provider beliefs

INTRODUCTION

Years after the availability and use of highly active anti-retroviral therapies (HAART), HIV/AIDS remains a significant cause of morbidity and mortality. Overall, declines in U.S.

AIDS rates have occurred in the HIV-infected population groups. But, disparities in the rate of infection and AIDS-related clinical outcomes exist between the various ethnic racial groups. The underserved and ethnic minority groups, particularly African-Americans, show the least declines in AIDS rates. African-Americans represent 12 percent of the U.S. population but accounted for 38 percent of adult and adolescent AIDS cases in 2001. While there has been a decrease in opportunistic diseases and deaths among whites with AIDS between 1991 and 2001, there has been an increase in these events among African-Americans in the same period.

The ethnic disparity in AIDS-related opportunistic illness and deaths may be attributed to current and past differences in access to HIV treatment and support services. For example, although the importance of psychosocial support services are frequently reported by HIV-infected patients, they often go unmet. Ethnicity appears to compound this problem. African-Americans with HIV/AIDS are more likely to have unmet social service needs.
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With regard to access to medical care, African-Americans are less likely to receive appropriate HIV treatment and more likely to experience delays in receiving appropriate HIV treatment. When AZT mono-therapy was in common use, there was a lower incidence of AZT treatment among African-Americans. This was not only because African-Americans were less likely to receive it but they were less likely to be offered AZT. Now with the advent of HAART, African-Americans also have less access than whites to HAART even after adjusting for level of need such as CD4 count and number of symptoms.

In light of these reports, medical and public health authorities must forge effective strategies to eliminate clinical treatment and care outcome disparities. A potentially effective strategy lies in improving the HIV treatment expertise of clinical providers who provide care to HIV-infected minority patients.

To this end, the Health Resources and Services Administration (HRSA), through funding from the Congressional Black Caucus, established the National Minority AIDS Education and Training Center (NMAETC) in 1999. Through training, clinical consultation and technical assistance, the NMAETC was mandated to strengthen the HIV clinical expertise of physicians, dentists, physician’s assistants, nurse practitioners, nurses and clinical pharmacists who were most likely to serve minority HIV-infected populations. It was believed that each of these six clinical disciplines has a critical role in the diagnosis of HIV-infection and/or clinical management of HIV disease.
In its initial year, the NMAETC focused primarily on assessing the training needs of African-American clinicians and/or clinicians that served African-American patients in the regions associated with each of the four NMAETC performance site locations. Needs assessment activities helped the NMAETC shape its training curriculum and ensure that training topics not only covered state-of-the-art HIV care but also specifically addressed pertinent care delivery challenges faced by the African-American providers in the above-mentioned disciplines.

Using multiple modalities – focused discussions and mailed questionnaires – the NMAETC set out to learn about African-American providers’ perceptions of: 1) the causes of poor clinical outcomes in minority HIV-infected patients, 2) barriers to effective HIV care delivery, and 3) priority training and technical assistance needs. Also germane to effective programming, needs assessment activities were used to help gauge to what extent the perceived barriers and needs differed between performance site locations. eriacta