Quality of comprehensive HIV care in underserved communities: does clinical training lead to improvement.

The AIDS Education and Training Centers National Evaluation Center led collaborative research to evaluate whether Minority AIDS Initiative (MAI)-funded clinical training changes clinical practice. Chart abstraction and feedback (34 clinics; n = 530) were used to assess adherence to clinical practice guidelines, identify training needs, and assess change in clinical practice (14 clinics, n = 271). Generalized estimating equations were used to account for repeated measures within each clinic. At baseline, clinics displayed 49% (95% confidence interval [CI] = 44-53) adherence to clinical practice guidelines. After feedback associated with the baseline chart review and subsequent implementation of MAI-funded clinical training, an 11% increase (95% CI = 7-16) in adherence to clinical practice guidelines was observed. MAI-funded clinical training was associated with increased adherence to clinical practice guidelines for HIV care. Chart abstraction is useful to assess clinical practice, facilitate conversations about quality improvement, and evaluate the effectiveness of clinical training.

Interventions delivered in clinical settings are effective in reducing risk of HIV transmission among people living with HIV: results from the Health Resources and Services Administration (HRSA)'s Special Projects of National Significance initiative.

To support expanded prevention services for people living with HIV, the US Health Resources and Services Administration (HRSA) sponsored a 5-year initiative to test whether interventions delivered in clinical settings were effective in reducing HIV transmission risk among HIV-infected patients. Across 13 demonstration sites, patients were randomized to one of four conditions. All interventions were associated with reduced unprotected vaginal and/or anal intercourse with persons of HIV-uninfected or unknown status among the 3,556 participating patients. Compared to the standard of care, patients assigned to receive interventions from medical care providers reported a significant decrease in risk after 12 months of participation. Patients receiving prevention services from health educators, social workers or paraprofessional HIV-infected peers reported significant reduction in risk at 6 months, but not at 12 months. While clinics have a choice of effective models for implementing prevention programs for their HIV-infected patients, medical provider-delivered methods are comparatively robust.