2015 Brazil

Group of GHIC students and Dr. Rambob in Brazil for GHIC project
Interprofessional care teams in Salvador, Brazil: A transferable model of care?

Winter 2015

Led by Isabelita Rambob, DDS, School of Dentistry

Students (school affiliation): Polina Iarikova (dentistry), Neda Mirjafary (nursing), Ozlem Yazar (social work)

Project Goal:

The purpose of this project was to offer UMB students an opportunity to study the Brazilian model for mitigating the HIV epidemic in an interprofessional setting and its applicability in community-based programs in Baltimore City.

Background:

HIV infection continues to be a major global public health issue. According to WHO, there were approximately 35 million people living with HIV in 2012. Currently in the United States, approximately 1.3 million people are living with HIV. Baltimore ranks second in the nation for its HIV/AIDS rates, with over 16,000 known cases. By the end of 2011, it was estimated that 490,000 Brazilians were living with this infection. Brazil is now recognized as a model for mitigating the HIV epidemic, due to a successful prevention policy associated with universal access to free antiretroviral (ARV) treatment, implemented within the public health system (Sistema Unico de Saude-SUS). The SUS, created in 1988 according to the principles of equity and the universal right to health care, played a major role in building the Brazilian AIDS program. Since its beginning, this program has been based on public and non-governmental mobilizations, particularly of AIDS-specific NGOs who reach out to the most vulnerable groups, advocate for their health rights and tailor health promotion/prevention messages to each group. The political and administrative mobilization allowed the implementation of specific structures of prevention; diagnosis and care devoted to HIV patients, negotiating with pharmaceutical industries to significantly reduce ARV cost, and producing several ARV drugs in the country.

Methods:

The Brazilian National AIDS Program is widely recognized as the leading example of an integrated HIV/AIDS prevention, care, and treatment program in a developing country. Programs have been established in 27 states and in more than 400 municipalities. In these states and municipalities, several HIV/AIDS facilities have been established which include voluntary counseling and testing centers, specialized assistance services for ambulatory care, and hospital services.

This project took place at the CEDAP-State Specialized Center for Diagnosis, Treatment and Research in STD and HIV/AIDS, located in Salvador, a city in the state of Bahia. This Center is a public health unit of the SUS that offers free comprehensive health care to people living with HIV/AIDS. For two weeks, three UMB students were given the opportunity to observe the services provided in this center in the context of their current field of studies (dentistry, nursing and social work). Students were able to recognize the impact of interprofessional education and collaborative practice teams on improving health outcomes for people living with HIV/AIDS.

Activities:

Each student shadowed a Brazilian professional specific to their field. Additionally, they were placed in rotations in different departments within the Center to give them insight to the interprofessional interactions that are integrated into patient care. Students were required to take extensive notes regarding how the program functions and how different professionals work together. The students compiled their notes into a report detailing their observations, concerns, and recommendations for how a similar program could be implemented in Baltimore City. Furthermore, each student selected and spent time with a local mentor outside of their field of study. Students were asked to compose essays about how their understanding of their mentor’s expertise would contribute to their professional growth and practice as a dentist, nurse, or social worker.

Outcomes:

The World Health Organization recognizes interprofessional collaboration in education and practice as an important strategy to help address the global health crisis and bolster the global health workforce. Students participating in this project gained a better understanding of how interprofessional education and collaborative practice can play a significant role in mitigating many of the challenges faced by people living with HIV/AIDS. It is hoped that their introduction to international interprofessional team approaches will inspire them to continue their development of becoming members of collaborative practice teams at home. Students submitted a report and gave oral presentations when they returned to the UMB campus. They discussed how interprofessional education can foster more integrated care and therefore, promote the development of innovative solutions to manage unmet health needs for people living with HIV/AIDS in Baltimore City.

Brazil 2015 - team presentation

"Interprofessional Externship Showcases the Value of Collaboration" - School of Dentistry News, 2/26/15

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