HealthHIV’s Staged Training to Engage Providers Model to Integrate HIV Care in Primary Care Settings
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Creating the STEP Model HealthHIV developed the STEP Model for HIV integration in primary care in response to limited existing models of HIV testing and care. The model provides a staged framework for integration of HIV care into primary care. At its core, this dynamic model classifies community health centers and other primary care delivery sites, based upon where they fall in the spectrum of HIV care delivery. Classifying health centers in this framework allows HealthHIV to deliver customized HIV capacity building and clinical training responsive to the needs of individual centers. The model is derived by merging two classification systems: ■ Stages of HIV Care ■ Models of Care
Stages of HIV Care The Stages of HIV Care classification system also developed by HealthHIV, aligns community health centers and other primary care sites along a spectrum according to the HIV testing, care, and treatment ser vices delivered. Community health centers providing only testing ser vices are classified as the Foundation Stage. Each succeeding stage represents an increase in the complexity of HIV care provided to patients.
Foundation Stage Provide HIV Testing (routine or targeted) but no medical management for patients with positive test results
Stage 1 Onsite management of stable HIV-positive patients who are ARV naive or on 1st line ARV therapy, and management of common complaints
The Stages of HIV Care were informed by the HRSA/HAB Guidelines for HIV Clinical Care as well as various State HIV care plans and the WHO clinical staging for HIV/AIDS for Adults and Adolescents.
Stage 2 Onsite management of stable HIV-positive patients who are on 2nd line ARV therapy and/or those with opportunistic infections or advanced HIV disease
Stage 3 Onsite management of complex HIV-positive patients who are on 3rd line or salvage therapy and/or with complex opportunistic infections, and/or the need for PMTCT
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Models of HIV Care The Models of HIV Care classification system focuses on how community health centers deliver care to patients living with HIV. Classification is determined through an assessment of the systems community health center’s have in place, to meet the primary care needs of their patients living with HIV. Focusing on how HIV primary care is delivered, each model incorporates the use of onsite staff in providing HIV care, with support from more experienced on-site, or previously identified community providers/mentors. Mentors or consultants are used to facilitate the delivery of most of the HIV care by the community health center’s staff providers/ clinicians, with availability for consultation as needed for cases of higher medical complexity or acuity. The Models of HIV Care were informed by the National Association of Community Health Centers’ resource “Integrating HIV Screening into Routine Primary and Dental Care: A Health Center Model” and the CDC’s Program Collaboration and Service Integration Framework. In addition, HealthHIV conducted qualitative interviews with CHCs to determine which models developed organically within CHCs.
External HIV Care HIV testing (routine or targeted), but no medical management for HIV Patients.
Collaborative HIV Care HIV care with primary care with extensive collaboration and consultation from clinical mentor.
Supported HIV Care HIV care within primary care supported by consultation with clinical mentor as needed.
Comprehensive HIV Care Management HIV and primary care fully integrated for management of complex co-morbid conditions, PMTCT, and complex OIs. Access consultation from clinical experts as needed.
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HealthHIV’s STEP (Staged Training to Engage Providers) Model The STEP (Staged Training to Engage Providers) Model is a framework for integrating HIV care into primary care, recognizing that community health centers are each at different stages in their HIV care provision. The model is used to classify community health centers along a spectrum of HIV care delivery, provide a framework for the delivery of capacity building assistance, and guide a stepwise progression for health centers implementing higher level of care and management for patients living with HIV. The model guides capacity building and clinical training to advance community health centers toward the goal of providing comprehensive primary care for their patients living with HIV.
Supported HIV Care
Stage 3
Collaborative HIV Care External HIV Care Foundation Provide HIV testing (routine or targeted) but no medical management for patients with positive results
Comprehensive HIV Care Management
Stage 2 Onsite HIV care integrated with primary care, supported by consultation with clinical mentor as needed for management of treatment failure and/or co-morbid conditions complicated bt HIV disease and/or trearment
Stage 1 Onsite HIV care integrated with primary care through extensive consultation from clinical mentor for initiation of ARV regimen and for management of more complex patients
Onsite HIV care integrated with primary care, including management of complex co-morbid conditions, PMTCT, and complex OI’s with access to consultation from clinical mentors as needed
The Model in Action: The HIV Primary Care Training and Certificate Program HealthHIV’s HIV Primary Care Training and Certificate Program is based upon HealthHIV’s STEP model for integrating HIV in Primary Care. The program is designed to improve clinical and professional knowledge, skills, and competencies as well as improve ability to provide quality care to people living with HIV.
This program is designed for primary care providers (MDs, or DOs, nurse practitioners, and physician assistants) who are responsible for caring for patients at-risk for or infected with HIV. For details of HealthHIV’s HIV Primary Care Training and Certificate Program, visit www.healthiv.org
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