Download Establishing Continuity of Care - AIDS Education and Training Centers

Assisting PLWHAs Returning to
Mexico and other Latin American
Countries: A Pilot Project
Oscar Gonzalez, PhD
Texas/Oklahoma AETC
Tracy Tessmann, MA
Texas/Oklahoma AETC
1
Overview
 Project Summary
 Establishing Continuity of Care
 Referral Process for HIV Providers
Serving Migrant Patients
 Program Challenges
 Navigating HIV Services in Latin
America
 Other Social Challenges
 Conclusions
2
Project Summary
 International Continuum of Care
Pilot project of Parkland Health &
Hospital System & Texas/Oklahoma
AETC
 HIV infected migrant patients returning
to their countries of origin are assisted
in linking to HIV clinical care
3
Project Summary - cont’d

Linkage to clinical care:
 Ensures continuity of treatment
 Reduces the development of resistance
 Encourages adherence to treatment
 Improves/promotes HIV prevention
 Reduces the spread of HIV

Helps people to establish and maintain
relationships with HIV providers and the
health care systems in Mexico and Latin
America
4
Establishing Continuity of Care
The target population is providers serving
HIV-infected Latino migrant populations in
the U.S.
The process involves:
 Dissemination of project information to HIV
clinicians
 Providers contact the project via e-mail or
telephone
 Response is generally 48 hours or less
 Situations are assessed individually
 Referrals are handled in a culturally appropriate
manner
5
Information Needed for Linkage
 Who?
 Why?
 When?
 Where?
 Regimen?
 How long?
6
Destination Referral Includes
Providing Information about:
 Requirements for accessing care in the
destination country
 HIV clinic location and contact person
 Availability of HIV treatment and services
 Physician’s name and credentials
 Intake appointment date and time
 Tips for navigating the health care system(s)
7
Successful Patient Linkage
Information Includes:
 Diagnosis letter
 CD4 count and viral load test results
 Genotype and phenotype test results
 List of HIV/AIDS and other medications
 Medications for 3 months
 Immunization history
 Opportunistic infections history
Other information needed:
 U.S. physician’s contact information
 Photo ID
 Proof of residence
8
Challenges
 Fragmentation/lack of a national health care
system for HIV
 Patients often rural, clinics mostly urban
 Clinical capacity often limited
 HIV medications available but access is limited
 Cost of international phone calls
 Lack of pre-travel planning by patients
 Referral follow-up
 Non-Mexican citizens do not qualify for HIV care
in Mexico
9
Navigating HIV Services in Latin
America and Mexico
 Scenarios are different
•
•
•
•
•
•
Epidemic profiles vary by country and are changing
Mexico had 1 HIV clinic in 2005, in 2008: 56
ARV treatment access gaps & limitations
Medications: universal access is not reality
Lack of support services
Funds and resources are still an issue
 Processes are different
•
•
Different treatment guidelines and standards
Access to clinical charts from U.S. is a challenge
10
Navigating HIV Services - cont’d
 Populations at risk are different
•
•
•
Newly vulnerable populations vary by country*
• Ex-military
• Migrants
• Sex workers
• MSM
• Transgender
• Sex tourists
• Young people and children
• Pregnant women
Feminization of the epidemic
Large clinician turnover
* Kaiser Family Reporting Manual on HIV*AIDS , July 2008
11
Other Social Challenges








Social taboos
Stigma
Discrimination
Homophobia
Criminalization of sex work
Lack of social justice laws
No integration between sex education,
HIV prevention/services and reproductive
health services
Human rights issues
* Kaiser Family Reporting Manual on HIV/AIDS , July 2008
12
Conclusion
 More than 200 referrals
 Processes being formalized
 Marketing to be expanded
 Limited funding
 Evidence of demand
13
Questions?
Oscar Gonzalez, PhD
HIV/AIDS US/MX Border Coordinator
Texas/Oklahoma AIDS Education & Training Center
1936 Amelia Court, Second Floor
Dallas, TX 75235
(214) 590-2834 PH
(214) 590-2184 FAX
[email protected]
www.aidseducation.org
14