Prior to La Clinica’s expanded services, Southern Oregon was a provider desert for primary care and HIV care. During the Covid pandemic, clinic champions discovered that newly diagnosed patients in Southern Oregon were experiencing wait times of up to 6 weeks to be seen by infectious disease doctors thereby delaying viral suppression. This coupled with a growing HIV cluster in the region, inspired Chris and Paul to step in to fill gaps in care. Acknowledging the proven benefits of the early treatment, they implemented rapid start antiretroviral therapy protocols, aiming to reduce the time between diagnosis and treatment. The leadership team was driven by their commitment to improving health outcomes and addressing disparities in their community.

The biggest challenge was securing staff time to develop an HIV Rapid Start program in primary care. Staff needed resources and support to feel confident in taking on HIV treatment and management. Once a champion was identified, developing an HIV Rapid ART start protocol required overcoming logistical hurdles such as training staff, developing consistent workflows, and addressing concerns about resource allocation such as staff time. Maintaining buy in from employees while balancing competing priorities also posed an initial challenge.

Clinic Champion V. Paul Garcia participated in the Practice Transformation Project (PTP) funded by Oregon Health Authority as part of End HIV Oregon. Paul was the first provider in the Mountain West Region to complete a Rapid Start Preceptorship at Multnomah County HIV Health Services. He shadowed providers who developed a protocol as part of a Special Project of National Significance (SPNS) project on Rapid Start and gave feedback to improve preceptorships for future participants. He’s also participated in EndHIV conferences and workshops to strengthen and share his knowledge of HIV and STIs with less experienced providers.

Paul meets monthly with EndHIV Oregon at ORPCA to receive technical assistance around developing workflows to support implementation of rapid start and plan staff trainings. He developed referral system maps for his clinic in partnership with HIV Alliance and Jackson County Public Health, and then later wrote a protocol based on his workflows to scale with La Clinica’s internal QI team for La Clinica to use system-wide. Dr. Chris Alftine supported these efforts.

Additionally, Paul joined EndHIV Oregon’s faculty in providing subject matter expertise for OPCA’s Syndemic webinar. He also teaches sexual health to La Clinica’s residents through their residency program.

The ripple effect of Paul’s efforts to provide comprehensive STI and HIV services in primary care has been massive. He’s championed building an HIV service program at La Clinica that he protocolized and piloted at his clinic site. He also worked to scale his protocol clinic system-wide and shared his process with providers across Oregon in the Community of Practice on Rapid Start. This is remarkable in that he demonstrated and inspired clinic champions across Oregon to integrate HIV care into primary care and develop workflows and protocols without large national grants.

Dr. Chris Alftine provided the necessary support for these efforts as well as the opportunity to provide STI/HIV education to all staff. Dr. Alftine also facilitated linking EndHIV Oregon to Jackson Care Connect so the two organizations could collaborate to train all Providers in Southern Oregon on STIs and HIV.

Paul and Dr, Alftine also promoted clinic services and education opportunities to community partners to facilitate better coordinated services to improve patient health outcomes, while reducing barriers to care.

La Clinica provides a model to integrate HIV best practices into HIV care and provides leadership to the state for other FQHCs looking to build this capacity. The model increases access to HIV care in primary care, in a sustainable way.

Submission written by Rayna Appenzeller, Practice Transformation Sr. Manager, HIV and STI Program at OPCA