bay residents read about SYHC’s free anonymous testing in the Reader (a county-wide newspaper).

· Social Marketing Campaign plan provided to Robyn Schulhof for review. Focus group to obtain feedback on marketing messages is planned for April/May. Mari will contact Yolanda & Sandi (UT, San Antonio) regarding evaluation plans for marketing campaign.

· The SD Union Tribune article (2-28-02) on the impact of HIV among Latinos along the border, primarily gay and non-gay identified MSM, has sparked a great deal of interest on this issue and on what services are in place to support them. After the article was published (2-28-02), I have been invited to participate on a KPBS radio show – These Days with Tom Fudge, two reporter from the SF Chronicle were here on March 25 to gather information for a story that will be published there and UNIVISION contacted me last week to set up a time for an interview on the services for Latinas in this region.

· Follow-up information was obtained on the epidemiological study: “HIV Prevalence, Risk Behaviors, and Access to Care Among Young Latino MSM in San Diego, CA and Tijuana, BC, Mexico”. A copy of preliminary study findings has been provided to Centro for dissemination to our border sister sites.

Evaluation (Mari)

· It was determined from a previous SPNS local partner meeting that each site was providing a variation of treatment education & planning activity. In order to capture this information more accurately and uniformly, Alisa Olshefsky met with our local Treatment Education and Advocacy team. A new treatment education and advocacy form was developed to better capture treatment plan activity across sites. The plan was presented to local partners for feedback on 3/25/02.

Multi-site Data as of 3/20/02

Southern CA Multi-site data highest grade completed

		Frequency	Valid Percent	Cumulative Percent
Valid
not of schooling age (<age 5)	1	.5	.5
elementary or middle school	74	33.9	34.4
technical certificate	6	2.8	37.2
GED	9	4.1	41.3
high school	89	40.8	82.1
associates degree	18	8.3	90.4
bachelors degree	11	5.0	95.4
masters degree	1	.5	95.9
doctoral or professional	1	.5	96.3
unknown	8	3.7	100.0
Total	218	100.0

Valley AIDS Council:

· Key Informant Interviews scheduled for April 5^th and 6^th 2002 at Valley AIDS Council. These interviews will be conducted by consultant Maria Ivonne Rivera from Washington, DC.

· Betty Duran and David Barney will be present to observe the first two interviews conducted by Ms. Rivera.

· Mr. Charles Smith (Project Director) and Elias Cantu Jr. (Project Coordinator) attended the 14^th National HIV/AIDS Update Conference held in San Francisco by Amfar.

· Mr. Smith presented at the Bill Graham Auditorium on Wednesday, March 20, 2002 in a session titled “Prevention, Care & Services on the Mexican Border” assisted by Mr. Cantu.

· Other presenters for that session were:

· Merilou Johnson from Denver, Colorado (AETC).

· Rossana Cardoso from Washington, DC (Farmworkers Justice Fund, Inc.)

· Fernando Sanudo from Vista, California (Vista Community Clinic).

· United Medical Center (Eagle Pass)

· Diana De la Rosa (LVN) reports:

· She did receive the information I sent her in reference to Hepatitis A Vaccines that she learned about at the AETC training held in Nuestra Clinica Del Valle in Pharr, Texas. This information was provided by Linda Ortiz (LVN) at VAC.

· Mr. Cantu inquired if any of the 14 patients being seen at UMC are co-infected with any STD’s and Diana reported none were co-infected with STD’s.

· Mr. Cantu also inquired how many of the 14 patients were female to find out if there were any pregnancies and Diana reported two females and they are not pregnant.

· Diana reported one patient with dermatitis problems. This patient is also experiencing episodes of violence resulting in jail time. This patient is also being seen by Dr. Parra from San Antonio, Tx.

· Gustavo De la Cerda (Case Manager) reports:

· Minimal problems with patients this month due to the majority of these patients were already seen by both Dr. Barbosa and Dr. Sinclair AETC during preceptorship during the last two months (January / February, 2002).

· Gustavo reports communication problems with UMC and case management in regards to the ADAP Medical Certification Form not being received by them from UMC when the physician has changed HIV medications; therefore, causing delays in patient’s medication orders from ADAP program.

· Gustavo reports Dr. Barbosa changed HIV regimen on 3 patients last month due to built up resistance to medications.

· Gustavo also reports problems with Laboratory.

· Gustavo recommends implementing monthly SPNS meeting between UMC Clinicians and UMC Case Management to increase communication levels between those two sites.

· Gustavo reports they did receive the dates for the next SPNS Partners Meeting in May from Monica Ruiz (SPNS-VAC).

· Nuestra Clinica Del Valle: (Pharr)

· Nora Rodriguez (Case Manager) reports:

· Training Randy Alligood, new Case Manager hired for NCDV patients.

· Visited NCDV and introduced Randy to Belinda Zamora (LVN) to get him familiarized with the patients and Case Management responsibilities.

· Participated in SPNS Grantees Conference Call last month with Betty Duran, David Barney, and Maria Ivonne Rivera to discuss Key Informant Interviews scheduled for April 5^th and 6^th. (Randy was also present for conference call).

· 961010: needs Pneumovax. Next appt. 04-10-02	· 2010404: Non-compliant with appts. Need home visit.
· 2020301: 2^nd Hepatitis B Vaccine 01-31-02. Ear infection	· 2020301(?): Reaction to HIV meds. Next appt. 04-10-02.
· 2010311: Reaction to HIV medications. D/C HIV and TB meds.	· 2020202: Started HIV meds on 03-27-02. New patient.

· Belinda Zamora (LVN) did not add to Nora’s report and agrees with the report provided by Nora because they just reviewed the patients together when they met with Randy at NCDV.

· Brownsville Community Health Center (Brownsville):

· Jim Odom (LVN) reports:

· BCHC now has seven patients on the SPNS Project.

· Of the seven, four are not very compliant with doctor’s appointments.

· Two have substance abuse issues (IDU-Cocaine).

· One has adherence to medications issues.

· Two patients experiencing elevated Viral Loads but are improving.

· Some have transportation problems as well as financial difficulties.

· ADAP Program problems with new pharmacy and staff at Autrey’s in Brownsville.

· None of the patients at BCHC are currently experiencing side effects to HIV meds for this report.

· Enery Mendoza (Case Manager) reports:

· Problems with charges from LabCorp due to Dr. Nuchovich ordering laboratory tests separately instead of VAC #1, which includes Hepatitis tests. Dr. Nuchovich out of town and not available for discussion in regards to laboratory charges.

· 2010402 : No show to referral w/ Dr. Soleja.	· 2010502 : Needs dental rescheduled. Referral to BMC for cyst removal.
· 2010703 : Need contact.	· 2010408 : ADAP Pharmacy (Autrey’s) problems.
· 2010309 : Possibly moving.	· 2011010 : Doing well. Yoga exercises. Visiting family.
· 2010411 : Patient doing well. Undetectable Viral Load.	·

PROJECT DATA COLLECTION ACTIVITIES (Sandi Duggan)

· Project data collection activities continue at a steady pace. As of March 19, 2002, there are 166 unduplicated records in the Local Database.

LOCAL EVALUATION SYSTEM LEVEL INTERVENTION ACTIVITIES

· Routine evaluation contact (e-mail and/or telephone call) with Project physicians and nurse care coordinators to systematically assess needs and satisfaction with the Juntos Project process reveal the following:

1. Project partners continue to stress the need for advance notice for planning purposes, especially where travel is involved.

2. A Project physician recommends alerting physicians of activities most relevant to their scope of work. For instance, provide ALL physicians with the opportunity to participate in clinical activities versus attending Project meetings, which are lengthy, often require travel and are mostly related to general Project business and little with patient care.

CRITICAL INCIDENTS

Positive – SPNS System Level Intervention – During Clinical Precepting at United Medical Centers (UMC) in Eagle Pass, Texas, Nurse Care Coordinator Diana de la Rosa shared information regarding a patient who presented with shingles. She recognized the dermatological case as a result of information learned from the nurse training held in the Valley the previous week. She briefed Dr. Barboza-Sosa about the patient. He treated the patient immediately and asked him to return for a follow up when Dr. Sinclair was on site.

Dr. Gary Sinclair, Medical Education Director at TOAETC, commented that HIV primary care at UMC is truly a success and a direct correlation with the nurse and physician clinical training (SPNS System Level Intervention). According to Dr. Sinclair, shingles is a very painful skin condition which would have put the patient at greater discomfort if he had been required to travel 2.5 hours to San Antonio in order to receive care.

During the aforementioned precepting, Drs. Sinclair and Barboza saw five patients. All had undetectable viral loads and were deemed medically stable. There has been a decrease in the numbers of distance consultations between Drs. Sinclair and Barboza, an indication of increased physician knowledge and enhanced clinical capacity for the provision of HIV primary care at UMC. Dr. Sinclair reports the decrease in consultations as a success and states, “Dr. Barboza knows enough that the patients are stable and knows enough to ask when he needs help.”

Positive – Shanta D’Lima, the newest Project physician has begun distance specialty consultation with Dr. Sinclair and has since done so on a regular and fairly steady basis. According to an e-mail response by Dr. Sinclair, the nature of one case in particular was complicated but he assured Dr. D’Lima that she is “catching on,” and along with all of the Project physicians, has “learned so quickly.”

Positive - Dr. Sinclair encourages the Project physicians to utilize Dr. Garcia, VAC Medical Director located in Harlingen, as a means of on site consultation and/or referral as needed. Via e-mail to the Dr. D’Lima, Dr. Sinclair wrote, “sending the patient to Dr. Garcia for a view visits to get some of the more acute issues worked out is not a failure in any way. In fact, its how we have envisioned the project working all along.”

Positive – Most recent HIV specialty consultations between the partner physicians and the HIV specialist suggest that physicians are willing, capable and competent in providing standard of HIV primary care in the lower Rio Grande Valley. Dr. Sinclair, in response to the Brownsville physician wrote, “You really are getting the hang of this. Always feel free to run things by me, but lets face it…you didn't really need me for this one...”

OTHER EVALUATION ACTIVITIES

· Local evaluation is finalizing an evaluation of the Juntos Project Marketing intervention. The Marketing Plan will utilize radio and TV spots, posters and brochures as a means to reach a heterosexual Latina population of women between the ages of 13-45 years of age whom according to VAC 2001 Compis data, are an untapped population at risk for HIV infection.

· Evaluation of SPNS system level intervention is on going and includes:

1. Process documentation of precepting proceedings (examples are provided in the Critical Incidents section)

2. SPNS participant evaluation of training

3. Identification of future training needs. Local evaluation findings are disseminated in Project evaluation and HRSA reports.

Centro de Evaluación:

• Key Informant Interviews: First group of interviews will be held at Valley AIDS Council on April 5 & 6^th, New Mexico April 8 & 9^th, El Paso April 11 & 12^th, Arizona April 22-24^th, and San Ysidro on May 16 & 17^th. The Centro de Evaluación will reimburse each project up to $50 for refreshments purchased for the participant interviews. Each project should submit a copy of the receipt for items purchased. Plan to have Maria attend the grantees meeting in Washington, DC to present a report on summary findings.
• Reminder to all projects to confirm their reservations at the Holiday Inn for the grantees meeting in July. Please let us know if you do not have a room confirmation number.
• Draft of agenda will be sent out by next Monday, April 8^th. Any suggestions for speakers or agenda items for the grantees meeting should be submitted to Betty before Friday, April 5^th.
• AETC – After extensive discussions between the Centro de Evaluación and HRSA staff, it has been decided that assessment of AETC training will remain a local evaluation issue and not addressed as multi-site. Adan said that at some later time, possibly in YR-05 we may discuss some method(s) which may capture information beneficial to supplementing local data on AETC. Thanked projects for their patience and encouraged them to continue their data collection efforts.

HRSA Issues: None

Next Conference Call set for 4/22/02 @ 10:30 am