PEDIATRIC PRIMARY-CARE PROVIDERS KNOWLEDGE OF HIV AIDS CARE/

To respond to the difficulties that community-based providers face in keeping abreast of the rapid changes in HIV-related care, an intensive pediatric HIV mentoring program (Pediatric HIV Miniresidency [MRI) wa s developed, linking a regional AIDS Education and Training Center (AE TC) with an urban children's hospital HIV outpatient care site. The pu rpose of this study was to evaluate HIV-related knowledge and perceive d skills, abilities, and willingness of community-based primary care p ediatric-providers and providers completing the MR. A convenience samp le of community-based primary pediatric practitioners and those partic ipants in the MR program completed a three-part mailed survey. The sur vey assessed practice characteristics, knowledge of pediatric HIV clin ical care, and perceived skills, ability, and willingness (PSAW) to pr ovide]HIV-related care. The main outcome measures were overall knowled ge and PSAW scores. One hundred nineteen community-based practitioners (NMRs), 20% of those surveyed, completed the instrument, as did 19 of 20 MR participants. NMRs exhibited low knowledge scores in key areas relating to the identification and evaluation of HIV-exposed children. Fewer than half of these respondents corrently answered questions rel ated to HIV antibody incidence in HIV-exposed newborns and recommended diagnostic testing of such infants. Providers completing the MR score d significantly higher on the knowledge survey (15.2 vs. 8.8, p < 0.00 1), and had higher PSAW scores (45.8 vs. 33.9, p < 0.001). Although th e generalizability of our study is limited by the low response rate, c ommunity-based physicians completing the survey demonstrated a lack of knowledge we believe necessary to provide pediatric HIV-related care (as defined by Public Health Service practice guidelines). Physicians completing the MR program had substantial HIV-related knowledge and ex pressed a willingness to provide care to HIV-exposed/infected children . An effective MR program provides a mechanism for developing a networ k of dedicated community-based physicians who are willing and capable of providing care to HIV-infected or exposed infants and children.