Rebekah Israel of the Black AIDS Institute discusses health literacy among the HIV/AIDS workforce and the implications for moving people with HIV along the continuum of care.
This presentation was given at the Under the Baobab African Diaspora Networking Zone at the International AIDS Conference, AIDS 2014.
Knowledge, Attitudes and Beliefs of the HIV/AIDS Workforce
1. Knowledge, Attitudes and Beliefs
of the HIV/AIDS Workforce
Health Literacy Amongst the HIV/AIDS workforce
and implications for moving PLWHA along the continuum of care
Rebekah Israel
Training and Evaluation
Coordinator
Black AIDS Institute
www.BlackAIDS.org
2. Black AIDS Institute
Founded in May of 1999, the Black AIDS Institute is the
only national HIV/AIDS think tank focused exclusively on
Black people. The Institute's Mission is to stop the AIDS
pandemic in Black communities by engaging and
mobilizing Black institutions and individuals in efforts to
confront HIV. The Institute interprets public and private
sector HIV policies, conducts trainings, offers technical
assistance, disseminates information and provides
advocacy mobilization from a uniquely and
unapologetically Black point of view.
4. Why Aren’t We There Yet?
But
We haven’t been exactly sure of
where we’re at to know where we
want to go or what to do with the
information.
We are failing in retention in care,
utilization of ARVS, and achieving viral
suppression.
There is lack of knowledge around and
resistance to PrEP.
4
We Know
1.Anecdotal experience
highlights lack of knowledge and
skills among many in the HIV
workforce
2.Early care and treatment
brings better clinical outcomes &
Viral suppression reduces
transmission of HIV
3.PrEP dramatically reduces
acquisition of HIV
6. Continuum of Care
by Race
http://www.cdc.gov/nchhstp/newsroom/docs/2012/Stages-of-CareFactSheet-508.pdf
African Americans are least likely to be in ongoing care or to have their virus under control
7. The Need to Assess
Health Literacy
Lack of science literacy, stigma, conspiracy beliefs,
etc. reduce the likelihood that communities will
access HIV prevention and medical treatment
AIDS Service Organizations and community based
organizations will play a different and more integral
role in HIV prevention and treatment
KNOWLEDGEKNOWLEDGE
STIGMASTIGMA
8. Goal of KAB Survey
Better understand what treatment
educators, prevention workers, and
outreach workers, client services
managers, local and state health
department employees know and
don’t know about the science of
HIV/AIDS.
9. Research Questions
Is the current AIDS workforce equipped to respond
to a post healthcare reform world where bio-
medical interventions are integrated into current
prevention and treatment models; equipped in
both knowledge and attitude capacities?
Is the current AIDS workforce up-to-date and
informed about biomedical interventions?
Are there gaps in knowledge, beliefs and attitudes
that continue to reinforce programmatic limitations
in fight against AIDS, specifically in communities of
color?
10. Project Details
All respondents had to meet the following
requirements:
– Worked or volunteered in HIV
– Age 18 or older
– Work in ASO, State/local health department, or other CBO
– Work focused in US and its territories
All respondents received incentives
– USCA 2012: $15 Amazon Gift Card and raffle for KindleFire Tablet
– National Roll-Out: $5 Amazon Gift Card
12. Average Score by Question
Category
07.11.2013
12
Letter gradesLetter grades CC FF FF DD
13. Education Levels Had
Greatest Impact
% Correct Answers by Level of Education
Sample size: 2166; Assoc. degree or below: 595; College degree: 735; Some graduate education or above: 836
Statistically significant differences between comparison groups marked with a letter (95% significance)
Overall mean:
62.3%
13
14. Tenure in HIV Field is a
Key Driver of Scores
% Correct Answers by Tenure in HIV Field
Sample size: 2166; 0-2 years: 485; 3-5 years: 611; 6-10 years: 423; 11-15 years: 269; 16+ years: 378
Statistically significant differences between comparison groups marked with a letter (95% significance) 07.11.2013 14
DD DD DD DD DD
15. Black and Latino Respondents
Scored Lower
"Other" consists of respondents identifying themselves primarily as any one of the following: American Indian or
Alaskan Native (n=28), Native Hawaiian or other Pacific Islander (n=23), Asian (n=42) or "Other" (n=57)
% Correct Answers by Race/Ethnicity
Sample size: 2166; African American: 832; Hispanic: 249; White: 935; Other: 150
Statistically significant differences between comparison groups marked with a letter (95% significance)
Overall mean:
62.3%
07.11.2013 15
FF FF DD DD
16. Smaller Organizations
Scored Lower
% Correct Answers by Organization Size
Sample size: 2166; 0-10: 647; 11-20: 490; 21-30: 402; 31-50: 242; 51-100: 185; 101 or more: 200
Statistically significant differences between comparison groups marked with a letter (95% significance)
Overall mean:
62.3%
07.11.2013 16
17. Director/Managers
Scored Higher
% Correct Answers by Primary Role
Sample size: 2166; Prevention & Outreach: 577; Case Mgmt/Social work: 497; Director/Manager: 343; Administrator: 150; Supportive
Services: 297; Other: 302
Statistically significant differences between comparison groups marked with a letter (95% significance)
Overall mean:
62.3%
07.11.2013 17
18. Respondents with Positive
Attitudes Scored Higher
Except for two attitudinal items, respondents with high familiarity /agreement were significantly more likely to have higher scores
Sample size: 2166 Statistically significant differences between comparison groups marked with a letter (95% significance)
% Correct Answers by Level of Familiarity % Correct Answers by Level of Agreement
07.11.2013
19. Conclusions
We need to improve the HIV treatment and Science
literacy among ASO’s and CBOs, particularly among
Blacks, Latinos, and people in the south—given the
demographics of the epidemic.
Increasing HIV science and treatment knowledge and
familiarity with bio medical interventions might
1. Help improve retention in care, utilization of ARVs,
and achieving viral suppression
2. Reduce resistance to ARV therapies and bio medical
interventions, particularly amongst Blacks, Latinos,
people living in the South
3. Decrease HIV related stigma and discrimination
20. Next Steps
Expand study
Develop training and capacity building services that fill these gaps
Policy changes
Increase funding and support for training and capacity building
Standardized base of knowledge for HIV workforce
07.11.2013
20
21. Increasing HIV Science Literacy
in the US: AAHU Model
African American HIV University
Science and Treatment College
22. AAHU
Aimed at strengthening organizational and
individual capacity to address the HIV/AIDS
epidemic in Black communities, the African
American HIV University (AAHU) is a
comprehensive training fellowship and
scholarship program. The program is designed
to decrease stigma and misperception and
increase the engagement of the Black
community in HIV prevention and treatment
services. This is achieved through leadership
development and information transfer among
key stakeholders.
23. AAHU Science and Treatment College
The STC curriculum prepares community-based, and
AIDS service organizations, and Health Departments on
how to improve their performance in the treatment
cascade. (CBOs/ASOs) to serve as liaisons between
people living with HIV/AIDS and the entities that serve
them. STC focuses on HIV and its relationship to human
biology, virology, pharmacokinetics, epidemiology, and
treatment strategies. By the end of AAHU STC,
organizations and their Fellows will be stewards of a
living, breathing Black Treatment Advocates Network
(BTAN).
24. AAHU STC 2013-2014
Cohort
11 US Cities 10 States
Atlanta, GA
Baltimore, MD
Chicago, IL
Jackson, MS
Kingston, Jamaica
Little Rock, AR
Los Angeles, CA
Melbourne, FL
Oakland, CA
Richmond, VA
St. Paul, MN
Washington, DC
Arkansas
California
District of Columbia
Florida
Georgia
Illinois
Maryland
Minnesota
Mississippi
Virginia
16 Fellows representing eleven U.S. Cities, ten States and Jamaica:
25. AAHU STC Trainings
Training 1: Science Academy (30 Days)
Internship 1
Training 2: Community Mobilization (7 Days)
Internship 2
Training 3: Program Planning, Implementation, &
Evaluation (7 Days)
Internship 3
Training 4: Advanced Science and Presentation Skills (7
days)
Internship 4
26. STC Internship Periods
60-90 day internships allow Fellows to apply the skills and
knowledge gained during trainings.
Internships allow Fellows to demonstrate proficiency in
executing key components of each training, that establishes a
(or contributes to an existing) Black Treatment Advocates
Network (BTAN).
Fellows have specific assignments during internships such as
conducting face-to-face meetings with local ASOs, CBOs,
health department staff, research institutions, and other
potential BTAN partners.
28. HIV Science & Treatment Knowledge
Assessment 30-Day Boot Camp
57%57%
90%90%
*Scores over 100% indicate extra credit awarded
29. Fellows’ Feedback
“Having the
opportunity to get a
firm foundation on
basic sciences and
the HIV lifecycle and
how they both
impact HIV
treatment.”
“Having the actual medical practitioners, researchers and
scientists instructing us was like an experience that can't
be matched by any other training I have ever
experienced.”
“The site visits
gave
tremendous
insight into the
behind the
scenes real-life
action of the
war against
HIV.”
30. Internship 1: From Boot Camp to the
Battlefield
16 STC Fellows trained approximately 500 people in
their local areas.
Chicago Fellows, facilitated three post-boot camp
presentations.
Approximately 70 participants were trained on the
following topics: The Origin of HIV &Basic HIV Science
Average pre-test of participants 40.2%
Average post-test of participants 94.2%
31. The mission of the Black Treatment Advocates
Network (BTAN) is to increase patient access to and
utilization of treatment and care, strengthen local
leadership and advocate for policy change in Black
communities.
BTAN is guided by the premise that when
people understand the science of HIV/AIDS
they are:
Less likely to participate in stigmatizing
behavior
More likely to access treatment
Better able to adhere to their regimens
Better positioned to influence HIV policy
Internship 2: BTAN Responding to the
Needs of the Community
33. Internship 2: BTAN Responding to the
Needs of the Community
13 STC Fellows facilitated
trainings on HIV Science and
Treatment. Total reach was
approximately 450 people in
their local areas.
8 BTAN cities hosted National
Black HIV/AIDS Awareness Day
reaching 925 people.
Internship 2 reach: 1,375
people
Total Fellowship reach: 1,875
people
34. BTAN National Black HIV
Awareness Day PrEP Events
The following BTAN cities hosted
NBHAAD PrEP themed events:
BTAN Little Rock
BTAN Bay Area
BTAN Atlanta
BTAN Los Angeles
BTAN Minneapolis
BTAN Broward
BTAN Jackson
BTAN Louisiana
Reaching 925 individuals
35. Training 3: Program Planning, Implementation, and
Evaluation
Internship 3
Training 4: Advance Science Skills
Internship 4
40. 7 New BTAN
Chapters
6 Re-launched
BTAN Chapters
1,875 People
Trained
520 People
Tested
350 New BTAN
Members
Community Impact
10 New
Community
Partnerships
44. THANK YOU!
FOR MORE INFORMATION PLEASE VISIT
www.BlackAIDS.org
OR CONTACT ME
Rebekah Israel
Training and Evaluation Coordinator
Black AIDS Institute
rebekahi@BlackAIDS.org
Editor's Notes
Founded in May of 1999, the Black AIDS Institute is the only national HIV/AIDS think tank focused exclusively on Black people. The Institute's Mission is to stop the AIDS pandemic in Black communities by engaging and mobilizing Black institutions and individuals in efforts to confront HIV. The Institute interprets public and private sector HIV policies, conducts trainings, offers technical assistance, disseminates information and provides advocacy mobilization from a uniquely and unapologetically Black point of view.
Education 10
College Degree 6.5
Tenure in the Field 15+ years 7.0
Tenure in the Field 10-14 years 4.5
Government employee 6.3
Hispanic/Latino -6.3
Black -6.2
LGBT 5.5
HIV + 4.8
Small org. -4.0
Director/Manager 3.2
Supportive Services -2.7
Volunteer -2.4
Deep south -2.3
Mal -1.8
Age -.1 w/ every year
Hi risk testing
Linkage to care
Adherence
ART
Viral suppression
Understanding biomedical interventions
AAHU STC…. And their fellows will be charged with developing and sustaining local BTAN
Each BTAN with 4 programmatic areas, treatment education, patient navi, disclosure, advocacy
r
Over 50 training days total in 11-months
Training 1: August 3-30, 2013
Training 2: November 10-15, 2013
Training 3: March 16-21, 2014
Training 4: May 18-23, 2014
Graduation & Symposium: July 10-13, 2014
For the purpose of this time, I’m going to talk about Training 1, Int 1, Internship 2 and overall impact.
Most Valuable Aspects of the 30-Day Science Academy
The following four aspects were most mentioned as being the most valuable in the evaluation
Internship 1 Requirements:
upload a weekly blog sharing their experiences as an AAHU Fellow
present a one of the Science Academy Modules; at least 4 hours of training
Coordinate and attend face-to-face meetings to form partnerships and initiate collaboration on the AAHU project
develop a draft CitySheet
attend between 3-5 webinars hosted by the Black AIDS Institute and AAHU Faculty
Internship 1 Report
Internship 2 Requirements:
upload a weekly blog sharing AAHU experiences on the Black AIDS Institute webpage
engage in activities and gain access to local data; to aid in assessing community needs
attend and/or join a local planning committee
launch Black Treatment Advocate Network (BTAN) and conduct a 3-day training
attend between 3-5 webinars hosted by the Black AIDS Institute and AAHU Faculty
Internship 2 Report including a needs assessment
Example: John Curry, Melbourne FL
Leaders of 2 of the largest Black churches attended
Secured partnerships with Gilead, Bristol Myers Squibb, and ViiV
BTAN members who hadn’t registered for an insurance plan could register during the training. There was a Marketplace Coordinator onsite!!!
There were speakers who were HIV positive that spoke at adherence (positive and negative examples). The participants got a chance to meet someone who was resistant to all the meds and has been given 12 months to live.
The Florida Faces of HIV 18 wheeler truck was on display to promote HIV testing
The HIV/AIDS Program Coordinator, the highest HIV position in the area was on site for Day 3
HIV staff from Orange County (Orlando) and Brevard (Melbourne)
I would estimate that the food and rental space cost between $1,000-$1,500 and it was all covered by the pharmaceutical companies
What were some successes from the events?
Participants commented that the PREP information sheets were thorough and simple enough that someone with no previous knowledge of PREP could easily comprehend.
Increased amount of clergy participation
We were able to have various community leaders in attendance; Black elected officials, Black clergy, Black media personalities, minority agency administrators, and consumers.
Gaining new partnership for future events.
Attendance; diversity of group; speed dating set-up; Phill; sponsors
How PrEP works; the location where PrEP is being implemented; and how a person can enroll in PrEP.
Great turn out!! The community came together to make the event a success The word got out successfully about the event
What were some of the challenges?
The primary challenge for me was the fact that the event almost seemed like a Department of Health event instead of a BTAN event.
Access to community.
Communication and Institute support
There were no Challenges
We were not prepared for the influx of people that we had. We were expecting only 300 but we had over 500 and we had to keep going out to get extra food. We didn't have enough volunteers to serve food and coordinate activities.
Summary of Pre/post test results and community impact
AAHU is just one of the methods that we use to in crease health literacy among the HIV work workforce. To help move Black people along the Continuum of care