The IHS Minority AIDS Inititative (MAI)

content relevant to the MAI:
FY06 Initiatives (ongoing) FY07 Proposals FY08 Proposals IHS MAI History (2000-2005)

FY08 Minority AIDS Initiative Projects (Funds Approved)

Over the past year, a National IHS HIV/AIDS Administrative Work Plan was developed with input from many stakeholders internal and external to the agency. This included a new MOU with HRSA, SAMHSA, a draft with NIH and also one with a community-based Capacity Building Assistance Network of three AI/AN organizations. We have worked diligently toward program transparency and integration. The HIV Program has also facilitated an expanded collaborative and integrative environment with native health and native HIV organizations as well as the Office of Urban Indian Health and some of the Tribal HIV infrastructure. Integration of activities (including all the MAI funded projects) is a key factor to success as information sharing, capacity building, resource mobilization and data collection are challenging in a ‘trifurcated’ healthcare delivery system. Through collaborative efforts and implementation of initiatives through MAI funded projects, we believe our strategic plan is having success. Additionally, with ongoing efforts from MAI funding to build infrastructure, we are moving toward more capacity to produce tangible outcomes. These outcomes (stated in our IHS HIV/AIDS Goals and Objectives) are now more aligned with the Office of Management and Budget requested measures.

Currently, eight MAI projects were approved for FY08.

• Chronic CareInitiative - HIV Center of Excellence, Phoenix Indian Medical Center
• HIV Testing Initiative - Office of Urban Indian Health
• Continuity of Care Project - Gallup Indian Medical Center
• Enhanced Prenatal and Universal Screening - IHSDivision of Epidemiology
• HIV Behavioral Health Trainings - IHS Division of Behavioral Health
• Quality of Care Initiative - IHS Office of Information Technology
• Community Health Representative Training and Youth Camps - CHR Program
• National Knowledge/Attitude/Behavior (KAB) Survey - IHS Division of Epidemiology

The overall IHS objectives through these 8 MAI funded projects are to:

1. Implement a new clinical quality reporting measure to improve the rates of HIV screening among patients with known STDs.
2. Continue the widespread improvement of quality health through use of innovative software deployed at I/T/U facilities – HIV Management System – to track CD4 and Viral Load.
3. Provide an innovative HIV training with a behavioral health and culturally fluent focus to I/T/U providers.
4. Implement a chronic care model and network to build capacity for quality treatment and care and technical assistance (TA) for IHS providers. Also, expand ongoing telemedicine network.
5. Improve overall IHS GPRA prenatal screening rates IHS-wide and implement pilot site universal screening.
6. Execute Tribal Advocacy and Youth STD/HIV Educational Camps from IHS para-professionals (CHRs) by bridging the gap between community and health system
7. Implement rapid and/or traditional HIV testing into Urban facilities.
8. Through a pilot project, improve continuity of care within a critical sub-population of seropositive substance users.

The HIV Center of Excellence (CoE) in Phoenix Indian Medical Center

Using the Chronic Care Model framework to improve capacity of Indian Health system facilities to deliver care to people infected with HIV. For people living with HIV, access to medical care and delivery of Highly Active Antiretroviral Therapy is the single most important determinant of survival. Access to such care is therefore critical to increasing the number of HIV infected ethnic and racial minority individuals surviving 3 years after a diagnosis of AIDS. The objective of this innovative initiative is to use the Chronic Care Model framework to improve capacity of facilities working in the Indian Health Service (IHS) system to deliver care to people infected with HIV. Such care is complex and involves a wide variety of specialized knowledge, skills, and attitudes including but not limited to medical diagnostics and interventions, pharmacotherapeutics, behavioral health interventions, case management and similar support systems, financial and community resource management, and access to decision support and education. Over the past several years of program development, the IHS has sought to increase capacity to deliver such care within the system by creating information system and technical enhancements, increasing access to web-based and other education, develop telemedicine based consultation, and to mobilize the informal network of health care facilities and providers. Our findings in these formative efforts suggest that significant variation in capacity exists within the system and without an infrastructure and framework on which to build, these efforts alone may not be successful in increasing access to care.

Office of Urban Indian Health (OUIH)

Initiative to continue to increase screening and rapid testing, which will expand services to clients, build capacity, and collect data as to barriers of implementation of testing services. The OUIHP will provide funding to facilities to continue to increase the number of AI/AN with an awareness of his/her HIV status by providing routine and/or rapid screening, together with appropriate prevention, pre and post test counseling, case management and data collection on HIV testing knowledge, attitudes, and behavior. Each funded program’s goal is to directly increase screening to American Indians/Alaska Natives (AI/AN). Each program may also collect evidence, as part of the testing process, to potentially address utility and barriers of increased routine HIV screening within this population. This is an augmentative project to continue and expand upon the FY05 and FY07 Urban Indian Health Rapid Testing Initiatives. This MAI proposal will continue the successful FY07 collaborative plan between multiple entities internal and external to the OUIHP including the Substance Abuse and Mental Health Services Administration (SAMSHA).

Continuity of Care - Gallup Indian Medical Center

The goal of this project is to enhance continuity of care (through programmatic and staff expansion) and prevent HIV transmission among HIV infected American Indian substance abuse patients as well as early intervention/access into Indian health system. Since 1987, Navajo Area has provided HIV primary care to many American Indian patients. With early detection of disease – through rapid testing of critical sub-populations and enhancement of staffing and clinical program, the goals of the program are much aligned with Minority AIDS Initiative goals and objectives. Some of the objectives include: case management of complex and non-adherent seropositive patients, medication adherence program development, training and education of personnel including coordinating with HRSA AIDS Education and Training Centers (through existing IHS MOU with HRSA) and increasing testing training and intervention screening for contacts early.

Division of Epidemiology and Surveillance (2 Projects)

• The Indian Health Service (IHS) will implement up-to-date HIV screening CDC recommendations in pilot site(s) and continue to increase prenatal screening across the I/T/U system in addition to its “early warning” system of detecting rapid increases in the rate of HIV infection among prenatal and highest-risk American Indian and Alaska Native (AI/AN) populations. The implementation project will be the first of its kind across any Indian health system facility and attempt to integrate all aspects of the CDC recommendations to include the progressive stance of universal screening. As well, the current and ongoing funding continues to improve the prenatal screening rates in I/T/U and is seen as a critical screening and surveillance tool. Early in 2008, with existing MAI funding, there will also be national recommendations ‘published’ within the I/T/U system to address prenatal screening findings and outcomes from FY06-07 funding. This project is also a collaborative with CDC, utilizing CDC assigned personnel to assist with project implementation.
• An innovative and scientifically sound national survey to understand knowledge, attitude, and behavior of people in IHS’ service population regarding HIV/AIDS, with a focus on acceptance and adoption of new CDC guidelines of routine opt-out HIV screening among 13-64 year olds. This project will be innovative as it would be the first of its kind on a national (vice regional) basis attempting to include multiple service populations with geographic and I/T/U health system variability.

Behavioral Health Trainings

Innovative and collaborative regional trainings in support of the Indian Health Service (IHS) Director’s Health Initiatives, the IHS Division of Behavioral Health (DBH) will facilitate multiple trainings, focusing on incorporating behavioral health (BH) service delivery into the primary care setting and enhancing the BH techniques of BH providers and those who work closely with HIV/AIDS clients. This proposal will focus on instructing BH service providers in the areas of risk assessment and utilizing motivational interviewing techniques when providing treatment services to AI/AN people, in general and HIV/AIDS clients, specifically. This training will also increase the service provider’s understanding of the recuperative benefits of traditional healing and its traditional function along the HIV/AIDS continuum of care within the service delivery spectrum. The trainees will also gain added respect for traditional healing as a culturally appropriate choice for clients.

• Link to more information surrounding the Regional Behavioral Health trainings.

Quality of Care Project – Office of Information Technology

The HIV Management System (HMS) clinical software application provides clinicians and case managers with a powerful tool within our data system (RPMS) to proactively manage the care of those patients at risk for or living with HIV/AIDS. This application, coupled with the other initiatives within IHS, will help improve the quality of care delivered and increase the clinical capability for providing health care for those infected with HIV. HMS was updated in FY08 to include new clinical quality measure to determine the rate of HIV screening among patients with known Sexually Transmitted Infections (STI). This measure will be implemented in our Clinical Reporting System (CRS), an application deployed at over 400 sites within the Indian Health System. This will be used to identify the patients who are 'at risk' for exposure to HIV based on this co-risk factor. This early identification will be used to extend early intervention, screening, counseling and education to 'at risk' patients, thus decreasing the rate HIV transmission and progression to AIDS. This methodology results in decreased morbidity and mortality and increased cost-effective care. Another enhancement is the integration of the HMS application into iCare. iCare is a population management tool that is a user interface component of the IHS Resource and Patient Management System (RPMS). This will provide I/T/U clinicians and case managers with an easy to use tool that will facilitate integrated patient care management.

Community Health Representatives (CHR)

Using Targeted Resources to Improve Tribal Community Advocacy for STDs and HIV/AIDS Prevention and Impacting Tribal Youth through Education, Tools and Resources. This innovative project will build capacity through utilizing new and previously trained (through FY07 MAI funds) community-based paraprofessionals known as CHRs – who can deliver culturally appropriate STDs and HIV/AIDS education to AI/AN communities. There are two goals to this project:

• Equip CHRs as community change agents with the HIV/AIDS/STDS information and tools necessary for them to advocate prevention efforts effectively with Tribal Councils, communities, schools and clinic/community based health providers. Tribal Council awareness and action are keys to providing the kind of visibility and follow through necessary for change in tribal communities.
• Provide tribal CHR Programs with resources to conduct Youth Camps, specifically targeting STDs/HIV/AIDS prevention utilizing knowledge and communication skills building class sessions among others and perhaps peer-modeling activities. Sample curriculum will be provided from already existing interventions and best and promising practices.

The direct impact of a cadre of CHRs with the capacity to educate and motivate their colleagues and tribal community members will augment extended impact per the outcome measures. Long-term impact is sustainable through an extended network of CHRs and community members (educated in HIV topics) as well as a more integrated community level response.

content relevant to the MAI:
FY06 Initiatives (ongoing) FY07 Proposals FY08 Proposals IHS MAI History (2000-2005)

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