Problem Addressed

• 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 like 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 suggest 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 Activity

• 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, and other activities designed to raise awareness about secondary prevention and healthy lifestyles within specific populations (e.g., persons living with HIV/AIDS). These activities also serve as a way to promote program services to audiences unfamiliar with them.

References/Related Articles

Contact the Innovator

Results

• Improved access to services: Information provided in March 2012 indicates that 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

Evidence Rating (What is this?)

Context of the Innovation

Planning and Development Process

• Partnering with other health care providers: Partners provide the program with clinic sites, funding for treatment, and research staff. Information provided in March 2012 indicates that major partners include the Massachusetts Department of Health/AIDS Bureau, Massachusetts General Hospital, Cambridge Hospital, Tufts Medical Center, and South End Community Center.
• Developing 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.

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 Sources

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 colocate services, which facilitates care coordination. Also consider working with academic partners to conduct randomized clinical trials, observational assessments, and longitudinal studies on the efficacy of treatment. Academic partnerships can also be an important mechanism for generating initial and ongoing interest and support.
• 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 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.
• Network with similar programs across the United States to share information and resources: Networking allows for dissemination of best practices in the context of integrating acupuncture treatment into patients' medical care (added March 2012).

Use By Other Organizations

• 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