The Intersection of HIV and SUD: An Innovative Partnership to Educate and Support Two Critically Important Workforces

A network of federally funded training centers has existed since the early 1990’s to educate and build the capacity of clinicians and healthcare professionals to diagnose, treat and manage HIV and other sexually transmitted diseases (STDs), substance use disorders (SUDs), mental health disorders and other social determinants of health, which impact access to quality care for vulnerable populations. The Ryan White HIV/AIDS Program (RWHAP) Part F AIDS Education and Training Centers[i] (AETCs); the Addiction Technology Transfer Centers (ATTCs), the newly established Prevention Technology Transfer Centers (PTTCs) and Mental Health Technology Transfer Centers[ii] (MHTTCs); and the Prevention Training Centers[iii] (PTCs), include national and regional sites across the United States (U.S.) to support training, technical assistance (TA), and workforce development for healthcare professionals to address existing and emerging needs in their respective fields. While each center works cooperatively from within to develop resources and provide and promote training opportunities for their stakeholders, the network of centers is uniquely positioned to work collaboratively to address a wider range of concurrent issues – interdisciplinary, to transform practice, improve care delivery and affect meaningful change across jurisdictions.

This post is about the intersection of HIV and SUDs – the emergence of a partnership which began with the RWHAP Pacific AETC’s (PAETC) Los Angeles regional partner at the University of California Los Angeles (UCLA) Department of Family Medicine and the Pacific Southwest ATTC (PSATTC), and expanded into a series of cross-collaborative work and a collection of resources developed as a result.

Beth Rutkowski:

This partnership began in 2004 with a focus on methamphetamine. Both the RWHAP PAETC Los Angeles regional partner and the PSATTC had been working independently on developing training curricula and resources on the topic, but when the PAETC received supplemental funding to work on HIV-related issues at the U.S./Mexico border, they immediately contacted us. Tom Freese and I received a request to set up a meeting with Tom Donohoe, Director of the Los Angeles PAETC, to help conduct needs assessments and deliver trainings. The first series we co-sponsored was “HIV, Methamphetamine, and Women.” Traveling and training with the PAETC and PSATTC faculty not only improved our respective knowledge of SUDs and HIV, but it helped us all sharpen our skills as trainers and content developers. We were cross-training each other as much as the bi-national participants who came to our trainings. In addition, the four-city tour of the border was a great experience. Often, the events that most shape us as trainers are learning and building relationships with other content experts in our respective priority areas. One of the most impactful results of this initial project was the development of a “Methamphetamine TIP sheet” for HIV clinicians. The tip sheet has been revised a few times over the years and is one of the most downloaded products from the AETC National Coordinating Resource Center website.

“It’s been more than 15 years since I first met with Tom and Beth about working together. I remember thinking at the time “this is a no brainer” given the intersects of substance abuse and HIV, but I had no idea how much our collaborations would improve—and transform—our HIV work. We had already been working on HIV and Methamphetamine with some of our University experts and decided to initiate our collaboration developing HIV and Meth trainings focusing on providers serving Latinos in LA County. These trainings were well received and started our being “connected at the hip” for much of the next 15 years…I have to say if you work in an AETC and have not yet collaborated with your local ATTC, please do so, and vice versa.” ~ Tom Donohoe, August 2019

A few years after the PAETC and PSATTC initiated the U.S./Mexico Border Training Series, we were encouraged to expand our partnership to encompass the other Region 9 Federal Training Centers, including the Curry International Tuberculosis (TB) Center, California STD/HIV PTC, and the Family Planning National Training Center. The resulting product was the development and delivery of multiple one- and two-day training events focused on the treatment of HIV, STDs, TB, hepatitis C, family planning, and substance use. The events were held along the U.S./Mexico border, as well in non-border communities such as Fresno, California. In each of these endeavors, the priority focus was on the provision of high quality, up-to-date data and best practices on how to treat people with HIV, TB, STIs, and substance use. We made a lot of amazing friends along the process and trained hundreds of clinicians.

“Our U.S./Mexico border work has led to 15 years of very collaborative, productive, and important work. Each year we continue to work with the PSATTC to continue our efforts on the border, and to develop curricula and materials that affect the epidemics throughout our region and nationally. In the next year, we will be working with the PSATTC on two new curricula: (1) HIV, Medicated-Assisted Treatment and Communities of Color and (2) HIV and Relapse Prevention. Having so many previous collaborations, I know these products will benefit from our joint passion to improve the lives of people we serve through training, TA, and capacity-building services. Through our collaboration with the PSATTC, I think we can make everything better.”
~ Tom Donohoe, August 2019

In 2010, our PAETC collaboration expanded even further when Tom Donohoe introduced us to his PAETC colleague Phil Meyer. Phil had the vision to use carry-over funds to support the development of two brief training curricula geared specifically towards HIV clinicians (target) and focused on the intersection of SUDs and HIV. Since meeting Phil nearly a decade ago, we have created approximately 20 products on a variety of topics, including, but not limited to: alcohol and HIV; cocaine, methamphetamine and HIV; heroin, prescription opioids, and HIV; HIV and psychotropics; How Change Happens; integrated treatment; marijuana and HIV; Nature of Addiction and HIV; screening, brief intervention, and referral to treatment; smoking and HIV; and, substance use, HIV, and special populations (adolescents, women, older adults). Many of these training products are available for viewing and downloading from the ATTC Product and Resource Catalog. Several of the training curricula were developed into free self-paced online courses. Additionally, many other regional ATTCs have developed HIV-related resources and products as well, so the ATTC Network Coordinating Office (NCO) compiled a list of HIV-related resources that have been developed by the ATTC Network here.

“In 2010, as the new Associate Director of the Charles Drew University site of the Pacific AIDS Education Training Center, I reached out to Tom Freese and Beth Rutkowski of UCLA’s PSATTC. As it turns out, that was one of the best decisions I made in the last decade. What followed has been a nine-year collaboration, which has produced 18 HIV/Substance Use Disorder curricula with four more coming in the next year. The PSATTC has always been open and responsive to our particular needs, customizing content to our very specific target audience. The work has been challenging, rewarding, and equally important, fun. I honestly could not recommend them more.” ~Phil Meyer, LCSW, August 2019

It is safe to say that our partnership with the PAETC represents one of the most fulfilling and fun experiences of my career. Our initial meeting marked the beginning of more than 15 years of collaboration that has impacted thousands of HIV and SUD clinicians throughout HRSA’s Office of Regional Operations Region 9 and beyond.

As the Ending the HIV Epidemic: A Plan for America[iv] initiative rolls out, consider partnering with your local AETC, TTC, and PTC to provide training to support the integration of the four key strategies of the Plan – diagnose, treat, prevent and respond – into your clinical setting with the goal of ending disparities in HIV care and new HIV infection once and for all.

[i] The AIDS Education and Training Center Program is a component of the Ryan White HIV/AIDS Program, funded by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau: https://hab.hrsa.gov/about-ryan-white-hivaids-program/part-f-aids-education-and-training-centers-aetc-program

[ii] The Technology Transfer Centers Program is funded by HHS, Substance Abuse and Mental Health Services Administration (SAMHSA): https://www.samhsa.gov/technology-transfer-centers-ttc

[iii] The National Network of STD Clinical Prevention Training Centers is funded by HHS, U.S. Centers for Disease Control and Prevention (CDC): https://nnptc.org/our-centers

[iv] The End the HIV Epidemic: A Plan for America initiative is funded by HHS, and coordinated by the Office of the Assistant Secretary for Health with support from HRSA, SAMHSA, CDC, the National Institutes of Health and the Indian Health Service: https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview