P5-S6.11 HIV prevention with positives provider training in a resource-constrained setting: the US Virgin Islands

Abstract

Background: To describe HIV Prevention with Positives training for healthcare providers in the USA Virgin Islands (USVI). Methods: The Caribbean region has the world's second highest adult HIV prevalence after Africa. In 2007, the prevalence rate of HIV among adults and adolescents in the USVI was 641.3 per 100 000 population. In the USVI, HIV clinical care is provided by three physicians at the USVI Department of Health or at community health centers. Due to a shortage of trained clinicians, non-clinical providers play a crucial role in the delivery of comprehensive HIV care. Ask Screen Intervene (ASI), a training curriculum, was developed by the National Network of STD/HIV Prevention Training Centers and the AIDS Education and Training Centers with support from Centers of Disease Control and Prevention. ASI was designed for clinical HIV providers and discusses risk assessment, STD screening, prevention messages and partner services for HIV+ patients. In June 2010, the Region II STD/HIV Prevention Training Center offered ASI in the USVI, in St. Croix and St. Thomas. ASI was targeted to clinical and non-clinical providers to encompass the range of providers caring for HIV+ patients. Participants completed an evaluation rating the training and a retrospective self-assessment of their confidence to perform learning objectives on a 5 point Likert Scale; 1=not at all confident and 5=very confident. Results: A total of 37 providers attended training in St. Croix and 42 in St. Thomas. Non-clinical providers represented a significant proportion of attendees; 62.2% in St. Croix, (23/37) and 40.5% in St. Thomas (17/42). Among all participants, course satisfaction ratings ranged from 4.28 to 4.59 (1=strongly disagree; 5=strongly agree), with high ratings for relevance of learning objectives and appropriateness of content. Participants reported post-training gains in confidence ranging from +0.69 to +1.24 Likert scale interval per each learning objective, including increased knowledge of STD screening and prevention counselling for HIV+ patients. The most frequently reported intended practice changes included asking more detailed questions routinely about sex practices and taking a more thorough sexual history. Discussion ASI training reached the intended target audience and resulted in gains in provider confidence and intention to change practice, and can be expected to positively impact patient outcomes. Further dissemination of ASI training appears warranted.