cultural competence in caring for african americans with...
TRANSCRIPT
Cultural Competence in
Caring for African
Americans with HIV
June 10 2016Alexis Powell MDAssociate Professor UM Dept of General MedicineDivision of Infectious Diseases
Objectives
1 Review the contribution of bias to health
disparities
2 Define cultural competence
3 Review the HIV burden in African
Americans
4 Look at aspects of health care where cultural competence may be usefully applied
In 1999 Congress charged the Institute of Medicine (IOM)with evaluating racialethnic disparities in health
- More than 100 studies were reviewed- Variables controlled access race vs
severityprogression place of care etc
Seminal Health Disparities Inquiry
ldquoDisparities exist in a number of disease areashellipand are found across a range of procedureshelliprdquo
The majority of studies find disparities in clinical services that are equally effective for all racial and ethnic groupsrdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
IOM Findings
ldquohellipbias prejudice and stereotyping on the part of healthcare providers may contribute to differences in carerdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
Bias a particular tendency trend or inclination feeling or opinion
especially one that is preconceived or unreasoned
Credit NASA ESA and A Feild (STScI)httpwwwnasagovmission_pageshubblescienceoutofwackhtml
ldquoQualities of a Good Physicianrdquo via Google
i-studentglobal AUA WebMD Soliant Health
Professionalism Compassion Confident Confident
Empathy Strong Work Ethic Empathetic Empathetic
Attentiveness Professionalism Humane Skilled
Forward Thinking Knowledge Personal Focused
Composure Confidence Forthright Knowledgeable
Industrious Humility Respectful
Passion Thorough Lives and Promotes a Healthy lifestyle
Respectful
Honest and Forthright
Humane
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Objectives
1 Review the contribution of bias to health
disparities
2 Define cultural competence
3 Review the HIV burden in African
Americans
4 Look at aspects of health care where cultural competence may be usefully applied
In 1999 Congress charged the Institute of Medicine (IOM)with evaluating racialethnic disparities in health
- More than 100 studies were reviewed- Variables controlled access race vs
severityprogression place of care etc
Seminal Health Disparities Inquiry
ldquoDisparities exist in a number of disease areashellipand are found across a range of procedureshelliprdquo
The majority of studies find disparities in clinical services that are equally effective for all racial and ethnic groupsrdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
IOM Findings
ldquohellipbias prejudice and stereotyping on the part of healthcare providers may contribute to differences in carerdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
Bias a particular tendency trend or inclination feeling or opinion
especially one that is preconceived or unreasoned
Credit NASA ESA and A Feild (STScI)httpwwwnasagovmission_pageshubblescienceoutofwackhtml
ldquoQualities of a Good Physicianrdquo via Google
i-studentglobal AUA WebMD Soliant Health
Professionalism Compassion Confident Confident
Empathy Strong Work Ethic Empathetic Empathetic
Attentiveness Professionalism Humane Skilled
Forward Thinking Knowledge Personal Focused
Composure Confidence Forthright Knowledgeable
Industrious Humility Respectful
Passion Thorough Lives and Promotes a Healthy lifestyle
Respectful
Honest and Forthright
Humane
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
In 1999 Congress charged the Institute of Medicine (IOM)with evaluating racialethnic disparities in health
- More than 100 studies were reviewed- Variables controlled access race vs
severityprogression place of care etc
Seminal Health Disparities Inquiry
ldquoDisparities exist in a number of disease areashellipand are found across a range of procedureshelliprdquo
The majority of studies find disparities in clinical services that are equally effective for all racial and ethnic groupsrdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
IOM Findings
ldquohellipbias prejudice and stereotyping on the part of healthcare providers may contribute to differences in carerdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
Bias a particular tendency trend or inclination feeling or opinion
especially one that is preconceived or unreasoned
Credit NASA ESA and A Feild (STScI)httpwwwnasagovmission_pageshubblescienceoutofwackhtml
ldquoQualities of a Good Physicianrdquo via Google
i-studentglobal AUA WebMD Soliant Health
Professionalism Compassion Confident Confident
Empathy Strong Work Ethic Empathetic Empathetic
Attentiveness Professionalism Humane Skilled
Forward Thinking Knowledge Personal Focused
Composure Confidence Forthright Knowledgeable
Industrious Humility Respectful
Passion Thorough Lives and Promotes a Healthy lifestyle
Respectful
Honest and Forthright
Humane
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
ldquoDisparities exist in a number of disease areashellipand are found across a range of procedureshelliprdquo
The majority of studies find disparities in clinical services that are equally effective for all racial and ethnic groupsrdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
IOM Findings
ldquohellipbias prejudice and stereotyping on the part of healthcare providers may contribute to differences in carerdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
Bias a particular tendency trend or inclination feeling or opinion
especially one that is preconceived or unreasoned
Credit NASA ESA and A Feild (STScI)httpwwwnasagovmission_pageshubblescienceoutofwackhtml
ldquoQualities of a Good Physicianrdquo via Google
i-studentglobal AUA WebMD Soliant Health
Professionalism Compassion Confident Confident
Empathy Strong Work Ethic Empathetic Empathetic
Attentiveness Professionalism Humane Skilled
Forward Thinking Knowledge Personal Focused
Composure Confidence Forthright Knowledgeable
Industrious Humility Respectful
Passion Thorough Lives and Promotes a Healthy lifestyle
Respectful
Honest and Forthright
Humane
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
ldquohellipbias prejudice and stereotyping on the part of healthcare providers may contribute to differences in carerdquo
httpwwwnationalacademiesorghmd~mediaFilesReport20Files2003Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-CareDisparitieshcproviders8pgFINALpdf
Bias a particular tendency trend or inclination feeling or opinion
especially one that is preconceived or unreasoned
Credit NASA ESA and A Feild (STScI)httpwwwnasagovmission_pageshubblescienceoutofwackhtml
ldquoQualities of a Good Physicianrdquo via Google
i-studentglobal AUA WebMD Soliant Health
Professionalism Compassion Confident Confident
Empathy Strong Work Ethic Empathetic Empathetic
Attentiveness Professionalism Humane Skilled
Forward Thinking Knowledge Personal Focused
Composure Confidence Forthright Knowledgeable
Industrious Humility Respectful
Passion Thorough Lives and Promotes a Healthy lifestyle
Respectful
Honest and Forthright
Humane
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Bias a particular tendency trend or inclination feeling or opinion
especially one that is preconceived or unreasoned
Credit NASA ESA and A Feild (STScI)httpwwwnasagovmission_pageshubblescienceoutofwackhtml
ldquoQualities of a Good Physicianrdquo via Google
i-studentglobal AUA WebMD Soliant Health
Professionalism Compassion Confident Confident
Empathy Strong Work Ethic Empathetic Empathetic
Attentiveness Professionalism Humane Skilled
Forward Thinking Knowledge Personal Focused
Composure Confidence Forthright Knowledgeable
Industrious Humility Respectful
Passion Thorough Lives and Promotes a Healthy lifestyle
Respectful
Honest and Forthright
Humane
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
ldquoQualities of a Good Physicianrdquo via Google
i-studentglobal AUA WebMD Soliant Health
Professionalism Compassion Confident Confident
Empathy Strong Work Ethic Empathetic Empathetic
Attentiveness Professionalism Humane Skilled
Forward Thinking Knowledge Personal Focused
Composure Confidence Forthright Knowledgeable
Industrious Humility Respectful
Passion Thorough Lives and Promotes a Healthy lifestyle
Respectful
Honest and Forthright
Humane
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Physicians and Implicit Bias How Doctors May Unwittingly Perpetuate Health Care Disparities
Elizabeth N Chapman 2013
Physicians demonstrate implicit bias favoring whites and view black patients as uncooperative
httpwwwncbinlmnihgovpmcarticlesPMC3797360
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Provider Contribution to Health DisparitiesVanRyn et al AJPH 2003
Lower expectations for minority patients (eg tight control of diabetes)
Less effort spent communicating with minority patients (eg influenza vaccine)
Gatekeeper bias- (eg African-Americans with renal failure less likely to be placed on renal transplant list - not related to patient preference)
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Everyone has bias
Recognizing and managing personal bias is essential to developing cultural competence
httpsmanagingbiasfbcom
httpsimplicitharvardedu
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Why Focus on BiasBecause Every Encounter is a Cross-Cultural One
Hippocratic Oath is inadequate
Joint Commission mandates it
Federal Laws
State Laws
Good Practice
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Cultural CompetenceAdministration on Developmental Disabilities 2000
ldquohellipservices supports or other assistance that are conducted or provided in a manner that is responsive to the beliefs interpersonal styles attitudes language and behaviors of individuals who are receiving services and in a manner that has the greatest likelihood of ensuring their maximum participation in the programrdquo
DHHS Administration on Developmental Disabilities 2000 retrieved from Curricula Enhancement Module Series A Project of the National center for Cultural Competence Georgetown University Center for Child and Human Development httpwwwnccccurriculainfoculturalcompetencehtml May 6 2016
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Cultural Competence ContinuumAdapted from Cross et al 19881989 and Ponterotto1988 retrieved from httpswwwpakeysorguploadedcontentdocsELinPAELL20ToolkitCross20Cultural20Competencepdf May 7 2016
Destructiveness
IncapacityhellipBlindnesshellipPre-competence
Advanced Cultural
Competence
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Variables of Systemic Vulnerability
Discrimination and
Segregation
Poverty and Incarceration
Stigma
Healthcare accessoutcomes
gap
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
HIV Burden in African Americans 2014 Data
44 of the 44000 new infections (=19500)
26 occurred in women
73 occurred in Men
57 occurred in MSM
39 aged 13 to 24
48 of all persons diagnosed with AIDS
From HIV Among African Americans CDC Fast Facts httpwwwcdcgovhivgroupracialethnicafricanamericans retrieved May 6 2016
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
HIV in African Americans
0
10
20
30
40
50
60
70
80
90
100
12 ofpopulation
44NewHIV DX
48AIDSDX
All Others
African American
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Florida is 1 in New HIV CasesJan 2016
Cases increased by 23
1 in 49 Blacks in FLA has HIV compared to 1 in 325 whites
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Adherence
bull There has been a greater benefit of HAART on mortality in whites as compared to blacks
bull ldquoIn Non-Hispanic Blackshellipa higher risk of HIV mortality even among those without concurrent AIDS indicating a need to identify and address barriers to HIV care in these populationsrdquo
Examination of Inequalities in HIVAIDS Mortality in the United States From a Fundamental Cause PerspectiveMarcie S Rubin MPH MPA Cynthia G Colen PhD and Bruce G Link PhD httpwwwncbinlmnihgovpmcarticlesPMC2866621
Racial-ethnic differences in all-cause and HIV mortality Florida 2000-2011Trepka MJ1 Fennie KP2 Sheehan DM2 Niyonsenga T3 Lieb S4 Maddox LM5
httpwwwncbinlmnihgovpubmed26948103
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Adherence
Bogart etal Medical Decision- Making 2001
Physicians less likely to prescribe antiretrovirals to patients that are likely to be non-adherent
Same physicians felt that African-Americans less likely to be adherent to treatment
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Moskowitz MD
A study of pain treatment provided for 169 HIV-infected indigent patients PCPs trusted white more than nonwhite patients despite similar rates of reported illicit drug use or opioid misuse
Dayna Bowen Matthew lsquoJust Medicine A Cure for Racial Inequality in
American Health Carerdquo
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Adherence
Blacks had a greater rate of HAART therapy at 94 compared to 83 of whites
-Oramasionwu et al 2009
However
ldquoBlack race was significantly associated with worse ART adherence which was not modified by the presence of depressionrdquo
- M C Kong et al 2012
httpwwwjournalnmaorgarticleS0027-9684(15)31110-XpdfhttpwwwncbinlmnihgovpmcarticlesPMC3514995
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
MACH14 StudyJ Acquir Immune Defic Syndr 201260(5)466-472
A study of 1886 participants (54 white 28 black 14 Hispanic) from the HIV Cost and Services Utilization Study
40 reported having a discriminatory health care experience since their HIV diagnosis
24 failed to ldquocompletelyrdquo or ldquoalmost completelyrdquo trust their health care providers
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Stereotype Threat-induced AnxietyUSC and Loyola Marymont Univerity published 2014
The affect of waiting room poster images depicting AA women in stereotypical health situations on anxiety levels of woman
Black women who strongly self-identified as black reported the greatest amount of anxiety
ldquoAn unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of peoplerdquo-Cleopatra Abdou
httpsnewsuscedu65893study-offers-new-clues-about-the-source-of-racial-health-disparities
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Health Literacy
Ratzan and Parker definition as used in a 2004 Institute of Medicine (IOM) report
ldquothe degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisionsrdquo
Andrulis and Bach 2007 Itrsquos more than understanding wordshellipldquohow a person interprets healthcare messagesrdquo
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Health Literacy
National Assessment of Adult Literacy 2003
ldquo58 of Blacks exhibited basic or below basic health literacy compared to only 28 of whitesrdquo
httpwwwnursingworldorgMainMenuCategoriesANAMarketplaceANAPeriodicalsOJINTableofContentsVol142009No3Sept09Cultural-and-Linguistic-Barriers-html
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Health Literacy
Low Income
Low Education
LackType of Insurance
Low Health LiteracyThe Health Literacy of Americarsquos Adults Results from the 2003 National Assessment of Adult Literacy httpncesedgovpubs20062006483pdf Retrieved May 7 2016
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
VanRyn etal Soc Sci Med 2000
Race of patient affected physiciansrsquo perceptions of and attitudes towards patients after controlling for covariates
African Americans perceived less pleasant intelligent educated adherent to medical advice
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Low Literacy Does Not Equal Low Intelligence
Health-Related
Experience
Health Literacy
Health-Related Experience is a major factor in developing Health Literacy
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Single Item Literacy Screener (SILS)
bull How often do you need to have someone help you when you read instructions pamphlets or other written health materials from your doctor or pharmacy
bull Answer Never Rarely Sometimes Often Always
bull Threshold If they answer lsquoSometimes Often or Alwaysrsquo support is needed
Norris NS MacLean CD Chew LD amp Littenberg B The Single Item Literacy Screener Evaluation of a brief instrument to identify limited reading ability BMC Family Practice 2006 721 available from httpwwwbiomedcentralcom1471-2296721
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Health Literacy Intervention
bull Culturally and Linguistically Appropriate Services(CLAS standards)
bull Health Coaches
bull Community Health Promoters
bull Clinical pharmacists
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Patient Trust
ldquoAfrican Americans have been shown to have greater awareness of the documented history of racial discrimination in the health care systemhelliprdquo
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
httpwwwncbinlmnihgovpmcarticlesPMC1497554pdf12815085pdf
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Jacobs et al 2006ldquothe majority of respondents indicated that the race of the
physician did not matterrdquo
Trust Technical and interpersonal competence
compassion reliability dependability communication
Distrust Experiences and expectations of racial and financial discrimination
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Racial Concordance
Several studies have reported that racial discordant clinical scenarios are rated as less participatory and less satisfactoryhellip
However only 22 of AA stated a preference for an AA doctor- Arnold Elser R 2007
Johnson RL Roter D Powe NR Cooper LA Patient raceethnicity and quality of patient-physician communication during medical visits Am J Public Health 2004942084ndash2090Cooper-Patrick L Gallo JJ Gonzales JJ et al Race gender and partnership in the patientndashphysician relationship JAMA 1999282583ndash589Saha S Komarony M Koepsell TD Bindman AB Patientndashphysician racial concordance and the perceived quality and use of health care Arch Intern Med 2005159997ndash1004
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Tuskegee Syphilis Study Legacy
ldquoMany participants perceived events that others would see as routine or incompetent medical care as experimentation and attributed this expectation to their knowledge of the Tuskegee Syphilis Study whether or not they could identify the study by namerdquo
httpwwwncbinlmnihgovpmcarticlesPMC1924632
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Religiosity
African Americans are the most religious ethnic group in the US- Pew Research Center 2009httpwwwpewforumorg20090130a-religious-portrait-of-african-americans
A study of YMSWM identified religion and spirituality as consistent sources of strength and coping regardless of
ongoing affiliation with a specific church Foster et al
httpwwwncbinlmnihgovpmcarticlesPMC4475678
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Religion
ldquoThe Black Churchrdquo misnomer trivializes the religious experience of African Americans
participate in the gamut of religious denominations
churches are diverse reflect individual communities
ignores the privately experienced ldquointeriorizedrdquo religion(described by Alport 1958)
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Religion
41 of patients want to discuss religion with their doctor but only 8 have done so
41 recalled an instance when religion played a part in medical decision- making
Williams J Meltzer D Arora V Chung G amp Curlin F (2011) Attention to inpatientsrsquo religious and spiritual concerns Predictors and association with patient satisfaction Journal of General Internal Medicine July 1 Published Online
McCord Gary et al Discussing spirituality with patients A rational and ethical approach Annals of Family Medicine
httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
ReligionWhitely(2012) proposes we adopt the notions of ldquoCultural Safetyrdquo or ldquoCultural Humilityrdquo in addressing religionhellip(Polaschek 1998 Tervalon amp Murray-Garcı a 1998)
Puchalski 2006 FICA assessment tool
Faith and Beliefs
Importance
Community
Address in carehttptpssagepubcomcontent492245fullpdf+html
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Religion
ldquoReligious beliefs may at different times exert different effects both positive and negativehelliprdquo-Elser Arnold et al
Religion effectHTN +DM -
Viewpoint Cultural Competence and the African American Experience with Health Care The Case for Specific Content in Cross-Cultural EducationEiser Arnold R MD FACP Ellis Glenn
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Religion
ldquohellipa set of beliefs concerning the cause nature and purpose of the universehellipoften containing a moral code governing the conduct of human affairsrdquo-Dictionarycom
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Spirituality
ldquoSpirituality uniquely predicts health and well-being outcomes in those with HIVAIDS such as improvements in life satisfaction functional health status and health-related quality of life after controlling for factors such as age and HIV symptoms (Pargament et al 2004)rdquo
Spirituality in HIV+ Patient Care
Joni L Utley MA amp Amy Wachholtz PhD MDiv
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Spirituality
Spiritual struggle anger or sense of punishment has been associated with poor adherence (Parsons Cruise Davenport amp Jones 2006)
Unpublished data from the Patient Centered Medical Home study at UM indicates the majority of patients seen in the HIV clinic feel ldquoless than humanrdquo
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Acknowledging Religionhellipmay validate some patients who has become marginalized by Stigma or Stigma Threat
Religion amp Spirituality
Patient
Wellbeing
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Religion
In the UK a clinic with a large Somali muslim community experienced a 50 no show rate conscientious scheduling decr the rate by 135
Gatrad A (1999) A completed audit to reduce hospital outpatients non-attendance rates Archives of Disease in Childhood 82 59-61
Retrieved from httpwwwhpoeorgHPOE_Live_WebinarsReligious_Competency_4_25_13_presentationpdf
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Summary
1 The examination of Provider bias is an integral part of improving cultural humilitycompetence
2 Reviewed the historical context of AA vulnerability and current HIV disparities
3 Low health literacy is multifactorial and does not equate low intelligence
4 The acknowledgement of a patientrsquos religion may be a welcomed opportunity to validate patients and strengthen the providerpatient bond
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
bullQuestions
bull apowellmiamiedu
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
This Presentation and resources are
made possible by AETC grant award
U1OHA29295 from the HIVAIDS
Bureau of the Health Resources
Services Administration (HRSA) U S
Department of Health and Human
Services (HHS)
The information presented is the
consensus of HIVAIDS specialists
within the SEAETC and does not
necessarily represent the official views
of HRSAHAB
The AIDS Education and
Training Center (AETC)
Program is the training arm of
the Ryan White HIVAIDS
Program The AETC Program is
a national network of leading
HIV experts who provide locally
based tailored education
clinical consultation and
technical assistance to
healthcare professionals and
healthcare organizations to
integrate high quality
comprehensive care for those
living with or affected by HIV
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
The South FL SE AIDS Education and Training Center
within the University of Miami Department of Medicine
Division of Clinical Immunology has over thirty faculty
members and staff dedicated to caring for patients with
HIVAIDS and includes some of the worldrsquos most renowned
researchers in infectious diseases We have specialty clinics
in adult medicine and obstetricsgynecology that provide
state of the art clinical care for those individuals infected with
HIV and other STIs HIV clinical care is provided by the UM
physicians for inpatient care at Jackson Memorial Hospital
(JMH) and University of Miami Hospital and outpatient care
at numerous sites on the UMJMH medical campus UM HIV
faculty also provide off site care at Federally Qualified
Health Centers
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
The South FL SE AETC includes the following counties
Polk Hardee Highlands Indian River Okeechobee St
Lucie Hernando Pasco Pinellas Hillsborough
Manatee Sarasota DeSoto Martin Palm Beach
Broward Miami-Dade Monroe Charlotte Glades Lee
Hendry and Collier
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
The US Department of Health and Human Services
(DHHS) has released updated versions of its
antiretroviral treatment guidelines for adults and
adolescents and for children with HIV The new adult
guidelines include revised recommendations for first-
line antiretroviral therapy (ART) as well as
management of treatment-experienced patients The
revised pediatric guidelines include a discussion of very
early treatment for HIV-infected infants
References
HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults
and Adolescents Updated April 8 2015
DHHS Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection Updated March 5 2015
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
TRAINING OPPORTUNITIES
Preceptorships
An intensive clinical training program offered to healthcare providers in Florida who have an
interest in learning more about the diagnosis and management of HIVAIDS opportunistic
infections and co-morbid conditions Each preceptorship is structured to meet the unique
needs of the individual participant based on his or her previous experience geographic
location and time available Experience 4 to 240 hours of clinical training at adult pediatric
obstetric andor family practice clinics where care is provided to HIV-infected patients All
training provided is consistent with current guidelines from the Department of Health and
Human Services or other nationally recognized guidelines when available
Individual andor Group Clinical Consultations
Individual and group clinical consultations are offered Individual clinical case consultation is
provided on the diagnosis prevention and treatment of HIVAIDS and related conditions
These consultations take place by telephone email or face-to-face meetings Group clinical
consultation with case-based discussions include information on pharmacology clinical
antiretroviral therapy updates drug-drug interactions and antiretroviral resistance
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
TRAINING OPPORTUNITIES Contrsquod
Chart Reviews
The chart review program offers clinics that provide HIVAIDS care an opportunity to assess
adherence to current Department of Health and Human Services (DHHS) and other published
guidelines utilized in the care and treatment of HIV-infected individuals Using a team of
specially-trained FC AETC faculty a review of selected patient charts is completed to identify
the strengths of the healthcare team as well as areas of opportunity for education and
training to support quality improvement efforts
Web-Based Education (Webinars)
We offer numerous web-based educational opportunities to increase the knowledge and skills
of HIV healthcare providers Our web-based educational opportunities cover a wide range of
HIV-related topics Trainings are provided both as live webinars or on-demand recorded
webinars Web-based education offers participants a way to stay up-to-date on current topics
Telehealth Case Based Group Consultations
This model uses a live audio-video-based platform (Adobe Connect) to provide educational
experiences through the creation of a learning network comprised of clinicians serving
HIVAIDS patients novice to expert throughout our region
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
FOR MORE INFORMATION PLEASE
VISIT
httphivaidsinstitutemedmiamiedupartnersse-aetc
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
National HIVAIDS Cliniciansrsquo Consultation CenterUCSF ndash San Francisco General Hospital
8009333413National HIVAIDS Telephone Consultation ServiceConsultation on all aspects of HIV testing and clinical careMonday - Friday 9 am ndash 8 pm ESTVoicemail 24 hours a day 7 days a week
8884484911National Cliniciansrsquo Post-Exposure Prophylaxis Hotline Recommendations on managing occupational exposures to HIV and hepatitis B amp C9 am - 2 am EST 7 days a week
8884488765National Perinatal HIV Consultation amp Referral Service Advice on testing and care of HIV-infected pregnant women and their infantsReferral to HIV specialists and regional resources24 hours a day 7 days a week
HRSA AIDS ETC Program amp Community Based Programs HIVAIDS Bureau amp Centers for Disease Control and Prevention (CDC)wwwncccucsfedu
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Monday JUNE 21st
Retention in Care for Transgender Clients
Sheryl Zayas DO
Monday JUNE 27th
Transitioning HIV Infected Youth to Adult Services
Ana Garcia PhD LCSW
Upcoming Webinars
Wednesday JULY 27th
Antiretroviral Resistance and Resistance Testing
Elizabeth Sherman PharmD AAHIVP
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Need Additional Information
Contact the South FL SE AIDS Education and Training Center
Franklin Monjarrez Program Manager fbm20medmiamiedu
Tivisay Gonzalez Program Coordinator tgonzalez1medmiamiedu
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
Target audience Physicians physician assistants nurses pharmacists social workers mental health workers
nutritionistdietitians
The Suwannee River Area Health Education Center Inc is a
Florida Board of Nursing Dentistry Pharmacy Psychology
Respiratory Care Occupational Therapy Nursing Home
Administration Clinical Social Work Marriage and Family Therapy
and Mental Health Counseling and Florida Council of Dietetics and
Nutrition approved provider of continuing education CE Broker
Provider ID 50-1922
This program meets the requirements for up to 10 contact hours
The Florida AHEC Network designates this live activity for a
maximum of 10 AMA PRA Category 1 Creditstrade
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you
We thank you for participating in
todayrsquos webinar and encourage you to
stay on WebEx and fill out the
Performance Evaluation after the call
ends This is a HRSA requirement that
helps us ensure continued funding
Thank you