American International Health Alliance

OrenburgNewYorkCity

Orenburg, Russia / New York City, New York

2004-2008

Focus: Evidence Based Practice, HIV/AIDS, Health Services Administration, Occupational Health, Drug Addiction and Control

The Partners

Partnership Objectives

Key Events and Achievements

Participating Institutions

The Partners

US Partners: Elmhurst Hospital Center was the lead US institution, drawing on its own extensive knowledge and expertise, as well as that of Mt. Sinai School of Medicine, the New York City Department of Health’s HIV Surveillance Unit and AIDS Institute, the AIDS Center of Queens County, and a vast network of area community- and faith-based organizations.

Russian Partners: The Orenburg Oblast AIDS Center was the lead Russian institution, joined by several other local and provincial organizations.

Partnership Objectives

The overall goal of the partnership was to strengthen the human and organizational capacity to develop a replicable and integrated model of HIV/AIDS treatment, care, and support based on international standards and best practices.

To achieve this, partners:

Increased the knowledge and skills of existing medical staff at the Orenburg AIDS Center in key areas related to HIV/AIDS care and treatment;

Increased the number of HIV patients receiving initial and ongoing care at the AIDS Center; and

Integrated social service organizations and other healthcare specialists into the routine management of HIV patients.

Key Events and Achievements

Institutional and Human Resource Capacity Building

During professional exchanges, Russian partners observed services provided by clinical staff at Elmhurst Hospital and other institutions, as well as staff and volunteers at numerous community-based organizations, including drug rehabilitation centers and patient-led support groups.

Partners established an HIV/AIDS Steering Committee in Orenburg to determine local needs using a community-based multidisciplinary approach. As a result, the committee created two case manager positions at the Orenburg AIDS Center, vastly improving coordination of clinical care and social support services for PLWH.

Due to an exceptionally high level of interest in partnership activities, Mt. Sinai Medical School and the Orenburg Medical School continue to discuss opportunities to develop an HIV curriculum for future implementation at Orenburg Medical School.

Partners conducted an HIV/AIDS knowledge and attitudes survey among healthcare workers and analyzed the findings to determine gaps and better focus training and capacity building activities. They also conducted periodic clinical chart audits to effectively monitor and evaluate patient care and outcomes.

Partners initiated a Patient Intake Clinic at the Orenburg AIDS Center and trained nursing staff to conduct medical assessments. Nursing staff were also trained in psychosocial skills, so they could better counsel and support newly diagnosed HIV patients. Forms and templates provided by Elmhurst Hospital Center were adapted for use in Orenburg.

Partners placed a strong focus on improving infection control and occupational health practices at Orenburg AIDS Center and other facilities that provide care and treatment to PLWH. Thanks to the advanced training they received through the partnership, the Russian clinicians continue to conduct local trainings on infection control.

US partners ensured that PLWH who receive care and treatment from the Elmhurst Hospital Center were very much a part of the professional exchanges they hosted for their Orenburg colleagues. The Elmhurst HIV patients initiated a letter-writing exchange with HIV-positive patients at the Orenburg AIDS Center, sending letters about their own experiences and offering hope to patients in Orenburg for the partners to distribute.

Orenburg AIDS Center nurses now routinely conduct patient assessments and provide patient education during their appointments at the center. Prior to the partnership, nurses were neither trained nor authorized to do this; these activities were done only by physicians.
Partners instituted a clinical mentoring program that operates on a monthly basis and brings experienced practitioners from AIDS Centers in both Orenburg and St. Petersburg to target sites where they assess the clinical skills of specialists from district and primary care clinics according to a well structured assessment form that includes both mentors and trainee feedback.

AIHA continues to monitor the quality of HIV care provided at the Orenburg AIDS Center. This is the fourth year when regular clinical chart audits were conducted in close collaboration with care providers in Orenburg and the monitoring will continue in 2009 through funding from a new cooperative agreement.

AIHA provided technical assistance for randomizing patient charts that are selected for treatment monitoring. Data from these clinical chart audits is analyzed, reported, and discussed with the AIDS Center administration in Orenburg.

In July 2008, AIHA conducted a second round of patient satisfaction surveys at the AIDS Center. Data is being analyzed and compared to baseline data from July 2007 and the results will be discussed with local institutions, administrations, and the Russian and US partners.

Infectious disease physicians working in primary care policlinics at the project sites were trained in management of ART for adult patients and are currently undergoing additional on-the-job training through mentoring by experienced care providers from the AIDS Center and the US partners.

Partners implemented a comprehensive PMTCT program in Orenburg to focus on continuous institutional evaluation of PMTCT services with a structured assessment tool. In addition, they implemented a training
program targeting ob/gyn, pediatric, and infectious disease services, along with a PMTCT monitoring system that utilizes a PMTCT database developed by AIHA in cooperation with partners.

Partners developed quality assurance tools — including HIV Patient Chart Audits, HIV Patient Satisfaction Surveys, and the PMTCT monitoring database — which they adapted and integrated into the care systems.

Orenburg partners, in cooperation with their St. Petersburg counterparts, developed a training course on stigma and discrimination for community-based institutions, including primary care centers, social services, and other non-HIV-specialty institutions. The course is used continuously with the active engagement of medical education institutions in Orenburg, as well as in St. Petersburg.

Partners implemented a case management system to effectively link medical and social services and provided extensive training and on-the-job mentoring for new case managers. Guidelines for implementation of the case management system were derived from this experience, developed, and replicated.

The Orenburg partners integrated a number of specialized training curricula on HIV/AIDS topics such as Adult ART, PMTCT, TB-HIV, and Palliative Care into professional medical education provided by regional medical education institutions.

AIHA supported the establishment of HIV/AIDS Information Resource Centers at the Orenburg AIDS Center and medical education institutions in the oblast to facilitate access to evidence-based information on HIV/AIDS care and treatment for faculty, doctors, nurses, social workers, NGO staff, and patients.

Continuation and expansion of the activities initiated through the Orenburg/New York City partnership is currently being funded by PEPFAR through AIHA's HIV/AIDS Treatment, Care, and Support Project.

Participating Institutions

Elmhurst Hospital Center
Mt. Sinai School of Medicine
New York City Department of Health’s HIV Surveillance Unit and AIDS Institute
AIDS Center of Queens County
Orenburg Oblast AIDS Center