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University of Maryland, Baltimore, MD
Interprofessional Global Health
Project in Brazil: Summary
Presentation
Ozlem Yazar, Neda Mirjafary, Polina Iarikova
Dr. Isabel Rambob
January 23, 2015
Purpose
The purpose of this project is 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.
- CDAP: State Specialized Center for Diagnosis, Treatment and
Research in STD and HIV/AIDS.
Upon graduation, students will be able to enter the workplace as a
member of the collaborative practice team in a diverse
environment.
Summary of Activities
Total time: 10 days
Location: Bahia, Salvador, Brazil
Team leader: Isabel Rambob,
DDS
Students:
● Ozlem Yazar - social work
student
● Neda Mirjafary - nursing student
● Polina Iarikova - dental student
Rotations: Centro Especializado em
Diagnóstico, Assistência e Pesquisa,
CRES, Hospital Couto Maia
Professionals shadowed /
consulted: infectious disease
specialists, dentist, nurse,
pharmacist, social worker,
psychologist, physical therapist,
art/dance therapist, lab technician
Observations
● Government funded healthcare to a large portion of the population
● Anyone, including legal foreign visitors, has access to care
● Public sector and private sector of healthcare
o Public sector is federally funded and provides universal access to all
o Private sector is not free but can be accessed to those who can afford it
o Medication is financed for both sectors by the government
● Sufficient funding; however, the money is not well managed or distributed
efficiently
● A smaller portion of healthcare providers are dedicated to providing excellent
care to the population regardless of obstacles or lack of funding
Concerns
SUS system delays and shortages
Staff: shortage of healthcare workers, long wait times
to see a provider, long wait times to receive lab results,
lack of health centers in rural areas
o Treatment delay: lack of access to care
leading to long (4-6mo) wait times
Diagnostic technology shortage (MRI, CAT scans, etc.)
Outdated technology and medication: require a higher
viral load to genetically sequence viral DNA; patient
required to take multiple pills instead of one
o Drug interactions and non-compliance
Recommendations:
public sector
● Strong need for primary prevention
system, especially in academic institutions
and targeted at males (65% of HIV+ are
males)
● Increase the number of healthcare
providers, especially physicians within
hospitals and clinics and rural areas
● Increase the number of diagnostic
equipment
● Shorten the diagnostic testing turn-around
Shadowing: Social Worker
● Social Worker’s role in HIV/AIDS epidemic
o Educating the patient on HIV/AIDS
o Encourage testing
o Encourage the use of condoms
o Encourage compliance
Shadowing: Social Worker
● Unexpected findings
o Schools/parents are not providing education on safe sex
o Socio-economic status does not play a role in the infected
population
o Refuse the use of condoms, knowing the partners status on
HIV/AIDS
Shadowing: Social Worker
● Take-home message
o Multidisciplinary team results in more success in treatment of
patients
o Patient can regain ownership of individual challenges by using
interprofessional team as a foundation to build upon
o Use vigilance when evaluating patient needs, look at the whole
picture
o Always encourage testings
o Make condoms available
o Empathize the importance of compliance
Shadowing: Nurse
● Nurse’s role in this epidemic:
o Advocate for the patient!
o Link the patient to other healthcare
professionals
o Play an active role in primary prevention and
educating the community on HIV/AIDS
o Understand the social context that the patient
is living in and make recommendations to the
healthcare team
o Empower the patient to play an active role in
their own health and understand HIV/AIDS
and the medications
Shadowing: Nurse
● Unexpected findings:
o Compliance with HIV/AIDS treatment can be very complex and
is impacted by many factors
Shadowing: Nurse
● Take-home message:
o Care for all patients using a team-approach
o Be compassionate
o Empower and motivate the patient to play an active
role in their care
o Encourage compliance
o Encourage patients to get tested
Shadowing: Dentist
● Dentist’s role in HIV/AIDS epidemic
o Frequent access to patient
o Diagnose oral lesions indicating HIV /
uncontrolled HIV

More than 90% of pts with HIV have at least one
oral manifestation
o Explain importance of being tested
o Encourage treatment compliance
o Emphasize smoking cessation

Smoking tobacco has also been suggested to
decrease effectiveness of HAART therapy
Shadowing: Dentist
● Unexpected trends and findings
o Comparable socio-economic population
of similar health status in Baltimore, MD,
frequently presents with worse Oral
Health
 Salvador population increasingly
interested in preserving natural
dentition
o Inability to access care as an HIV+
patient because of stigma and prejudice
 Patients concealing diagnosis
Shadowing: Dentist
● Take-home messages:
o Ensuring fair access to and treatment of patients with complex
medical statuses
o Comprehensive healthcare approach
o Communication with professionals of other fields for best
results
o Patient education
o Vigilance regarding unexpected lesions
Mentorship Program:
● Shadowing the professional outside the field of studies
● Apply the obtained knowledge to the future career, thus
enhancing the interprofessional approach to patient care
● Nursing student - Infectious Disease Specialist, Dr. Marcio
Oliveira
● Social Work student - Pharmacist, Tatiana Haguihara
● Dental student - Infectious Disease Specialist Dr. Alessandro
Farias
Baltimore Community-based Clinics
Interprofessional collaboration can promote the development of
innovative solutions to manage unmet health needs for people living
with HIV/AIDS in Baltimore City.
Baltimore Community-based Clinics:
Recommendations
● Mandatory educational
lecture following the
diagnosis
● Interprofessional treatment
● Affordable medication
● Target the at-risk population
● Increase testing centers’
availability
OBRIGADA!