Post on 22-Jul-2016
description
www.healthhiv.org
HealthHIV’s
to Integrate HIV Care in Primary Care Settings
Staged Training to Engage Providers
Model
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@HealthHIV
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HealthHIV developed the STEP Model for HIV integration in primary care in response to limited existing models of HIV testing and care.
The model provides a staged framework for integration of HIV care into primary care. At its core, this dynamic model classifi es community health centers and other primary care delivery sites, based upon where they fall in the spectrum of HIV care delivery.
Classifying health centers in this framework allows HealthHIV to deliver customized HIV capacity building and clinical training responsive to the needs of individual centers.
The model is derived by merging two classifi cation systems:
� Stages of HIV Care
� Models of Care
Creating the STEP Model
Stages of HIV CareThe Stages of HIV Care classifi cation system also developed by HealthHIV, aligns community health centers and other primary care sites along a spectrum according to the HIV testing,care, and treatment services delivered. Community health centers providing only testing services are classified as the Foundation Stage. Each succeeding stage represents an increase in the complexity of HIV care provided to patients.
The Stages of HIV Care were informed by the HRSA/HAB Guidelines for HIV Clinical Care as well as various State HIV care plans and the WHO clinical staging for HIV/AIDS for Adults and Adolescents.
Foundation Stage
Stage 2
Stage 1
Stage 3
Provide HIV Testing (routine or targeted) but no medical management for patients with positive test results
Onsite management of stable HIV-positive patients who are on 2nd line ARV therapy and/or those with opportunistic infections
or advanced HIV disease
Onsite management of stable HIV-positive patients who are ARV naive or on 1st line ARV therapy, and management of common complaints
Onsite management of complex HIV-positive patients who are on 3rd line or salvage therapy and/or
with complex opportunistic infections, and/or the need for PMTCT
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The Models of HIV Care classifi cation system focuses on how community health centers deliver care to patients living with HIV. Classifi cation is determined through an assessment of the systems community health center’s have in place, to meet the primary care needs of their patients living with HIV. Focusing on how HIV primary care is delivered, each model incorporates the use of onsite staff in providing HIV care, with support from more experienced on-site, or previously identifi ed community providers/mentors. Mentors or consultants are used to facilitate the delivery of most of the HIV care by the community health center’s staff providers/clinicians, with availability for consultation as needed for cases of higher medical complexity or acuity.
The Models of HIV Care were informed by the National Association of Community Health Centers’ resource “Integrating HIV Screening into Routine Primary and Dental Care: A Health Center Model” and the CDC’s Program Collaboration and Service Integration Framework. In addition, HealthHIV conducted qualitative interviews with CHCs to determine which models developed organically within CHCs.
Models of HIV Care
External HIV Care
Supported HIV Care
Collaborative HIV Care
Comprehensive HIV Care Management
HIV testing (routine or targeted), but no medical management for HIV Patients.
HIV care within primary care supported by consultationwith clinical mentor as needed.
HIV care with primary care with extensive collaborationand consultation from clinical mentor.
HIV and primary care fully integrated for management of complex co-morbid conditions, PMTCT, and complex OIs.
Access consultation from clinical experts as needed.
HealthHIV’sThe STEP (Staged Training to Engage Providers) Model is a framework for integrating HIV care into primary care, recognizing that community health centers are each at different stages in their HIV care provision. The model is used to classify community health centers along a spectrum of HIV care delivery, provide a framework for the delivery of capacity building assistance, and guide a stepwise progression for health centers implementing higher level of care and management for patients living with HIV.
The model guides capacity building and clinical training to advance community health centers toward the goal of providing comprehensive primary care for their patients living with HIV.
HealthHIV’s HIV Primary Care Training and Certifi cate Program is based upon HealthHIV’s STEP model for integrating HIV in Primary Care. The program is designed to improve clinical and professional knowledge, skills, and competencies as well as improve ability to provide quality care to people living with HIV.
This program is designed for primary care providers (MDs, or DOs, nurse practitioners, and physician assistants) who are responsible for caring for patients at-risk for or infected with HIV. For details of HealthHIV’s HIV Primary Care Training and Certifi cate Program, visit www.healthiv.org
HealthHIV’s STEP (Staged Training to Engage Providers) Model
The Model in Action: The HIV Primary Care Training and Certifi cate Program
External HIV Care
SupportedHIV Care
CollaborativeHIV Care
ComprehensiveHIV Care
Management
Provide HIV testing (routine or targeted)
but no medical management for
patients with positive results
Onsite HIV care integrated with primary care, supported by
consultation with clinical mentor as
needed for management of treatment failure
and/or co-morbid conditions compli-
cated bt HIV disease and/or trearment
Onsite HIV care integrated with
primary care through extensive consultation
from clinical mentor for initiation of ARV regimen and
for management of more complex
patients
Onsite HIV care integrated with primary care,
including management of
complex co-morbid conditions, PMTCT, and complex OI’s
with access to consultation from clinical mentors as
needed
Foundation
Stage 2
Stage 1
Stage 3
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