By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
An interview with Lexie Hach, Regional Health Specialist, Bureau of HIV, STD, and Hepatitis, Capacity Extension Program, Iowa Department of Public Health.
Tags: Detailing Visits, Evidence-Based Medicine, Stigma, Rural AD Program
Anna: Hi, Lexie! We’re excited to chat with you today about your detailing work in rural Iowa. Your program started about 5 years ago and was born out of the HIV and Hepatitis Community Planning Group (CPG). Can you share more about the CPG and how the detailing program was created?
Lexie: The CPG is made up of healthcare providers, people with lived experience, case managers, educators, and other stakeholders. The group serves in an advisory capacity to the Bureau of HIV, STD, and Hepatitis at the Iowa Department of Public Health (IDPH) and their main task is to ensure that the state has an inclusive participatory planning and evaluation process for the delivery of prevention and care services.
About 5 years ago, the CPG recognized a need for more education in the rural parts of Iowa related to best practices in HIV, sexually transmitted infections (STIs), and Hepatitis. That’s when we learned about AD. We started building our detailing program based on a lot of the work that New York City’s program was doing. We now have 5 detailers, who we call Regional Health Specialists (RHS).
Anna: What an interesting start to your program! You’re currently assigned to detail in 15 counties in central Iowa covering over 20 sexual health topics, from stigma to your statewide condom program to new screening recommendations. Do you detail on these topics beyond the primary care setting?
Lexie: Yes! Our goal as detailers is to provide the best health outcomes for people living with HIV and those living with, or at risk for, STIs and Hepatitis C. We meet with the medical community including, local health departments, community-based corrections, substance use specialties, mental health, and many community based organizations.
We also attend a variety of community meetings. We know that many people living with HIV pass through community-based organizations. We want to make sure that those organizations are equipped with the correct information to get people the care they need through resources or referrals. Our team has created detailing materials for both medical professionals and community-based organizations to maximize our impact.
Anna: Working with community-based organizations is a great way to make sure people have access to the best possible prevention and care, especially in a rural state like Iowa. How does Iowa’s geography impact your detailing work?
Lexie: Iowa has 3.1 million people with about 54 people per square mile. Our state is 85% farmland with country roads, winter weather, and a lot of construction. It is not uncommon to lose cell service or your GPS signal while driving in the very rural parts of Iowa. We’ve adapted our detailing approach because of this and have found that group sessions work best for us. We identify champions in the clinics and are then able to set up 1:1 visits with clinicians as needed.
Anna: We often hear from programs that group detailing is a great way to get your foot in the door and spread the word about AD. It’s nice to know that it’s working so well for your program too! I imagine Iowa’s geography also impacts patient care.
Lexie: Yes, it does. There can be stigma around seeking sexual health care in rural parts of Iowa. Many times, patients know someone working at the clinic in their town. It’s common for patients to travel long distances to get to a clinic where they don’t know anyone. It’s also common for patients to have to travel over 2 hours to access HIV care at a specialty clinic.
Anna: And that’s 2 hours one way! Has your program been able help with increasing access to care?
Lexie: Yes, I can share one story that stands out the most to me. A couple of years ago, I was presenting at a community meeting with 15 or so people in attendance. The CEO of a federally qualified health center (FQHC) in Southern Iowa was also present and we were able to connect and network afterwards. We talked about how far patients must travel for Ryan White HIV care and he saw a need that the community health center could fill. We connected with senior leadership, there were additional meetings, and together we were able to bring Ryan White HIV care services to the health center. Those services are still there today and now people living with HIV in Southern Iowa can access Ryan White services closer to home.
Anna: There is so much to be said about the power of AD, networking, and champions! Let’s wrap up with hearing about some of your program’s successes from this past year.
Lexie: We’re so proud of all that we’ve accomplished this year! Here are some highlights:
Anna: Those are some impressive numbers across both the clinical and community settings. Thank you for letting us feature your detailing work and learn more about the impact your team is making in your state!
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Biography. Lexie Hach holds an Associate Degree in Nursing, Bachelor of Arts degree in Health Promotion and Women’s Health, and a Master of Arts degree in Community Health Education. Lexie is currently a Doctoral student in Public Health (DrPH) with an Epidemiology concentration at the University of Nebraska Medical Center (UNMC).
Lexie has held positions in nursing, health education, public health, and healthcare marketing. Lexie has been with the Bureau of HIV, STD, and Hepatitis Capacity Extension Program at the Iowa Department of Public Health for over five years as a Regional Health Specialist (RHS). Lexie was previously with the bureau as a Disease Intervention Specialist (DIS).
Lexie was instrumental in developing and implementing the RHS program in Iowa’s rural communities. In her RHS (academic detailing) role, Lexie educated a variety of different stakeholders on best practices related to HIV, STIs, and Hepatitis in central Iowa. Lexie has helped support the Sexually Transmitted Disease (STD) Program as a DIS due to COVID-19 and also helped as a COVID-19 contact tracer. Lexie was the previous workforce health department co-chair for Iowa’s statewide strategic plan to stop HIV in Iowa (Stop HIV Iowa). Lexie recently returned to her roots in the STD program and now serves as an Integrated DIS and Special Projects Coordinator, but continues to work alongside her fellow RHS colleagues.
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