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Evaluation of Minority AIDS Initiative‐Funded AETC Training UMBAST Continuity of Care Training Evaluation BACKGROUND Initiative, UMBAST collaborators conducted an evaluation to assess The mission of the U.S./Mexico Border AETC Steering Team the outcomes of trainings guided by the curriculum. (UMBAST) is to provide collaborative capacity building assistance and focused education activities for health care providers serving METHODS U.S./Mexico border communities in Arizona, California, New To evaluate the curriculum, participant Information Forms (PIF) and Mexico, and Texas. UMBAST collaborators include the Mountain pre‐ and post‐training data were collected from training Plains AETC, Pacific AETC, Texas/Oklahoma AETC, AETC National participants. Knowledge was assessed using a survey that consisted Evaluation Center, and AETC National Resource Center. These of multiple‐choice questions and self‐report items about: 1) the HIV centers have worked together to develop curricula, disseminate epidemic in Mexico, 2) the Mexican healthcare system, 3) HIV care information, build an informative website, and evaluate programs. in Mexico, and 4) Centros Ambulatorios de Prevención y Atención al SIDA e Infecciones de Transmisión Sexual—CAPASITS (HIV/STD‐
UMBAST collaborators have spent the last 8 years developing best dedicated treatment centers) in Mexico. practices in HIV care for HIV‐infected individuals living on the US/
Mexico Border (60 miles or 100 km above the border with Mexico), A total of 137 clinicians completed all of the assessments associated including those who travel between the United States and Mexico. with this evaluation (the PIF and pre‐ and post‐knowledge tests at As part of this work, participating AETC regions developed the trainings in 4 border states, CA, AZ, TX and NM) during the initial 6 Continuity of Care for Patients Returning to Mexico curriculum, which months of the curriculum evaluation project. These 137 aims to increase trainees’ knowledge about: 1) the HIV epidemic, 2) participants were also sent an email 6‐8 weeks after the training health and HIV care delivery systems in the United States and and invited to take part in an online follow‐up survey. Open‐ended Mexico, 3) barriers that migrating patients face when trying to questions in the survey asked participants if they had changed any access HIV services and medications on both sides of the border, practice behaviors following the training and, if so, to provide and 4) ways to help patients access care. examples of those changes. Participants were also asked about any barriers they had encountered in making changes. A total of 48 During the two‐year development phase, the curriculum was pilot trainees completed the online follow‐up survey. We also collected tested and clinician focus groups were conducted to improve its anecdotal reports from trainers about additional feedback provided content and organization. Then, in 2008 under the Minority AIDS after trainings were delivered. FINDINGS Overall, the average knowledge score pre‐training was 39.9%. Trainees showed significant increases in knowledge immediately following the training program; the average knowledge score post‐training was 78.4%. Trainees’ knowledge about the Mexican health and HIV care systems increased significantly after training. At pre‐test, 82% of respondents rated their knowledge of such systems as low or low to medium, as compared to 6% immediately after the training. In addition, trainees’ self‐reported knowledge about HIV clinical care in Mexico increased significantly after training. At pre‐test, just 21% of respondents rated their knowledge of care in Mexico as high or medium to high, as compared to 62% immediately after the training. A +97% overall percent change was observed on the 7‐item knowledge test. (continued on back) Evaluation of Minority AIDS Initiative‐Funded AETC Training FINDINGS (continued) CONCLUSIONS In the online follow‐up survey, the majority of participants reported few barriers to applying what they had learned. Participants—who were all clinicians practicing in the four border UMBAST training was associated with states—mentioned that the cutting‐edge information and resources provided, the relevance of an increase in knowledge after the the training content, and networking opportunities helped them use what they had learned. trainings and the ability of participants Participants provided a number of examples of how they had been able to use information from to use information learned at the the curriculum: training in their diverse clinical settings. Dissemination of the information “I am focusing on getting a more detailed history of my clients in regards to risk factors and learned by clinicians into their work then offering more suggestions on how they can reduce their risk behaviors. I am letting my patients know that there are providers who offer assistance to them (HIV infected clients) upon settings created a demand for updated their return to Mexico and am able to give them information on how to obtain help in Mexico.” materials and further trainings. “We have a number of patients in our clinic who return to Mexico after receiving care at our The Continuity of Care for Patients hospital. This training gave me a better understanding of medication availability for our Returning to Mexico curriculum, patients.” including more than 50 slides with instructor talking points, pre/post tests “I am letting my patients know that there are providers who offer assistance to them with answer keys and 7 bilingual one‐
(HIV‐infected clients) upon their return to Mexico and am able to give them information page fact sheets for HIV providers on how to obtain help in Mexico.” assisting migrants with HIV, can be found at www.aetcborderhealth.org. To Participants provided examples that demonstrated better patient communication, improved learn more about UMBAST, visit their diagnostic/referral skills, and the development or revision of policies and procedures at their website or contact Tom Donohoe at agency/clinic. Participants also discussed their abilities to disseminate information learned in donohoe@ucla.edu. the trainings. Some trainees conducted trainings at their own agencies/clinics, others taught their colleagues, and many shared materials from the training with others. “The presentation was very informative and effective. I was able to bring back the information and share with case managers and staff.” “I plan to use the material as a resource as we look at policies and planning in the future.” “I have told several patients about increased capacity for HIV care in Mexico, in case they want to return.” UMBAST faculty trainers also reported increases in new inquiries regarding specific HIV resources for migrants after the training sessions. Follow‐up questions came from both direct participants as well as other UMBAST team visits CAPASITS facilities in Matamoros, Tamaulipas, Mexico clinicians who learned of these materials and resources from those who had participated in trainings. Requests for trainings from new agencies increased after these initial training sessions, as did downloads and page views of curriculum materials on the UMBAST website. Trainers hope to share results from these subsequent sessions at the 2010 Ryan White HIV/AIDS Program Grantee Meeting in Washington D.C. This project was conducted in collaboration with the AETC National Evaluation Center For more information, visit http://aetcnec.ucsf.edu