280-09-0291_Attachment 1_SOW

RFP 280-09-0291

Attachment 1

DESCRIPTION/SPECIFICATIONS WORK STATEMENT

Title:

HIV/AIDS Education and Training of Psychiatrists I.

Background Information and Objectives A.

History and Background SAMHSA is committed to achieving the nation’s goals to combat HIV and AIDS and to disseminate knowledge about the mental health aspects of HIV/AIDS and the ethical issues of providing services to people living with or affected by HIV/AIDS.

According to the Centers for Disease Control and Prevention (CDC) [1] at the end of 2003, the latest date for which these data are available, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS [2]. In 2006, in the 33 states with long-term, confidential name-based HIV reporting, 35,314 new cases of HIV/AIDS in adults, adolescents, and children were diagnosed [3]. Using a new and innovative system designed to estimate the number of new HIV infections for the United States in a given year, CDC estimated 56,300 new HIV infections occurred in 2006 [4]. Almost half of new HIV infections were among African Americans -- only 13% of the over-all population in the 33 states. By age, persons aged 25-34 and 35-44 accounted for the largest proportion of those newly diagnosed, 26% and 32% respectively.

During the 1990s advances in HIV treatments slowed the progression of HIV infection to AIDS and led to decreases in deaths across the nation, 50 states and the District of Columbia. Similarly to the period from 2002 through 2005, estimates in 2006 suggest the number of AIDS cases remained stable and that deaths decreased but it is too early to determine whether this trend will hold. Advances in care and treatment have led to increasing numbers of persons who are living with AIDS and HIV. With longer life expectancies, the treatment and management of mental health becomes progressively more relevant. Conversely, the presence of mental illness and substance abuse are associated with higher rates of HIV [5].

Since the early 1980s, first the National Institute of Mental Health, and then the Center for Mental Health Services (CMHS), have provided support for a program to develop model educational approaches to train traditional and non-traditional mental health care providers in neuropsychiatric and psychosocial aspects of HIV/AIDS; i.e., the CMHS Mental Health Care Provider Education (MHCPE) Program.

Given the fact that the effects of the illness and the physical and psychological ramifications of the medical regimen for treatment are constantly changing, relatively frequent updates and continuing education of mental health service providers are crucial. Further, individuals with HIV/AIDS are asked to make critical life altering decisions in view of ever changing options for medical treatment, such as beginning Highly Active Anti-Retroviral Therapy (HAART), a multi-drug treatment for HIV/AIDS or the use of protease inhibitors. Thus, in addition to coping with the psychosocial impact of the physical illness, the neuropsychiatric sequella of the disease, and the treatment adherence/compliance aspects of chronic care, HIV/AIDS infected individuals and their mental health care providers need to be much more involved in their health care decision making process. This includes quality of life issues (e.g., the consequences of having a chronic and debilitating illness, as opposed to a disease that was once considered to be an automatic death sentence) as well as financial issues.

The involvement of psychiatrists in the diagnosis and treatment of AIDS and HIV infection in patients is essential because of the prevalence of HIV-related neuropsychiatric complications, psychiatric comorbidity and psycho-dynamic aspects of the disease.

Clinical experience and research provide substantial evidence that HIV directly infects the brain resulting in central nervous system impairment and neuropsychiatric disorders including HIV-1 associated dementia, minor cognitive-motor disorder, delirium, depression, and psychosis.

While potent new treatments have improved the health of many individuals living with this disease, they do not work for everyone, and the long-term effectiveness of new treatments is unknown. For psychiatrists, new drug treatments present significant challenges. Complex drug interactions associated with HIV treatment often have mental health complications. The slowing of HIV viral replication in the peripheral body systems, for example, does not necessarily occur with a similar slowing of the virus in the brain. Moreover, current treatment regimens show poor penetration into the brain, making cognitive-motor disorders even more likely. For individuals with pre-existing severe mental illness, significant substance abuse experience, and/or infection with both HIV and Hepatitis C the assessment of cognitive capacity is particularly complex but critically important. The introduction of antimicrobials and new antiretrovirals to the treatment regimen makes the assessment and prevention of significant drug interactions increasingly important.

Psychiatrists are uniquely qualified to provide care and treatment to those infected with the HIV virus. Among the contributions psychiatrists can make are: understanding and treating the psychodynamic issues that contribute to an individual’s ability to change risk behaviors to avoid infection; understanding the complex medical issues that may lead to central nervous system dysfunction as part of the differential diagnosis of neuropsychiatric syndromes; assessing and monitoring patients for the neuropsychiatric consequences of pharmacologic agents used to suppress the viral load or fight opportunistic infections; providing psychopharmacologic treatment for the consequences of HIV brain infection as well as psychiatric consequences of systemic diseases; assisting in the optimal use of current treatment strategies and adherence efforts; and treating patients, including their support network, for the emotional impact of the HIV infection and AIDS.

The American Psychiatric Association’s (APA) AIDS Program Office is dedicated to providing quality training, materials and services to psychiatrists working in the HIV/AIDS arena through its American Psychiatric Institute of Research and Education (APIRE) AIDS Education Project (AEP). Over time the goals of the office have changed to meet the evolving educational needs of the psychiatric community and the demands presented by the HIV/AIDS epidemic. Currently the AEP has trained over 32,200 total psychiatrists, psychiatric residents, medical students, and other mental health providers.

Further, this contract addresses several of the goals in The President’s New Freedom Commission on Mental Health report. For example, Goal 1 (1.1): The project will provide national education that addresses the misconceptions about mental illness (and HIV/AIDS). Goal 3: The contractor will train psychiatrists in the provision of culturally competent HIV related mental health services and will reach providers in rural and geographically remote areas. Goal 5 (5.2): The contractor provides a bridge between research and evidence based practices and services by offering psychiatrists up-to-date state-of-the-science training in HIV-related mental health service provision; in addition (5.3) the contractor activities develop the workforce to become more willing and more capable of providing evidence based treatment.

B.

Goals and Objectives The activities outlined in this contract represent a key component in SAMHSA’s commitment to expand the knowledge and capacity of mental health service providers, particularly, psychiatrists as they struggle to address (1) neuropsychiatric and psychiatric aspects of HIV infection and (2) the needs of individuals in psychiatric care who have at least one co-occurring general medical condition.

The primary goals of this initiative are:

· To provide training to psychiatrists on the psychiatric, neuropsychiatric, and co-occurring disorders in patients with HIV infection;

To provide training to psychiatric residents, medical students and relevant health care providers on the psychiatric, neuropsychiatric, and co-occurring disorders in patients with HIV infection;

· To provide technical assistance to trainers on an ongoing basis;

· To update existing training materials and develop new resources;

· To provide education/training opportunities to psychiatrists utilizing new and emerging technologies;

· To utilize the CMHS Ethics and HIV/AIDS Curricula when conducting ethics workshops, and

· To participate in the evaluation component of the MHCPE Program.

II.

Services to be Performed The Contractor shall develop and deliver educational programs and materials that will provide training to an increasing number of psychiatrists, and will develop informational products pertaining to psychiatric treatment and other special topics of interest to CMHS.

A. General Requirements

1.

Independently, and not as an agent of the Government, the Contractor shall furnish all necessary labor, materials, supplies, equipment, and services (except as otherwise specified herein) and perform the work described below.

2.

All work under the contract will be monitored by the Government Project Officer (GPO).

B. Specific Requirements

The Contractor shall fulfill the objectives of this contract by performing the following tasks:

Task I - Plan of Performance

The Contractor shall meet with the GPO, in person or by telephone, within 7 days after the contract effective date (CED) to review the scope of work, and discuss and clarify the plan of performance submitted with the proposal. The Contractor shall incorporate the GPO’s comments and submit a final plan within 14 days of receiving the GPO’s comments. A revised final plan of performance and timetable for conducting the tasks and requirements shall be provided to the GPO by no later than 30 days after the CED.

Task II- Provide Training to Psychiatrists on the Psychiatric, Neuropsychiatric, and Co-occurring Disorders in Patients with HIV Infection

The Contractor shall facilitate training and education on local, regional, and national levels. The Contractor shall be required to train an estimated 1,000 practicing psychiatrists annually.

Training shall be coordinated by utilizing the Contractor’s network members and, wherever possible, local clinicians to deliver the Contractor’s HIV/AIDS training curriculum in their immediate area. Special emphasis should be placed on providing training in rural and underserved areas.

Training shall focus on HIV and infection of the brain, spinal cord and central nervous system (CNS); neuropsychiatric sequelae of HIV disease(including complications of the CNS, mood and anxiety disorders, pain, sleep disorders and insomnia, substance abuse disorders, and psychosis; and psychological and behavioral issues presented by HIV disease. Attention should also be paid to current and emerging treatment options, issues related to drug interactions, patient compliance/adherence. In addition, trainers should be sensitive to cultural differences in the presentation of psychiatric symptoms and understand cultural barriers to psychiatric treatment. Moreover, the prevention and treatment strategies suggested need to incorporate the special cultural and treatment related issues for older adults; women; lesbian, gay, bisexual, and transgender (LGBT) people, and youth.

Task III- Provide Training to Psychiatric Residents, Medical Students and Relevant Health Care Providers on the Psychiatric, Neuropsychiatric, and Co-occurring Disorders in Patients with HIV Infection The Contractor shall implement its HIV/AIDS curricula in its efforts to incorporate HIV curriculum into training. The Contractor shall also train in an effort to raise awareness of the psychiatric and neuropsychiatric components of HIV infection. The Contractor shall provide assistance and services, including faculty recruitment and training, training coordination, material distribution, and other ongoing support to training institutions.

Task IV - Provide Technical Assistance to Trainers on an Ongoing Basis The Contractor shall recruit and maintain a national faculty of regional trainers who provide education and training to health and mental health care professionals across the country. The Contractor shall provide technical assistance to qualified psychiatrist-educators as they work to implement their training initiatives in their respective areas. This assistance will be particularly important in rural and underserved areas.

Technical assistance shall also include keeping psychiatrists apprized of developments in the field. Available technology shall be used as often and effectively as possible in outreach efforts.

Task V - Update/Expand/Use HIV/AIDS Training Materials The Contractor shall develop training tools and materials that are tailored to individual needs and keep pace with emerging issues (e.g., HIV and dementia among the elderly, drug interactions and drug resistance).

The Contractor shall pay particular attention to issues of national significance, including HIV among increasing numbers of minorities, older adults, youth, and women. Curricula must be culturally relevant and meet the needs of diverse populations, including ethnic and cultural minorities; children, adolescents and their families; women; LGBT individuals; men who have sex with men; people with serious mental illness and/or substance abuse and other co-occurring problems; older adults; homeless persons; and persons who are incarcerated.

Because of the importance of understanding consumer perspectives, it is expected that people living with and/or affected by HIV/AIDS will be involved in the development/modification of curricula.

Task VI– Provide Education/Training Opportunities to Psychiatrists Utilizing New and Emerging Technologies

The Contractor shall update and expand the current website providing training support to trainers and educational resources and clinical information for students and clinicians. The Contractor shall also explore opportunities to provide clinical support or case discussions for psychiatrists treating patients with HIV/AIDS. Effective new distance learning technologies (e.g. video conferencing) should be employed where it would be cost-prohibitive to send trainers, particularly in rural and underserved areas.

Task VII - Use of the CMHS Ethics and HIV/AIDS Curricula The Contractor shall use the CMHS MHCPE Ethics and HIV/AIDS Curricula for all ethics training workshops that are supported under this contract (a copy of the new materials will be distributed by the government as they are updated and revised). If new trainers, or advanced training, are needed, provision will need to be made for this training.

Task VIII - Participate in the Evaluation Component of the MHCPE Program The Contractor shall use the CMHS OMB-approved Participant Feedback Forms to evaluate CMHS-funded trainings conducted by the AIDS Education Project. The Contractor shall work with the CMHS GPO and the Data/Coordinating Center on the evaluation component.

Task IX - Association Contractor Meetings At the GPO’s request, the Contractor shall attend up to three (3) local HIV/AIDS education contractor meetings (i.e., the three mental health provider professional associations: American Psychiatric Institute for Research and Education, American Psychological Association, and National Association of Social Workers.

Task X - Preparation of Reports The Contractor shall prepare and submit the following reports to the GPO in the quantities and at the times indicated in the Delivery Schedule.

a. Quarterly Progress Reports The Contractor shall submit one (1) hard copy and one (1) disk copy or copy via e-mail (exclusive of items unsuitable for this format), of a progress report for each quarter during the life of the contract. The report should: (1) detail activities which involve expenditures and obligations; (2) address problems encountered and how they were (or will be) resolved; (3) address planned activities for the upcoming reporting period; and (4) contain a statement that the contract will (or will not) be completed in accordance with the time frame specified in the delivery schedule and will (or will not) be completed within the budget amount. The quarterly time frame will be determined with GPO.

The Contractor shall add an annual summary report to the fourth quarter progress report. The report should: (1) summarize activities which involved expenditures and obligations; (2) address planned activities for the upcoming year; and (3) contain a statement that the contract will (or will not) be completed in accordance with the time frame specified in the delivery schedule and will (or will not) be completed within the budget amount.

b. Draft Final Report Six (6) weeks prior to the contract expiration date, the Contractor shall submit to the GPO for review and approval one hard copy of a draft final report that summarizes the results of the activities conducted during the performance of the contract, including problems encountered and their solutions. The Contractor shall incorporate any comments or suggestions received from the GPO into the final report.

c. Final Report The Contractor shall submit one (1) hard copy and one (1) disk copy or copy via e-mail (exclusive of items unsuitable for this format), of the final report to the GPO, as approved above, and one (1) hard copy to the Contracting Officer, by the contract expiration date.

Task XI – Transfer of Activities

Turnover at End of Contract (1) The Contractor shall provide, by no later than the eighth month of the final performance period, three (3) copies of plans for transfer of the project to either the government or a new contractor (as applicable). If necessary, the Contractor shall initiate transition activities sixty (60) calendar days prior to the expiration of the contract. These activities include:

(a) continued full service to the customers of HIV/AIDS Education and Training;

(b) at the Contracting Officer’s discretion, participating in five (5) or more meetings with the new contractor to effect a smooth transition and to receive detailed information on the operation of the project.

(c) providing complete documentation and all hardware, software, materials and data produced or acquired with contract funds, or under the Contractor’s control as Government Furnished Property or Materials,and turn them over to SAMHSA or the new contractor in good condition; and, during a three (3)-week transition period, assure that the Contractor’s senior personnel train the new personnel (contractor or government) in all system operation and maintenance functions; and,

(d) performing appropriate close-out of all outstanding technical and related work.

(2) Unless the underlying data used in the selected study analysis are leased or proprietary, analytic files (where source files are reduced in volume and tailored to specific analyses), or data analytic programs, then the results produced under the auspices of this project shall be property of the federal government. If State data are used, the federal government shall collaborate with the participating States in planning, carrying out and disseminating the results of such analyses.

All information and materials, including data developed under this contract, are the property of the government and shall be delivered as part of the turnover at the end of the contract. No information developed under this contract shall be released by the Contractor without the written permission of the government.

REFERENCES:

1.

CDC. HIV/AIDS in the United States (CDC HIV/AIDS Facts, Revised August 2008). Atlanta: US Department of Health and Human Services, CDC; 2008. http://www.cdc.gov/hiv/resources/factsheets/us.htm.

2.

Glynn M, et al. Estimated HIV prevalence in the United States at the end of 2003. National HIV Prevention Conference; June 12–15, 2005; Atlanta. Abstract T1-B1101.

3.

CDC. HIV/AIDS Surveillance Report, 2006. Vol. 18. Atlanta: US Department of Health and Human Services, CDC; 2008.

4.

Hall HI, Ruiguang S, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008; 300:520-529.

5.

Meade, CS, and Weiss, RD. Substance abuse as a risk factor for HIV sexual risk behavior among persons with severe mental illness: review of evidence and explorations of mechanisms. Clinical Psychology: Science and Practice. 2007; 14, 23-33.

Delivery Schedule Item

Revised Final Plan of Performance

Quality Assurance Surveillance Plan

SEQ CHAPTER \h \r 1

To be Met

Task I

Revised Final Plan of Performance

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