The Alaska Native Tribal Health Consortiums Healthy Transitions Project A Special Project of Nationa

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions ProjectA
Special Project of National Significance
Presented byTracy Speier, B.A., Project
Coordinator, ANTHCand Gloria Eldridge, Ph.D.,
Evaluator, UAAFunding provided by the US DHHS
PHS Health Resources and Services Special Project
of National Significance Grant 1_H97_HA_00256-01
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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project
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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project
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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Goal 1
• Examine medical services and outcomes for
• HIV positive individuals newly referred to the
  ANTHC Ryan White Title III EIS program.
• HIV positive individuals already receiving
  services through the ANTHC Ryan White Title III
  program.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• ANTHC Ryan White Title III EIS program
• New program (less than one year old) N? 87.
• First Title III program awarded to an
  Native-owned and operated health care facility.
• Unique model Provides services for all HIV
  individuals statewide through a network of urban,
  rural and remote clinics in Alaska.
• In the Anchorage area, provides services for
  Alaska Natives only and collaborates with other
  Title III program for non-Natives.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Workplan
• Discussion and agreement with Ryan White Title
  III EIS program.
• Prepare and submit IRB protocol.
• Discussions with Ryan White Title III EIS program
• CAREWare database
• Standard variables custom variables
• HIPAA protections
• Data-sharing plan
• Develop research questions
• Value to Ryan White Title III EIS and ANTHC
• Do not duplicate routine reporting (CADR)
• Of interest to other programs
• Can be addressed with data available
• Train Title III EIS staff
• Human subject protection informed consent
  procedures

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Research Questions
• 1. Demographic characteristics of patients in
  Title III EIS?
• 2. Are there differences between patients living
  in rural and remote areas of the state and those
  living in urban areas?
• Entry into Ryan White Title III EIS
• Medical outcomes
• Treatment adherence
• Case management and other services
• Relocation patterns
• 3. Are there differences between Alaska Native
  and non-Native patients in rural and remote
  areas?
• Entry into Ryan White Title III EIS
• Medical outcomes
• Treatment adherence
• Case management and other services
• Relocation patterns

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Research Questions (continued)
• 4. Are there differences between male and female
  patients?
• Entry into Ryan White Title III EIS
• Medical outcomes
• Treatment adherence
• Case management and other services
• Relocation patterns
• 5. What are rates of co-occurring infectious
  diseases?
• TB
• Hepatitis
• STD
• 6. What are characteristics associated with
  testing and entry into Ryan White Title III EIS?

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Goal 2
• Development of a collaborative relationship
  among ANTHC, Regional Tribal Organizations, and
  the Alaska DOC to develop an integrated system
  for discharge planning and transitional case
  management to facilitate
• health screening
• early identification of HIV
• referral into treatment, and service referrals
  for high risk Alaska Natives being released from
  prison

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Workplan
• Meetings with ANTHC and DOC to develop agreement
  for collaboration.
• Select pilot intervention site.
• Planning meetings with ANTHC, RTOs and DOC to
  develop
• Pilot transitional case management and discharge
  planning program
• Assessment instruments
• Protocols for recruitment of participants,
  informed consent, and follow-up evaluation
• Write and submit IRB protocol.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Importance of developing ANTHC/DOC collaboration
• Alaska Natives are 18 of the population of
  Alaska but 36 of the population of the Alaska
  Department of Corrections.
• HIV rates are 4 times higher in correctional
  populations than in the general population in the
  U.S.
• Short sentences and rapid return to community
  with high rates of recidivism.
• Correctional facilities house large proportions
  of individuals with
• Infectious diseases, including HIV, hepatitis,
  TB, and STDs
• Substance abuse, Mental health problems
• Poor access to health care outside of prison
• Prison provides a window of opportunity to
  address important personal and public health
  problems.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Barriers to developing prison/health provider
  collaborations
• Correctional systems are mandated to provide
  security and custody.
• Health care, programs, and rehabilitation are
  secondary.
• Correctional systems have limited budgets.
• Budgets declining while rates of incarceration
  are increasing.
• Health care budgets are strained by providing
  community standards of care for HIV and
  hepatitis.
• Correctional systems are under public scrutiny.
• Stigma against prisoners, substance abuse, HIV
• Antipathy to providing perks for prisoners
• Attitude that criminals should do hard time and
  a long time
• Lack of awareness that prisoners return to their
  communities

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Barriers to developing prison/health provider
  collaborations
• Stigma and lack of knowledge about HIV in
  correctional institutions
• Administrators
• Correctional officers
• Program staff
• Inmates
• Visitors
• Prison rules and regulations constrain
  HIV-education.
• Substance use and sexual activities are
  disciplinary infractions.
• Harm reduction methods not available in prisons.
• Prohibitions on explicit educational
  materials/props.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Barriers to developing ANTHC/DOC collaboration in
  Alaska
• Change in state administration
• Correctional administrators serve at the pleasure
  of the governor.
• New administrations cause pervasive changes and
  delays in implementing programs.
• Change in philosophy of corrections away from
  rehabilitation/programs to custody/security.
• Shrinking state budget for corrections
• Substance abuse treatment, sex offender
  treatment, and other treatment programs cut from
  state corrections budget.
• Prison overcrowding and pressure from private
  prison corporations to contain costs.
• Cutbacks in access to health care for prisoners.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Barriers to developing ANTHC/DOC collaboration in
  Alaska
• Public attitudes toward prisoners
• Conservative state with punitive view of
  corrections.
• Negative attitudes toward providing health care
  and other services for prisoners in the face of
  cutbacks to other state programs.
• HIV is not seen as high priority need in the
  state.
• Limited history of cooperation between ANTHC,
  other Regional Tribal Organizations, and the
  Department of Corrections
• Question of who pays for services for
  incarcerated Alaska Natives?
• Need for cross-cultural awareness Alaska Native
  cultures vs. Corrections culture vs. Public
  Health culture vs. medical treatment culture.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project

• Goal 3
• Conduct in-depth risk assessments and make
  appropriate referrals for HIV identified Alaska
  Natives who are on pre-release status or who are
  in community corrections.
• Note Implementation and the final form of goal
  3 are dependant upon goal number 2.

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The Alaska Native Tribal Health
ConsortiumsHealthy Transitions Project
The Alaska Native Tribal Health
Consortiums Healthy Transitions Project 4210
Tudor Center Dr. Suite 301 Anchorage, Alaska
99508 1-907-729-3951 tspeier_at_anmc.org