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University of Maryland, Baltimore, MD Interprofessional Global Health Project in Brazil: Summary Presentation Ozlem Yazar, Neda Mirjafary, Polina Iarikova Dr. Isabel Rambob January 23, 2015 Purpose The purpose of this project is to offer UMB students an opportunity to study the Brazilian model for mitigating the HIV epidemic in an interprofessional setting and its applicability in community-based programs in Baltimore City. - CDAP: State Specialized Center for Diagnosis, Treatment and Research in STD and HIV/AIDS. Upon graduation, students will be able to enter the workplace as a member of the collaborative practice team in a diverse environment. Summary of Activities Total time: 10 days Location: Bahia, Salvador, Brazil Team leader: Isabel Rambob, DDS Students: ● Ozlem Yazar - social work student ● Neda Mirjafary - nursing student ● Polina Iarikova - dental student Rotations: Centro Especializado em Diagnóstico, Assistência e Pesquisa, CRES, Hospital Couto Maia Professionals shadowed / consulted: infectious disease specialists, dentist, nurse, pharmacist, social worker, psychologist, physical therapist, art/dance therapist, lab technician Observations ● Government funded healthcare to a large portion of the population ● Anyone, including legal foreign visitors, has access to care ● Public sector and private sector of healthcare o Public sector is federally funded and provides universal access to all o Private sector is not free but can be accessed to those who can afford it o Medication is financed for both sectors by the government ● Sufficient funding; however, the money is not well managed or distributed efficiently ● A smaller portion of healthcare providers are dedicated to providing excellent care to the population regardless of obstacles or lack of funding Concerns SUS system delays and shortages Staff: shortage of healthcare workers, long wait times to see a provider, long wait times to receive lab results, lack of health centers in rural areas o Treatment delay: lack of access to care leading to long (4-6mo) wait times Diagnostic technology shortage (MRI, CAT scans, etc.) Outdated technology and medication: require a higher viral load to genetically sequence viral DNA; patient required to take multiple pills instead of one o Drug interactions and non-compliance Recommendations: public sector ● Strong need for primary prevention system, especially in academic institutions and targeted at males (65% of HIV+ are males) ● Increase the number of healthcare providers, especially physicians within hospitals and clinics and rural areas ● Increase the number of diagnostic equipment ● Shorten the diagnostic testing turn-around Shadowing: Social Worker ● Social Worker’s role in HIV/AIDS epidemic o Educating the patient on HIV/AIDS o Encourage testing o Encourage the use of condoms o Encourage compliance Shadowing: Social Worker ● Unexpected findings o Schools/parents are not providing education on safe sex o Socio-economic status does not play a role in the infected population o Refuse the use of condoms, knowing the partners status on HIV/AIDS Shadowing: Social Worker ● Take-home message o Multidisciplinary team results in more success in treatment of patients o Patient can regain ownership of individual challenges by using interprofessional team as a foundation to build upon o Use vigilance when evaluating patient needs, look at the whole picture o Always encourage testings o Make condoms available o Empathize the importance of compliance Shadowing: Nurse ● Nurse’s role in this epidemic: o Advocate for the patient! o Link the patient to other healthcare professionals o Play an active role in primary prevention and educating the community on HIV/AIDS o Understand the social context that the patient is living in and make recommendations to the healthcare team o Empower the patient to play an active role in their own health and understand HIV/AIDS and the medications Shadowing: Nurse ● Unexpected findings: o Compliance with HIV/AIDS treatment can be very complex and is impacted by many factors Shadowing: Nurse ● Take-home message: o Care for all patients using a team-approach o Be compassionate o Empower and motivate the patient to play an active role in their care o Encourage compliance o Encourage patients to get tested Shadowing: Dentist ● Dentist’s role in HIV/AIDS epidemic o Frequent access to patient o Diagnose oral lesions indicating HIV / uncontrolled HIV More than 90% of pts with HIV have at least one oral manifestation o Explain importance of being tested o Encourage treatment compliance o Emphasize smoking cessation Smoking tobacco has also been suggested to decrease effectiveness of HAART therapy Shadowing: Dentist ● Unexpected trends and findings o Comparable socio-economic population of similar health status in Baltimore, MD, frequently presents with worse Oral Health Salvador population increasingly interested in preserving natural dentition o Inability to access care as an HIV+ patient because of stigma and prejudice Patients concealing diagnosis Shadowing: Dentist ● Take-home messages: o Ensuring fair access to and treatment of patients with complex medical statuses o Comprehensive healthcare approach o Communication with professionals of other fields for best results o Patient education o Vigilance regarding unexpected lesions Mentorship Program: ● Shadowing the professional outside the field of studies ● Apply the obtained knowledge to the future career, thus enhancing the interprofessional approach to patient care ● Nursing student - Infectious Disease Specialist, Dr. Marcio Oliveira ● Social Work student - Pharmacist, Tatiana Haguihara ● Dental student - Infectious Disease Specialist Dr. Alessandro Farias Baltimore Community-based Clinics Interprofessional collaboration can promote the development of innovative solutions to manage unmet health needs for people living with HIV/AIDS in Baltimore City. Baltimore Community-based Clinics: Recommendations ● Mandatory educational lecture following the diagnosis ● Interprofessional treatment ● Affordable medication ● Target the at-risk population ● Increase testing centers’ availability OBRIGADA!