National HIV Curriculum: Broadening HIV Clinical Training
For several decades, delivery of state-of-the-art HIV care has been guided by treatment guidelines and training clinicians on their use through the AIDS Education and Training Centers (AETC) and other means. However, there is a growing shortage of clinicians trained in HIV care. Seasoned professionals who have been around since the early days of the epidemic are retiring. HIV training in health professional schools is lacking.
Enter the online, self-guided, interactive AETC National HIV Curriculum (NHC), a HRSA-funded effort to both educate and expand the HIV clinical workforce. In this blog, we summarize the National HIV Curriculum’s genesis, what it offers, and upcoming HRSA plans for additional HIV training for the health professions.
According to HRSA’s April Stubbs-Smith, Director of the Division of Domestic HIV Programs in the HIV/AIDS Bureau, the agency has had a long-standing interest in “developing a comprehensive curriculum under the umbrella of the Ryan White HIV/AIDS Program (RWHAP) that all recipients can use—not just RWHAP-funded agencies but any provider delivering HIV [care]—from 101, how to treat it, how to engage with patients.” Ms. Stubbs-Smith added that “even though the NHC isn’t 101, it's really a tool that any type of provider can use—doctors, nurses, and medical students—that will provide them with enough information” to engage with a patient living with HIV and secure medical or nursing education credits as they get prepared.
The NHC’s goal, according to Editor-in-Chief David H. Spach, MD, “is to make the content in the National HIV Curriculum heavily based on existing excellent federal guidelines that address HIV clinical care.” The NHC was launched in July 2017 and is the latest in a series of HIV health profession training tools developed under the auspices of the AETC Program, the clinician training arm of HRSA’s RWHAP—specifically through the AETC National Coordinating Resource Center (NCRC), administered through Rutgers University School of Nursing.
The NHC is not HRSA’s first foray into HIV clinical training. HRSA and the AETC Program have been producing various clinical training tools for decades, like the Guide for HIV/AIDS Clinical Care and earlier guides on women’s HIV care and primary care for people living with HIV/AIDS. Other training efforts included, for example, an AETC project from 2013-2018 focused on nurse practitioners and physician’s assistants and work being undertaken at various regional AETCs such as the 2015-2019 interprofessional education (IPE) project.
The NHC also has history, having evolved from local and state ideas in a manner that is pretty characteristic of RWHAP initiatives that tend to emerge from community collaborations. Its roots stretch back to 2010 when the University of Idaho (UI) started work on a Graduate Medical Education (GME) project with the University of Washington (UW) Northwest [since renamed to Mountain West] AETC, targeting four medical school residency programs that were going to integrate HIV primary care into family practice models. Dr. Spach, NHC’s father—if you will—operates out of UW and realized that residents were coming out of medical school with very little knowledge of HIV.
Jump to 2015 and funding from HRSA was secured to work on development of a national curriculum, in partnership with the AETC NCRC. John Nelson, PhD, AETC NCRC Program Director, explained the multi-year process that started with the GME resources and expanded them to a set of HIV core competencies under the direction of Dr. Spach and a multidisciplinary group of HIV clinicians across the AETC network. Spach, who is also Editor-in-Chief of the National STD Curriculum, Hepatitis C Online and the Hepatitis Web Study, explained that NHC’s focus was determined by a national Core Competency Working Group that “included a broad representation of health professionals and national experts who are engaged in HIV clinical care and education.” Nelson described how the Working Group members were drawn from across the AETC network and included varied disciplines, like medicine (e.g., family practice, infectious disease, psychiatry), nursing, and pharmacology, and others.
The NHC is an online portal that offers Continuing Medical Education (CME) or Continuing Nursing Education (CNE) credits. You can earn over 80 CME credits or CNE contact hours. Given that NHC is entirely federally funded, it is free to use and devoid of advertisements. Below are the main sections of the NHC, which Dr. Spach summarizes in this 10-minute video.
The antiretroviral medication section includes in-depth information on all approved antiretroviral medications and is tied into FDA’s approval database.
There are 37 lessons in the NHC. They are organized under six modules that include materials on HIV diagnosis, clinical manifestations, treatment, and prevention. These six modules represent core competencies to provide baseline knowledge for practitioners.
Each of the 37 lessons offers these four sections: Overview/Quick Reference; Self-Study CNE/CME (to track progress and receive CE credits); a Question Bank CNE/CME (an interactive board-review style questions with CE credit); and Clinical Challenges (expert opinions for challenging and controversial cases).
The interactive Question Bank provides more than 450 board-review style questions with CNE/CME, credit. This feature lets users get answers but also test their own knowledge.
This section examines how HIV challenges are addressed by HIV clinical experts, where choices are presented and learners can select what they believe is the correct answer and can compare their responses to other learner choices, much like the interactive learning at the Ryan White Clinical Conferences.
Tools and Calculators
The NHC has a wide range of tools and calculators covering substance use screening, mental health screening, as well as clinical care calculators to assess patient wellness.
Rounding out the Curriculum are links to the Clinical Consultation Center's phone and online clinician-to-clinician guidance and education, HIV Resources links to various HIV guidelines and databases. Also tucked away in the main page's footer is a comprehensive Master Bibliography.
“Thus far,” said Spach, “we have seen broad use from physicians, advance practice nurses, physician assistants, nurses, pharmacists, and students.” Users can make use of NHC in varied ways, according to Dr. Spach, “in that it offers a dual functionality.” Users can “register on the site and work through the Curriculum in a modular fashion and track their progress as they work through the modules.” Or, said Spach, “they can use the site as a quick reference to access information at any time, with or without having registered.”
Explained Spach, the NHC also has what’s called a “group learning feature where an instructor, clinic manager, or residency director can invite participants into learning groups and track their progress as they work through the Curriculum, identifying patterns of questions answered and missed.” The video below describes the functionality and use-cases of Learning Groups. For example, said Spach, “a residency program director could identify residents who are particularly interested in HIV, invite them to a learning group, suggest materials on the Curriculum for the residents to work through, and track progress of work completed. The learning group function is a great resource for helping a leader set up a curriculum for students and for residency programs looking to establish an HIV track.”