1. Operation H.O.P.E.F.U.L. Sean McIntosh, AS Program Coordinator Faculty, Florida/Caribbean AIDS Education and Training Center

2. Disclosures of Financial Relationships This speaker has no significant financial relationships relevant to the content of this CME activity. This speaker will not discuss any off-label use or investigational product during the program. This slide set has been peer-reviewed to ensure that there are no conflicts of interest represented in the presentation.

3. Objectives Discuss current options for regular patient teaching sessions on health maintenance Introduce current projects and tools to assist providers with preventive care Utilize Operation H.O.P.E.F.U.L. tools to improve patient health literacy

4. Operation H.O.P.E.F.U.L. Healthy Objectives for People Enjoying Full, Uninterrupted Lives with HIV/AIDS

5. Operation H.O.P.E.F.U.L. is Prevention with Positives

6. Project Background Chart Review Assessment revealed limited documentation in the area of prevention OR Limited variance in prevention education offered

7. Project Background Need for: –Fresh prevention messages Primary Prevention Secondary Prevention –Resources to support health literacy –Prompts to begin difficult conversations –Strategies that support effective time management during appointments

8. Project Background The data demonstrate the need –Patient Survey –Provider Survey –Peer-Reviewed Literature

9. Florida MMP Provider Fact Sheet, 2007/2008 Combined Medical Monitoring Project CDC funded-project that targets a variety of indicators in multiple clinics throughout the state, including reported risk behaviors Source: Florida Department of Health

10. Florida MMP Provider Fact Sheet, 2007/2008 Combined Source: Florida Department of Health

11. Florida MMP Provider Fact Sheet, 2007/2008 Combined Source: Florida Department of Health

12. Patient Surveys Exit surveys 16 clinics in 9 states assessing prevention counseling within past 6 months Result: Significantly higher numbers of patients in clinics with written procedures to guide the provision of HIV prevention counseling reported receipt of prevention counseling and receipt of counseling “was not associated with patient race, gender, or sexual orientation.” JAIDS, Vol 37, Supplement 2, October 1, 2004

13. Recommended Standard of Care The Institute of Medicine recommends HIV prevention interventions (PwP) become a standard of care in clinical settings that serve HIV-infected patients. JAIDS, Volume 36, Number 4, August 1, 2004

14. Provider Identified Barriers Lack of time Lack of specialized training Lack of funding for staff time Some providers consider themselves “advocates for their patient rather than as guardians of the public health” JAIDS Vol 36 No 4 Aug 1, 2004

15. Importance of Providers 61 in-depth interviews with researchers and interventionists across 15 projects Findings: Models that requires PCP to deliver standardized assessment & counseling demand buy-in from the providers and someone in a position of power to enforce the change in clinical practice. AIDS Behav (2007) 11:517-529

16. Interventions Delivered in Clinical Settings are Effective in Reducing Risk of HIV Transmission Among People Living with HIV: Results from the Health Resources and Services Administration (HRSA)’s Special Projects of National Significance Initiative AIDS Behav (2010) 14:483-492 HRSA SPNS Project Results

17. 5 year study across 13 demonstration sites N=3556 participants –Medical care provider intervention vs. health educator/social worker/HIV peer –Education targeted at reducing unprotected vaginal or anal intercourse with HIV uninfected or unknown status Results –All interventions associated with reduced unprotected sex –Medical care provider interventions resulted in significant decrease in risk after 12 months AIDS Behav (2010) 14:483-492 HRSA SPNS Project Results

18. HIV Primary care clinics are an important setting in which to deliver prevention messages as patients are likely to be seen for regular care four or more times per year. Results suggested behavioral interventions are most effective if delivered in “doses”, such as routine medical care visits over time AIDS Behav (2010) 14:483-492 HRSA SPNS Project Results

19. “Based on our research, there is no one model that will both function and be accepted in every clinic.” “Successful integration depends on the complementary fit between the intervention model and the clinical setting.” AIDS Behav (2007) 11:S17-S29 Integrating Prevention with Clinical Care

20. Operation H.O.P.E.F.U.L Healthy Objectives for Persons Enjoying Full, Uninterrupted Lives with HIV/AIDS

21. Operation H.O.P.E.F.U.L Operation H.O.P.E.F.U.L. is a tool that assists health care providers provide fresh prevention messages in on a variety of topics.

22. Operation H.O.P.E.F.U.L Current topics include: Sex OI Prevention Smoking Cessation Adherence Exercise Nutrition

23. Operation H.O.P.E.F.U.L It is a challenge to educate our patients/clients on topics such as drug use and risky sexual practices, and how they relate to HIV. Sensitive subjects are approached by written 'open-ended' questions peer reviewed to be non-judgmental

24. Operation H.O.P.E.F.U.L Teaching points and behavior change suggestions are included to guide the provider and patient/client into negotiating a contract for change.

25. Operation H.O.P.E.F.U.L At each clinic visit, a card should be selected and discussed with the patient/client to offer continual reinforcement of healthy lifestyle behavior.

29. Sample Charting Form

30. Demonstration

31. Tips for implementation

32. Questions and Answers