MPCA News

Community Health Center Clinical Highlight: HIV/AIDS Services, Yellowstone City-County Health Department

There were 609 cumulative reported cases of AIDS in Montana through September 30, 2003. Montana currently has effective public health programs for the prevention and management of HIV statewide, through two Ryan White Comprehensive AIDS Resource Emergency (CARE) Act Title III grantees, located at Missoula City County Health Department and Yellowstone City County Health Department (YCCHD) in Billings. Major services provided under this funding include: 1) primary care services for low-income, medically underserved persons in existing primary care systems, and 2) clinical prevention services through medical, education and psychosocial services. These services are delivered through a network of public health and private practices across the state.

Through additional funding from the University of Washington, YCCHD has served as the Northwest AIDS Education and Training Center's (AETC) Montana office since 1999, with the purpose of increasing providers' capacity to provide high quality HIV/AIDS care within Montana's health care system through training and consulting services. Training is available for all Montana providers with activities based on local needs, and designed to educate a diverse group of providers including physicians, nurse practitioners, physician assistants, nurses, oral health professionals, and pharmacists. Emphasis is placed on interactive, hands-on training at four levels:

• Level 1 provides group education for prevention, screening, and counseling services; 130 participants received this training in 2003-4.
• Level 2 provides staff inservice in correctional facilities and other areas where HIV has increased prevalence, with 72 participants in 2003-4.
• Level 3 provides preceptorship for clinicians at Deering Clinic under the guidance of Medical Director Dr. Ron Smith and HIV specialist, Physician Assistant Kathy Hall; 18 clinicians were precepted in YCCHD's HIV Clinic in 2003-4.
• Level 4 provides clinical consultation by telephone or on-site with complex issues related to the management of antiretroviral therapy; 14 participants received clinical consultation services in 2004.

"The HIV program has shown progressive growth since it was started at YCCHD in 1999," says Community Health Services Director, Debbie Hedrick. In addition to the training outlined above, YCCHD"s HIV staff has developed innovative screening and counseling approaches, providing services in Billings' bars and adult bookstores as well as in jails, prisons and drug treatment centers. When new testing technology emerged, allowing testing to be done by a finger-stick blood sample instead of a venous blood draw (with results available in 20 minutes), YCCHD implemented this type of testing and has performed over 400 rapid tests since September, 2003. "Having the results available at the time of testing is so much better for the client, and makes our counseling efforts much more effective," says Hedrick. As new recommendations for the treatment of health care workers injured by accidental needle-stick have been developed by the Centers for Disease Control, YCCHD's HIV team has developed Post-Exposure Prophylaxis (PEP) protocols which are available for distribution, and provides PEP consultation as well.

"We're very proud of our program," says Hedrick, "and we want to get the word out that we are here to provide services and support for patients, facilities, and clinicians."

Hedrick can be reached at 406-247-3377, or at debbieh@ycchd.org.

Montana Primary Care Association 1805 Euclid Avenue Helena, MT 59601 Phone: (406) 442-2750 Fax: (406) 449-2460