Image: Barry Zingman, MD
The Montefiore AIDS Center and its Center for Positive Living/ID Clinic outpatient treatment facility were cited among two sites in the country demonstrating best practices in caring for Latinos with HIV, according to a recent study conducted for the Health Resources and Services Administration (HRSA).
The study assessed healthcare providers' strategies to improve Latino patients’ access to and use of HIV medical and support services. Evaluators visited ten exemplary HIV providers and rated them according to three objective quality-of-care parameters: the percentage of patients being prescribed highly active antiretroviral therapy (HAART), and the percentage who have had at least one CD4 count or viral load test done in the past year.
The AIDS Center, a thriving treatment facility of the Einstein/Montefiore Division of Infectious Diseases, was the largest site surveyed in the study, with a staff of 24 physicians, physician assistants, and nurse practitioners who manage approximately 32,000 patient visits each year. The Center was one of two sites found to provide the largest percentage of 43 service strategies, administrative policies, and organizational practices to help Latinos overcome barriers to HIV care.
"We are very proud to have been selected for this distinction, particularly because Latinos are just one part of the incredibly diverse patient population we see at the AIDS Center," said Barry Zingman, MD, Professor of Clinical Medicine (Infectious Diseases) and Medical Director of the AIDS Center.
“Our success is testimony to the true team effort of the CPL/ID Clinic staff, and we all take pride in this recognition of our work,” said Robert Grossberg, MD, Medical Director of the Center for Positive Living/ID Clinic. “We are a multicultural group who is sensitive to the needs of Latino patients, and our well-structured quality improvement plan focuses on maintaining and improving our already high standard of care.”
Latinos make up 14 percent of the U.S. population (the country’s largest ethnic group), but disproportionately represent those living with HIV/AIDS, comprising 17 percent of those diagnosed with the virus and 19 percent reported to be living with AIDS. Latinos are also reported to be less likely to remain engaged in HIV care due to barriers at multiple levels.
The AIDS Center, a model program of highest quality patient care for HIV/AIDS treatment worldwide, was designed with particular focus on the needs of Latinos, including Latino leadership and staffing, culturally sensitive educational materials and support groups, on-site evaluation and treatment for hepatitis C, individualized assessment and planning for medication management and adherence, mental health services and substance abuse treatment, translation services, and support groups.
"Much of our success can be attributed to ongoing collaboration among the administration, staff, and providers, as well as strong support from our medical leadership," said Daisy Rodriguez, MS, MBA, Administrative Director of the AIDS Center. "Additionally, the fact that we are both bilingual and bicultural means we understand the social nuances of our Latino community, and we can reach out and engage them in a user-friendly way."
Ongoing quality improvement efforts include an active Consumer Advisory Board, customer satisfaction surveys, and various support and focus groups to engage Latino clients. Input is utilized in program planning and evaluation of services, according to Joan Vileno, RN, the Center’s QI Coordinator. “Quality is the core of our commitment to clients at all levels of our service delivery,” Vileno said. “This is truly a team effort, and I am honored to work in such a comprehensive HIV program with wonderful clinicians and associates.”
Many of the AIDS Center’s voluntary clinical research studies (10-15 trials are conducted at any given time) are led by Latino study coordinators and offer features such as informed consents translated to Spanish. Some studies are geared exclusively to Latino patients, such as Dr. Jonathan Shuter’s efforts to develop effective smoking cessation strategies for Latinos living with HIV/AIDS. Shuter’s program, Positively Smoke Free, offers an intensive cessation strategy with a motivational behavioral model tailored specifically for HIV-positive individuals. A forthcoming Spanish-language version of the program’s website, Positivamente Sin Fumar, was recently completed under a project funded by the American Legacy Foundation. Under Shuter's direction, the AIDS Center is also the main recruitment site for a large NIH-sponsored trial of smoking cessation strategies for HIV-infected Latino smokers.
Offering a broader range of clinical trials is one of Zingman’s goals, as well as further expanding HIV testing initiatives at Einstein/Montefiore’s three hospitals and increasing the number of patients seen at the AIDS Center and Center for Positive Living/ID Clinic.
“Montefiore and Einstein regularly reach out to populations in need, and this distinction says a lot about how effectively both institutions nurture programs like the ours,” said Zingman. “We had tremendous freedom in developing this program, and this, along with our dedicated staff, allows us to thrive for our Bronx community.”