California’s vast geography includes many rural and underserved areas where access to quality HIV care and prevention services is limited. Patients living in these rural areas often have to travel >50 miles…

California’s vast geography includes many rural and underserved areas where access to quality HIV care and prevention services is limited. Patients living in these rural areas often have to travel >50 miles to access these services, and rural healthcare providers that do offer them are often overextended to handle the demand. Rates of retention in care and viral suppression for people with HIV in these areas are lower than the national average. In addition, barriers such as cost of care, HIV stigma and discrimination, confidentiality concerns, and substance use are existing barriers that affect people with HIV living in rural communities. Click on the infographic to the right for more information >>

In this short video rural clinicians and people with HIV describe the challenges of access and stigma in rural environments. Challenges include finding providers who are knowledgeable about HIV, fear of disclosure in communities with a single medical provider or pharmacy, and fear of community rejection if one’s HIV status is known. The positive impact of a supportive and knowledgeable healthcare provider is also discussed. The video was created by the AETC Program Rural Health Committee in 2016.

In response to a request from the California Department of Public Health Office of AIDS, Pacific AETC has collected a list of on-demand training, toolkits, guides, and other healthcare resources that support existing and new HIV service providers in these communities.

In addition to these resources, Pacific AETC’s network of Local Partners offers real-time training, technical assistance, clinical preceptorships, and other capacity-building services for new and non-HIV providers looking to expand their practice to include HIV services.

National and Regional Resources that are valuable to providers in rural and underserved areas are located below this map.  Click on the Local Partner Areas in California to see what resources are available specific to your area.

Resources and Partner organizations

Smartphone App

HIV Care Tools – The popular AETC Program app supports health care providers with point-of-care tools for HIV screening, prevention, and care.

On-Demand Learning

National HIV Curriculum – Provides free educational courses on up-to-date information and knowledge for HIV prevention, screening, diagnosis, treatment, and care.

Webinar: Making the Case for Opt-Out HIV Testing (awaiting HRSA approval)

Webinar: HIV Prevention and Treatment Challenges in Rural America

Webinar Series: The Continuum of HIV Care in Rural and Underserved Communities: Strategies for Addressing Treatment Disparities in the Southeast US, Parts 1 & 2 – This archived training series covers the following:

• HIV therapies based on their efficacy, safety, adherence potential, and drug-drug interactions
• Strategies to improve rapid HIV treatment initiation in rural and underserved settings
• Applying current recommendations, clinical evidence, and patient characteristics into treatment selection for patients with HIV
• Incorporating the latest clinical evidence and guidance into treatment decisions and patient monitoring
• Utilizing interprofessional strategies for optimizing HIV management, reducing stigma, and engaging rural and underserved populations in care and treatment
• Integrating evidence-based interprofessional strategies that can be used to improve retention in HIV care and adherence among rural and underserved populations

Pacific AETC On-Demand Courses

2022 Mpox and HIV Syndemic (1 CE)

The largest outbreak of Mpox (previously called Monkeypox) globally and in the United States has been ongoing since May 2022. Mpox has disproportionately impacted people with HIV. This course will review the history and trends of the current outbreak, as well as virology, clinical manifestations, testing, prevention, and management of Mpox.

HIV and Tuberculosis (1.5 CEs)

This presentation aims to be a primer for TB/HIV co-infection for those learning the basic concepts of both. Through this presentation, the learner will be able to explore the link between HIV, Tuberculosis, and poverty and gain familiarity with diagnosing active tuberculosis, first-line therapy for drug-susceptible tuberculosis, and management for diagnosis and treating latent tuberculosis infection. Implications of the link to poverty will be further explored with an introduction to the existence of drug-resistant tuberculosis and the global movement to end the TB Epidemic.

Injectable Antiretroviral Therapy (1 CE)

For many years, oral antiretroviral medications have been the only medications available for persons living with HIV. However, long-acting injectable antiretroviral medications are now available as an alternative for people who meet specific criteria. This lecture will review long-acting injectable ART.

Linkages and Retention in HIV Care (1 CE)

This session is a case-based lecture where we discuss multiple barriers to care for HIV patients. We will then discuss possible modalities to address these barriers to care. We will discuss some studies that have shown that these interventions work in reducing HIV burden and decreasing viral loads.

Motivational Interviewing (6 CEs)

This training will describe the four components of the spirit of Motivational Interviewing (MI) and why each is important to the effective application of MI; explain the rationale for using MI skills in HIV treatment settings; define at least three (3) key principles of MI that that can be utilized in conversations with clients; describe the importance of active listening before problem-solving solutions for the client; describe and demonstrate the effective delivery of at least three (3) MI micro-skills that can be used to help increase readiness for change.

California Statewide HIV and Aging Educational Initiative Webinar Series

• Session 1: Benefits for Older Adults with HIV
• Session 2: Navigating Housing Resources for Older Adults with HIV
• Session 3: Addressing Oral Health Among Older Adults With HIV
• Session 4: Addressing the Mental Health Needs of Older Adults with HIV
• Session 5: National HIV/AIDS and Aging Awareness Day- Remembering the Past, Reflecting on the Present, Envisioning the Future

Slide sets

• Leveraging mHealth, Telehealth, and At-home Testing in Rural Areas: Implications for the HIV Care Continuum
• Strategies for Identifying Mental Health Needs and Connecting Individuals to Support
• Engagement Skills to Enhance Motivation and Trauma-Informed Approach: Lessons from the Pacific Mental Health Awareness Training Program 
• Medications for Opioid Use Disorder Among Culturally Diverse People with HIV

Materials

Factsheet and Resources:

• HIV Care and Treatment in Rural Communities (HRSA)
• Ending the HIV Epidemic (EHE) : Treating Stimulant Use Disorder with Contingency Management
  • Slides
  • Fact Sheet
  • Case Vignettes
  • Flowchart – Symptom Screen

Toolkits

Rural HIV/AIDS Prevention and Treatment Toolkit (RHI) 

The toolkit compiles evidence-based and promising models and resources to support organizations implementing HIV/AIDS prevention and treatment programs in rural communities across the United States. The modules in the toolkit contain resources and information focused on developing, implementing, evaluating, and sustaining rural HIV/AIDS programs. There are more resources on general community health strategies available in the Rural Community Health Toolkit.

Non-Occupational HIV Post Exposure Prophylaxis (nPEP) Toolkit Developed by the AETC, includes:

• nPEP Quick Guide for Providers  Step-by-step assessment and treatment reference guide.
• nPEP Myths and Facts Flyer  Common misconceptions about nPEP are addressed.
• nPEP Key Concepts for Providers Poster  Highlights core concepts for success with post-exposure prophylaxis.
• Medication Assistance Program Quick Guide  Contacts for public, non-profit, and manufacturer-operated programs to help patients pay for medications, including for PEP.

Pacific AETC PrEP Provider Toolkit

This site improves providers’ understanding and confidence in providing this essential tool. Providers will be guided through the most relevant and practical aspects of PrEP care and be provided with various resources to help providers streamline PrEP into their everyday practice. This toolkit primarily utilizes information from the Center for Disease Control and Prevention’s (CDC) PrEP Clinical Guidelines, updated in December 2021. Minor modifications of these guidelines are suggested to reduce any confusion that may deter providers from utilizing PrEP while allowing for more comprehensive care that does not jeopardize safety.

Climate Change and Continuity of Care: Policy Brief and Disaster Planning Toolkit (CAPS)

Natural disasters related to climate change are on the rise in California, but the impacts of climate-related events on healthcare delivery and client engagement in care are not well understood. The critical care needs of those receiving HIV, STI, and harm reduction services are of particular importance; disruptions to services pose an immediate threat to continuity of care and client health. The Northern California HIV/AIDS Policy Research Center (CAPS) conducted a rapid response qualitative study to better understand climate-related disruptions to services, document adaptive strategies, and provide recommendations for policy action.

Policy Brief: Climate Change and Continuity of Care: Maintaining Access to Prevention and Care Services during Climate-Related Events in California

Toolkit: Disaster Planning Toolkit for Clients and Providers – This toolkit is a guide for a planning conversation with your clients about preparing for future climate-related events (e.g., wildfires,floods, heat waves, etc.).

Printable Guides

• Quick Guide to Help Healthcare Providers Increase PrEP Uptake in BIPOC Communities
• Prescribing PrEP: A Guide for Healthcare Providers
• Pocket Guide for PrEP Screening (Updated 1/2023)
• Pocket Guide to Open-Ended Sexual Health Questions (Updated 1/2023)
• Trans Health Pocket Guide (Coming soon!)

Federally approved clinical practice guidelines for HIV/AIDS

• HRSA Clinical Care Guidelines and Resources
• DHHS Guidelines

Regional Rural Health Resources