The synergy found in HRSA's HIV work across domestic and global programming was just one of the topics covered in HIV.gov's Facebook Live interview with Harold Phillips, Director of the HRSA HIV/AIDS Bureau's Office of HIV/AIDS Training and Capacity Development.
In the 30-minute interview, Phillips highlighted HRSA's Global HIV/AIDS Program work on, for example, training health care workers in techniques to help patients achieve viral suppression, models of care delivery, HIV interventions targeting hard-hit populations, and ensuring the quality of HIV care that is delivered. HRSA has supported the work of the United States President's Emergency Plan for AIDS Relief (PEPFAR) since its inception in 2003.
As for what's going on at the 2018 International AIDS Conference, Phillips found encouragement from the insights being shared across U.S. and international programs through PEPFAR, the continued uptake of PrEP, and getting youth on PrEP and in care if they are HIV infected. Phillips said there was a visible sign of progress in the form of the large contingent of youth attending the meeting, reportedly the largest such event to date.
Highlights of HRSA HIV/AIDS Initiatives
Phillips explained that HRSA's domestic and global HIV programs inform each other, by design, as HRSA was brought to work on PEPFAR given its well-established efforts in HIV/AIDS care and treatment domestically under the Ryan White HIV/AIDS Program (RWHAP), which was established in 1990. Phillips said HRSA's Global HIV/AIDS Program seeks to “take some of those lessons learned in the domestic sphere and apply them globally.” Perhaps most notably among those experiences were the significant improvements in viral suppression seen among RWHAP clients--from 69.5% in 2010 to 84.9% in 2016 (RWHAP Annual Client-Level Data Report, 2016).
Below are some of Phillips' comments on select HRSA/HAB technical assistance and training projects:
- Consumer Involvement. Phillips outlined the principles of consumer and community involvement in HIV/AIDS work that began in the RWHAP with the involvement of front-line voices in planning and have expanded to provide new roles for consumers as peer educators and program managers.
- Key Populations. Regarding populations disproportionately impacted by HIV, Phillips commented on gay men, particularly gay/bisexual men, youth, and drug users, citing the heavy impact of HIV on African American gay men, high proportion of youth who fall out of care, and the uptick in HIV cases seen among drug users that may be associated with the opioid epidemic in the United States. HRSA has multiple efforts currently under way, such as the HRSA HAB Building Futures: Supporting Youth Living with HIV initiative.
- Social Determinants of Health. These are the “elements that impact your health outcomes” based on such factors as race, housing status, employment, and income, Phillips said. He highlighted HRSA programs that address SDOH to improve health outcomes, including a housing and HIV care initiative. Unstable housing is a major barrier to a person’s ability to achieve viral suppression. HRSA is also looking at programs that integrate employment, health services, and HIV care. Another area involves programs to link behavioral health with HIV care. These initiatives are “building bridges” across federal funding streams “to really make a difference” and, in turn, support interventions at the state and local levels. It sends a message to the community, said Phillips, about the value of collaborative endeavors.
Health care needs of refugees in such areas as South Sudan are addressed by PEPFAR with health care training in camps
- Clinical Training. HIV education and training in the health care work force has a 30-year history under the AIDS Education and Training Centers (AETC) program. It was established in 1988, several years before the Ryan White program was first created under the Ryan White CARE Act. AETC training, such as the National HIV Curriculum, as well as other specialized activities reach a wide range of clinicians on HIV treatment, cultural competency in care delivery, and other clinical topics like hepatitis C care and treatment. Also available under the AETC network are a series of clinician-focused warmlines and hotlines through the National Clinician Consultation Center.