A three-day program on treatment advocacy, started last year in San Francisco, has trained 200 people so far, with 80% of them passing a test to be certified as treatment advocates. Because this program can be a model for other areas, AIDS Treatment News interviewed Matt Sharp, a well-known treatment activist who is the coordinator and one of the teachers of the new course. The Treatment Education Certification Program (TECP) is designed for case managers, treatment advocates, peer advocates, substance abuse counselors, mental health counselors, and outreach workers.

AIDS Treatment News: Why was the TECP established?

Matt Sharp: This program was created by the Ryan White Planning Council (the local group which determines how the Federal Ryan White CARE Act money is spent in the community and how these programs are implemented by the Department of Public Health). Since the beginning of the epidemic, there have been volunteer peer advocates, or buddies, who help people who are ill with practical chores. There have also been volunteer treatment advocates who help their friends navigate the medical system and get the care they need.

More recently the People With AIDS Caucus of San Francisco's Ryan White Planning Council has decided that, because of the complicated, confusing HIV treatment scenario, some of these people should come into the service agencies, be trained, and be paid.

ATN: Who designed the curriculum?

The treatment advocate helps clients and patients understand the complexities of HIV treatment, and helps guide them in working with their doctor. The grassroots idea of advocating for people with HIV in their treatment has now become institutionalized--which is a good thing, although there are also problems with bureaucratization. Two agencies working together received the contract for this program. They are Project Inform, and my agency, the Asian & Pacific Islander Wellness Center. Sharp: The course was designed by Judy Leahy of Project Inform. I was hired later, and helped edit the curriculum, when the classes were about to begin. We teach the classes together. ATN: What are the major elements of the course?

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Our program is peer led and run, which breaks down barriers that can come with training led by doctors or professors. People are less afraid to interact and ask questions.

Sharp: We start with a discussion of health care and peoples' experiences with the medical system. We cover HIV pathogenesis, standard of care, antiretroviral strategies, side effects and drug interactions, opportunistic infections, research, clinical trials, adherence issues, access to care, benefits, referral and resource information, and strategies for working with multiply diagnosed and underserved clients. Participants receive a treatment education manual.

ATN: Is there any followup?

Sharp: Participants can always ask us questions. In addition, they are invited to monthly Provider Work Groups--three-hour meetings on cutting-edge issues. Topics have included hepatitis C, post-exposure prophylaxis, nutrition and drug therapy, and transgender issues including hormones and HIV antiretroviral treatment. Upcoming topics include domestic violence, cultural competency for HIV service providers, and immune-based therapies.

Participants are also invited to attend the Project Inform Town Meetings, 3-hour updates on the latest treatment news. These often follow major treatment conferences, when there is the most news to report.

Also, the 20% who fail the certification test are offered one-on-one tutoring and three chances to take the test again. All who have chosen to do this have ultimately passed.

ATN: Are these people employed first, or do the use the certification to help get a job?

Sharp: Almost everybody is already in their job when they take this training. Many are highly skilled; they may have social-work degrees, or are psychotherapists. Others have few job skills and are new at their positions, and may be people with HIV themselves. We had some complaints from employers, who were reluctant to release employees for the three-day training, which is required by their Ryan White contracts. We negotiated with them and addressed some of their concerns in the second year of the training program.

ATN: What other HIV treatment training programs are happening elsewhere?

Sharp: There are some, but our program is unique in that it is peer-led and offers a certification test, and is directed toward this population.

HRSA (the Health Resources and Services Administration) recently issued an RFP for similar training [this RFP closed September 3]. The Asian & Pacific Islander Wellness Program and Project Inform have applied together for a grant; if we get it we will expand a similar training to the northwest quadrant of the United States, (depending on what other programs are funded) including Alaska and Hawaii, and as far east as Montana.

This program is funded by the appropriation obtained by the Congressional Black Caucus, so it will have more of a minority emphasis. A total of $3.3 million can be awarded, to five to ten programs.

ATN: If other agencies are interested in setting up a similar program in their area, how can they get more information?

Sharp: They can call me at 415-292-3420 ext. 337, or Judy Leahy at 415-558-8669 ext. 213.