SummaryThe AIDS Care Project, a program of Pathways to Wellness, provides free and low-cost acupuncture, Chinese herbal medicine, and shiatsu (a form of acupressure) to underinsured persons to help them manage symptoms and medication side effects. The program primarily serves patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), although individuals with other chronic conditions can receive services as well. Patients generally receive program services in hospitals and clinics where they receive other treatment, including antiretroviral therapy; when necessary, services can be provided in patients' homes. The program has enhanced access to acupuncture and herbal treatments for low-income individuals with HIV/AIDS and other chronic illnesses, reduced side effects from antiretroviral therapy, and alleviated pain in patients experiencing chronic pain.Suggestive: The evidence consists of post-implementation data on services provided to patients, with an implicit assumption that, in the absence of the program, most individuals served would have been unable to access these services. The evidence also includes limited pre- and post-implementation comparisons of the effects of acupuncture on antiretroviral therapy side effects and self-reported pain levels in small groups of patients.
Developing OrganizationsAIDS Care Project
Date First Implemented1988
Vulnerable Populations > Impoverished; Medically or socially complex; Medically uninsured; Urban populations
Problem AddressedAlthough integrative or complementary health services can help individuals with HIV/AIDS, most low-income patients find it difficult to access them.
- Benefits of integrative health services: Some HIV/AIDS patients find that acupuncture relieves peripheral neuropathy that can occasionally be caused by certain medications, allowing them to experience less pain, increased strength, and improved sensation.1 Many HIV/AIDS patients using integrative health services such as acupuncture report benefits, including feeling and coping better, feeling more in control, and having enhanced treatment outcomes.2 A growing body of literature and clinical evidence suggests that acupuncture may positively affect adherence to antiretroviral medications by controlling digestive side effects. Studies also link acupuncture treatment for HIV/AIDS patients with improvements in common symptoms such as sleep deprivation and diarrhea.3,4
- Lack of access for low-income patients: HIV/AIDS patients with incomes of less than $15,000 per year are less likely to use integrative health services.5
Description of the Innovative ActivityThe AIDS Care Project provides free and low-cost acupuncture, Chinese herbal medicine, and shiatsu to underinsured persons to help them manage symptoms and medication side effects. The program primarily serves patients with HIV/AIDS, although individuals with other chronic conditions can receive services as well. Patients typically receive program services in hospitals and clinics where they receive other treatment, including antiretroviral therapy. Critical program components include the following:
- Free or low-cost complementary care: Patients with HIV/AIDS living at or below the poverty level can receive acupuncture services free of charge and Chinese herbal medicine and shiatsu on a sliding-fee scale. Those with other illnesses can receive all three services on a sliding-fee scale or through managed care or other insurance coverage. Service offerings are outlined below:
- Clinic-based acupuncture services: Patients can receive acupuncture services at three hospital-based outpatient infectious disease clinics that provide antiretroviral therapy to most patients with HIV/AIDS. Acupuncturists serve as part of the treatment team and communicate regularly with other providers to coordinate care. The program now offers services at two additional offsite clinics (located away from the hospitals) and two community health centers that offer a full range of services, including pediatrics, adult care, vision, dental, and mental health. Through these community-based centers, the program reaches a broader population, serving patients suffering from conditions like musculoskeletal disorders, headaches, and chronic pain, in addition to those with HIV/AIDS.
- Group acupuncture treatment: The program offers group treatment, with up to seven patients participating in acupuncture sessions three to four times a week. During these sessions, patients sit in comfortable chairs and receive treatment on easily accessible parts of the body, such as arms, legs, or ears.
- Other complementary services: The program provides other complementary treatments, including Chinese herbal medicine and shiatsu, to those suffering from HIV/AIDS or other chronic illnesses.
- Education services/outreach activities: In cooperation with community groups and social service organizations, the program conducts workshops, seminars, support group talks, and other activities designed to raise awareness about secondary prevention and healthy lifestyles within specific populations (e.g., persons living with HIV/AIDS). These outreach strategies and other community activities (such as clinic presentations and participation in professional panels) also serve as a way to promote program services to audiences unfamiliar with them. According to information supplied in May 2013, the program has given presentations and sample demonstrations of acupuncture treatments at a number of local, national, and international AIDS conferences.
References/Related ArticlesChang BH, Sommers E. Acupuncture and the relaxation response for treating gastrointestinal symptoms in HIV patients on highly active antiretroviral therapy. Acupunct Med. 2011;29:180-7. [PubMed]
Chang BH, Sommers E , Herz L. Acupuncture and relaxation response for substance use disorder recovery. Journal of Substance Use. Dec. 2010;15(6):390-401.
Sommers E, Porter K, Parton B. Providing acupuncture to homebound patients: theoretical and public health considerations. American Acupuncturist. 2010 Spring;51:20-23.
Chang BH, Boehmer U, Zhao Y, et al. Relaxation response with acupuncture trial in patients with HIV: feasibility and participant experience. J Altern Complement Med. 2007;13(7):719-724. [PubMed]
Sommers E, Al-Hadidi A, Porter K. International efforts toward integrated care: acupuncture in Iraq. American Acupuncturist. 2009;48:36-39.
Sommers E, Porter K. Providing acupuncture in a public health setting: strategies and community-based practice. J Urban Health. 2005;82(suppl 2):ii83, Abstract 19008.
Sommers E, Mandell R. Innovative approach to HIV-care in Africa: training local healthcare providers to use acupuncture for symptom management. J Urban Health. 2005;82(suppl 2):ii48-ii49, Abstract 03009.
Porter K, Sommers E. National resources for the integrative medicine movement. Acupuncture Today. 2008;9(3).
Research updates from the AIDS Care Project are available at http://www.pathwaysboston.org/research/pathways_research.html.
Contact the InnovatorElizabeth Sommers, LAc, MPH, PhD
Pathways to Wellness
1601 Washington Street—3rd Floor
Boston, MA 02188
(617) 859-3036, ext. 24
Innovator DisclosuresDr. Sommers reported that Pathways to Wellness received grant or contract funding from the AIDS Bureau of Massachusetts Department of Public Health as support for provision of services; additional information on funders is available in the Funding Sources section.
ResultsThe program has enhanced access to acupuncture and herbal treatments for low-income individuals with HIV/AIDS and other chronic illnesses, reduced side effects from antiretroviral therapy, and alleviated pain in patients experiencing chronic pain.
Suggestive: The evidence consists of post-implementation data on services provided to patients, with an implicit assumption that, in the absence of the program, most individuals served would have been unable to access these services. The evidence also includes limited pre- and post-implementation comparisons of the effects of acupuncture on antiretroviral therapy side effects and self-reported pain levels in small groups of patients.
- Improved access to services: Since 1990, the program has provided more than 82,000 acupuncture and herbal treatments to people living with HIV/AIDS in Massachusetts, and now provides more than 10,000 treatments a year.6 Most patients likely would not have been able to access these services in the absence of this program.
- Fewer side effects: A pre- and post-implementation comparison of 10 randomly selected charts (from a total of 40 new clients in 2007) suggests that half of patients entering the program experienced digestive side effects related to use of antiretroviral therapy. Of these, 60 percent reported complete resolution of symptoms within a year of starting acupuncture treatment.7 A separate post-implementation analysis of 10 new and 10 continuing patients (both randomly selected) who received program services between July 2008 and June 2009 found that all new patients experienced fewer digestive side effects, with 70 percent experiencing complete management of their symptoms. In addition, 80 percent of continuing patients experienced a reduction in symptoms, including 40 percent who experienced complete resolution of their symptoms.
- Less pain: A pre- and post-implementation comparison of 19 patients receiving home care found that 74 percent reported that pain levels fell by 50 percent or more, while 16 percent (3 patients) reported complete resolution of their pain at the end of an acupuncture session.8
Context of the InnovationIn 1988, the founders of the AIDS Care Project noted the increasing number of persons living with HIV/AIDS seeking acupuncture for relief of symptoms. Recognizing the need for these services, they developed a volunteer organization composed of acupuncturists to share information on available types of treatment to alleviate symptoms. The program evolved and grew over the years. By 1989, it became a 501(c)(3) organization, with an all-volunteer staff and an office donated by the YWCA. By 1996, the program (still a nonprofit) had paid office staff, an appointment system, formal record keeping, and funding from the Ryan White CARE Act, the Massachusetts Department of Health/AIDS Bureau, and private donors. In 2000, the program expanded its mission and opened its doors to all under the name Pathways to Complementary Medicine, now renamed Pathways to Wellness (still a nonprofit agency). Federal support of the program through the Ryan White Care Act ended in 2005, when the act stopped funding complementary therapists, including acupuncture.
Planning and Development ProcessKey steps in the growth and evolution of the AIDS Care Project include the following:
- Partnerships with other health care providers: Partners provide the program with clinic sites, funding for treatment, and research staff. Major partners include the Massachusetts Department of Health/AIDS Bureau, Massachusetts General Hospital, Cambridge Hospital, Tufts Medical Center, and the South End Community Health Center (SECHC), which houses the AIDS Care Project. Information provided in May 2013 indicates that the AIDS Care Project and SECHC are collaborating to offer more HIV-specific health care, education, screening, and treatment through SECHC.
- Development of care standards: Program leaders developed standards for providing acupuncture to individuals with HIV/AIDS in response to a request by the AIDS Bureau of the Massachusetts Department of Public Health in 2000.
- Training internships: To expand access to care and further develop staffing capabilities, program staff partnered with the New England School of Acupuncture, Boston University School of Public Health, Harvard School of Public Health, and Emerson University/Tufts Medical School joint program in Health Communications to develop four types of internships. This step allowed the program to become a clinical training site for acupuncture students, a posttraining site for herbalists, a field practicum site for public health students interested in research or biostatistics, and a place for students of health communications to serve a graduate internship.
- Ongoing clinician training: All staff attend orientation sessions and participate in continuing professional education courses.
- Use of social media: Use of Facebook and Twitter has helped engage the public and has advertised the idea of wellness promotion for people with HIV/AIDS, according to information provided in May 2013.
Resources Used and Skills Needed
- Staffing: The program has 8 administrative staff (4 full- and 4 part-time), 20 clinical staff (mostly acupuncturists), 5 to 7 acupuncture student interns, 5 to 10 herbal student interns, 2 public health interns, and 1 to 2 health communications interns. The program also has 20 volunteers, an 8-member client advisory board, and a 12-member board of directors. Clinical staff (acupuncturists and herbalists) are all licensed by the Commonwealth of Massachusetts Board of Registration in Medicine.
- Costs: The annual operating budget is approximately $1 million per year, which covers salaries, benefits for full-time staff, rent, supplies, and the provision of free care.
Funding SourcesMassachusetts Department of Health/AIDS Bureau; Boston Foundation, Boston, MA; Partners Health Care, Boston, MA
In addition to the funding sources noted above (see the Context section), the AIDS Care Project is also funded through private donations and in-kind contributions from organizations and individuals. In-kind donations include office space, database design, and the sponsoring of promotional activities.
Getting Started with This Innovation
- Seek input from stakeholders: Solicit feedback from key stakeholders (e.g., acupuncturists, patients, community members) to ensure that services are responsive to community needs and priorities.
- Secure nonprofit status early: Once the demand for services has been established, secure 501(c)(3) status, which allows for the acceptance of charitable donations.
- Form and maintain board with diverse skills and expertise: Forming a board of directors early can help to create community support. Cast a wide net when recruiting board members (both initially and over time). Including community members with varying backgrounds and expertise may allow for the provision of new services, the development of new partnerships, and enhanced access to resources.
- Build partnerships, including with academia: Community partnerships provide a lifeline of referrals and support. Consider teaming with an existing clinic or agency to co-locate services, which facilitates care coordination. Deepen any working relationships with agencies serving women, as minority women often lack resources to get information, testing, access to care, and medications. Also consider working with academic partners to conduct randomized clinical trials, observational assessments, and longitudinal studies on the efficacy of treatment. Academic partnerships, like the one between the AIDS Care Project and Boston University School of Public Health, have been an important mechanism for enlisting patients, generating initial and ongoing interest and support, and promoting adherence to antiretroviral and other treatments.
- Work with a consultant: Laws and regulations for acupuncture vary by state; a consultant or a board member experienced in business management can assist in developing contracts and establishing formal partnerships.
Sustaining This Innovation
- Seek ongoing funding: Look for innovative ways to secure ongoing funding—for example, research funds through medical training centers can provide much needed support.
- Recruit interns and students: Take advantage of nearby professional and graduate training programs to develop internships. Interns can provide many needed services that go beyond treatment, such as developing communication materials and performing statistical analysis.
- Expand services to new settings and populations: By providing services in clinics open to the public, patients will not be identified as having a specific illness, thus reducing the stigma associated with HIV/AIDS. Expanding services to new populations also promotes funding opportunities and new partnerships.
- Coordinate communication using electronic medical records: Look for opportunities to use electronic medical records to coordinate communication between physicians, integrative practitioners, and other health professionals. Make sure to consider Health Insurance Portability and Accountability Act guidelines and patient control of access to their medical records as a part of this effort.
- Continue reporting and outreach, including to local AIDS service organizations: Active support from community stakeholders is essential at all stages of the program. Local AIDS service organizations can provide educational presentations and create opportunities for clients and staff to experience acupuncture. The AIDS Care Project has made presentations and given sample demonstrations of acupuncture treatment at local, national, and international AIDS conferences (updated May 2013).
- Network with similar programs to share information and resources: Networking allows for dissemination of best practices in the context of integrating acupuncture treatment into patients' medical care.
Use By Other OrganizationsCenters offering similar services include the following:
- Legacy Community Health Services and the American College of Acupuncture and Oriental Medicine in Houston, TX
- Arnold School of Public Health Research Center, South Carolina HIV/AIDS Council, and Palmetto AIDS Life Services in Columbia, SC
Sparber A, Wootton JC, Bauer L, et al. Use of complementary medicine by adult patients participating in HIV/AIDS clinical trials. J Altern Complement Med. 2000;6(5):415-22. [PubMed]
Phillips KD, Skelton WD. Effects of individualized acupuncture on sleep quality in HIV disease. J Assoc Nurses AIDS Care. 2001;12(1):27-39. [PubMed]
Anastasi JK, McMahon DJ. Testing strategies to reduce diarrhea in persons with HIV using traditional Chinese medicine: acupuncture and moxibustion. J Assoc Nurses AIDS Care. 2003;14(3):28-40. [PubMed]
Duggan J, Peterson WS, Schutz M, et al. Use of complementary and alternative therapies in HIV-infected patients. AIDS Patient Care STDs. 2001;15(3):159-67. [PubMed]
7 AIDS Care Project. AIDS Bureau of the Massachusetts Department of Public Health Contract Monitoring Activities Report (CMAR). January 25, 2008.
8 Sommers E, Porter K, Parton B. Providing acupuncture to homebound patients: theoretical and public health considerations. American Acupuncturist. In press.
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Service Delivery Innovation Profile
Original publication: April 14, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: June 05, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: May 06, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.