In October 1987, the Health Resources and Services Administration (HRSA) Bureau of Health Professions,* under the Department of Health and Human Services (DHHS), established the AIDS Education & Training Center (AETC) Program to essentially build the HIV clinical workforce in the United States. Now under the HRSA HIV/AIDS Bureau, the AETC evolved its purpose to provide locally-based, tailored education, clinical consultation and technical assistance to healthcare professionals and healthcare organizations to integrate high quality, comprehensive care for those living with or affected by HIV.
In the early days of the AETC, there were two Centers that served the Pacific region: the AETC for Southern California (based in Los Angeles and led by the University of Southern California) and the Western AETC (based in Fresno through University of California, Davis). The AETC for Southern California covered the Los Angeles, Long Beach, Orange, Riverside, and San Bernardino area; the Western AETC covered the rest of California, plus the states of Arizona, Hawai`i, Nevada. The two entities worked in collaboration to serve the region.
In this first iteration of the program, much of the Western AETC infrastructure was overlaid across existing the California Area Health Education Centers (AHEC) Program, based at academic institutions throughout the state. The California AHEC is part of the National AHEC Program, which was developed by Congress in 1971 to recruit, train and retain a health professions workforce committed to underserved populations through robust community-academic partnerships. The Western AETC also negotiated similar relationships with AHEC Programs in Arizona and Nevada. Combined with other local partners at academic health institutions and healthcare entities in Honolulu, Hawai`i and California locations in Oakland, Contra Costa County, and the North and Central Coasts, our region began to take shape.
The start of our AETC program with this infrastructure was strategic and continues to influence our work today (though the AETC program is no longer officially affiliated with the AHEC Program), including local partnerships based at academic institutions throughout our region. The decision to prioritize these partnership sites was an intentional one: when funding ebbed, the academic institutions would have stronger infrastructure to sustain training the HIV clinical workforce. Indeed, these partnerships have been critical to the success and longevity of the program, as these academic institutions continue to support the work through their longstanding relationships and standing within local communities and their invaluable in-kind clinical, programmatic, and administrative expertise. Development of this workforce, and the faculty to train them, was based on Diffusion of Innovation theory, and led by Universities of California, Davis and San Francisco. However, the decentralized and network structure of the program always prioritized local partners as leaders and implementors: local clinicians would see these local thought leaders as the trusted innovators, resulting in greater acceptance and adoption of recommended HIV treatment and management guidelines included in our trainings.
The two Centers held a series of Joint Management Council (JMC) meetings which advised on current and future strategies for the region’s HIV training plan, and coordination of activities and objectives. In the mid-90s, with encouragement from HRSA, plans solidified to merge the two Centers and the JMC decided that University of California, San Francisco (where the Western AETC was then housed) would lead the new entity, now named Pacific AETC. Some Local Partners also changed / merged in the intervening years; eight Local Partners now cover the entirety of our Pacific region.
In 2000, Pacific AETC started its HIV technical assistance and training activities with the 6 US-Affiliated Pacific Islands (US-API). In close collaboration with the Hawai`i Local Partner, the efforts began by connecting with Pacific Island Jurisdictions AIDS Action Group and the Pacific Island Health Officers Association. HRSA (with leadership from Howard Lerner) soon mobilized Pacific AETC to add the six Pacific jurisdictions – American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Republic of the Marshall Islands, and the Republic of Palau – to the Pacific AETC region’s service territory.
Several of the AETC’s evaluation measures and services were established by the Pacific AETC. The concept of evaluating HIV training and technical assistance activities by a system of levels of training (Levels 1-3) was born out of the original AETC for Southern California at USC and adopted nationally. Operating out of UCSF, the Western AETC established an HIV/AIDS Warmline, which branched off to become the National Clinician Consultation Center, bringing a spotlight to the importance of clinical consultation as follow up to training (and adding the Level 4 category). Later iterations of the model noted the importance of institutional capacity building (and Level 5) was added. Finally, Pacific AETC joined the Northwest AETC (now renamed as Mountain West AETC) to become the International AETC in April 2002. That initiative further parsed out the Levels: breaking Level 5 into 5 and 6, which denoted whether capacity building efforts were on or off site. In recently years, the types of modalities have expanded and replaced the use of levels for tracking training activities.
The AETC program continues to evolve and Pacific AETC continues to be at the forefront of practice and innovation. This includes highlighting emerging science and healthcare innovation, and our commitment to health equity. Our recent priorities, for instance, includes training efforts in biomedical prevention interventions like PrEP and PEP, implementing practice transformation activities for select clinic sites, and assisting providers to understand and address issues that can hinder access to HIV services.
While the programming has evolved over the 30+ years of the AETC program, much of the work remains ongoing, urgent, and life-saving: ensuring healthcare professionals have the clinical and programmatic knowledge and skills needed to support care for people with or affected by HIV.
* The Bureau of Health Professions is no longer in existence.