Sharing the Details: Implementing and Evaluating the Integration of New York State AIDS Institute Health Equity Competencies for Health Care Providers into Clinical Training Activities.

Background: The New York State (NYS) Department of Health (DOH) AIDS Institute (AI) Clinical Education Initiative (CEI) trains the NYS health care workforce to improve health outcomes related to HIV, sexual health, hepatitis C, and for people who use drugs. Methods: In 2019, CEI began consistently integrating health equity into CEI activities through a working group that mapped NYS DOH AI health equity competencies for providers onto planned clinical education. We conducted a convergent mixed methods study on qualitative and quantitative participant feedback form (PFF) data to evaluate these competencies between April 1, 2021, and September 30, 2022, and conducted an annual survey of NYS clinician needs in 2021 and 2022. Results: The CEI Health Equity Working Group analyzed 25 measures within 4 health equity competencies that were grouped into 4 interventions: resources, internal tools, activity creation, and evaluation. Eighty-nine percent of PFF respondents (n=20,166) strongly agreed/agreed that CEI activities included multiple viewpoints; qualitative comments described informative and helpful activities. When asked how they address patient-identified social determinants of health (SDOH) needs, 84% and 71% of annual survey respondents reported they made the highest number of referrals for health insurance coverage assistance in 2021 and 2022, respectively. Discussion: CEI continues to address participant feedback and seamless incorporation of health equity components into their work. Health Equity Implications: Health equity in clinical practice and trainings is crucial in acknowledging and addressing SDOH that continue to impact NYS clinicians and their patients.

The Implementation of a State-wide Rapid Initiation of Antiretroviral Therapy as a Best Practice in Primary Care Practices Using an Academic Detailing Approach: Lessons Learned from New York State, United States.

Background: New York State Department of Health AIDS Institute policy recommends that primary care clinicians should initiate same-day-antiretroviral treatment (ART) of a new HIV diagnosis or at the next clinical visit as the standard of care. However, non-HIV-specialized primary care clinicians might not be sufficiently trained to initiate a specialized ART with a newly HIV diagnosed patient. We assessed clinicians' knowledge and attitudes toward the rapid initiation of ART and provided academic sessions as a training method to guide clinicians through the implementation of a new standard of care. Methods: A Research Electronic Data Capture (REDCap), Health Insurance Portability and Accountability Act (HIPAA)-compliant, online survey was sent to primary care clinicians to assess their knowledge and attitudes towards Rapid Initiation of ART (RIA). We provided personalized academic detailing sessions, addressing questions and concerns gathered from both the initial survey and the individual pre-assessment questionnaire completed prior to the sessions. Results: The survey was initially distributed in February 2019, followed by 4 weekly reminders. Approximately 585 providers completed the survey. Subsequently, 552 health care providers from 25 out of 62 counties in NY State were detailed between March 2019 and March 2021. Lessons learned from the sessions included the identification of pragmatic strategies that could be used in the design of effective detailing sessions, followed by enhanced clinical knowledge, which improved patient care. Conclusion and Global Health Implications: Inconsistencies in the current testing practices result in missed HIV diagnoses and an increased risk of HIV transmission. Academic detailing-training techniques can be used to respond to clinician-identified key issues/attitudes that may result in a new intervention, suggesting a promising approach in addressing the implementation barriers of of rapid-treatment initiation as the standard of care. The academic detailing approach can be easily adapted and can be beneficial in global public health, HIV/ AIDS control, and other conditions that require a medical practice change.

Attitudes, practices, and priority of HIV screening and testing among clinical providers in Transylvania and Moldavia, Romania.

Screening and linkage to care are core, foundational strategies for HIV transmission prevention and for identifying People Living with HIV (PLHIV). In Romania - with an atypical experience in the HIV/AIDS epidemic - providing care for HIV+ patients identified early is a priority, though screening and testing can pose a challenge in some areas. METHODS: A survey of 125 clinical providers to explore important dimensions of HIV/ AIDS clinical care was conducted in Transylvania and Moldavia, where clinicians identified poor/ latent screening as a major problem in providing timely care and in preventing the spread of disease. We analyzed determinants of offering HIV screening/testing to patients using Pearson Chi-square analysis and logistic regression. Logistic regression generated Odds Ratios (OR) to reflect the magnitude of association between the relevant variables, with 95% confidence interval (95% CI) indicating statistical range. RESULTS: In total, 40.8% of providers did not provide HIV screening/testing to at least one segment of the population. Hospital-based providers were significantly more likely to offer HIV screening/testing to all segments than were non-hospital-based providers (58.1% v. 35.5%, respectively; p < .05). Providers located within institutions with screening/testing policies were more likely to offer such services to their patients (p < .05). Overall, 94.4% of providers indicated interest in more training around HIV screening/testing. DISCUSSION: Reaching Romanian and global goals for reducing HIV require more timely screening and action based on positive status. Romanian clinicians are interested in expanding HIV screening/testing and are interested in participating in training that helps them feel more prepared to undertake this work.