The RWHAP Best Practices Compilation gathers and disseminates interventions that improve outcomes along the HIV care continuum. Explore the Compilation to find inspiration and new ideas for improving the care of people with HIV. Learn more about the Best Practices Compilation and submit your innovation today for possible inclusion.
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The New York City HIV Care Coordination Program is a structural intervention that combines multiple strategies, including multidisciplinary care coordination, patient navigation, and personalized health education to address client medical and social needs. Multiple evaluations of the program consistently show improvements in viral suppression and engagement in care, especially for people with a new diagnosis of HIV or who are out of care.
Evidence-Based Intervention
People with a new diagnosis of HIV; People with HIV who are not in care
Retention in HIV medical care; Viral suppression
Clinical service delivery model; Outreach and reengagement activities; Support service delivery model; Systems/structural interventions
New York, NY
Stay Connected for Your Health helps clients stay engaged in HIV medical care through clinic-wide messaging, enhanced personal contact, and behavioral skills training. Originally implemented by six academically affiliated HIV clinics nationwide more than 10 years ago, this 12-month intervention has become well-established and is incorporated in many provider trainings. Evaluations show that people with HIV receiving behavioral skills training and personalized and frequent positive messages about care engagement were more likely to be engaged in care.
Evidence-Based Intervention
All clients
Retention in HIV medical care
Outreach and reengagement activities
Birmingham, AL
Miami, FL
Baltimore, MD
Boston, MA
New York, NY
Houston, TX
The Max Clinic, located within the University of Washington’s Harborview Medical Center complex in Seattle, offers walk-in services and incentives to clients reengaging in HIV care, especially those who have not been well served by the traditional health care model—including clients who are experiencing homelessness, or who have mental health and substance use issues. The Max Clinic offers rapid antiretroviral therapy, incentives, a flexible clinical model, and access to comprehensive support services. Max Clinic clients were significantly more likely to reach viral suppression after 12 months than a comparable control group.
Evidence-Based Intervention
People with HIV who are not in care
Viral suppression
Clinical service delivery model
Seattle, WA
Five clinics implemented Tailored Motivational Interviewing (TMI) to better serve young people with HIV as part of a RWHAP Part F SPNS initiative. Motivational interviewing is a well-documented approach to engage youth in care and facilitate behavior change in a variety of contexts. Clients participating in TMI received integrated HIV medical care and TMI, and demonstrated improved engagement in care and health outcomes.
Evidence-Based Intervention
Youth ages 13 to 24
Viral suppression
Support service delivery model
Los Angeles, CA
Ft. Lauderdale, FL
Baltimore, MD
Detroit, MI
Philadelphia, PA
Collaborative Care Management (CoCM) integrates mental health and primary care, with a care team of a primary care provider, behavioral health care manager, and psychiatric consultant. Together they provide comprehensive and coordinated care to people with HIV who have co-occurring depression or other psychiatric disorders. Four sites implemented CoCM as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. CoCM led to statistically significant increases in antiretroviral therapy (ART) prescription and viral suppression.
Evidence-Based Intervention
People with diagnosed mental illness
Prescription of antiretroviral therapy; Retention in HIV medical care; Viral suppression
Clinical service delivery model
Washington, DC
Baton Rouge, LA
Detroit, MI
Tulsa, OK
PositiveLinks is a mobile platform deployed by clinics or community-based organizations to connect people with HIV to a digital support community. The client-facing app helps people with a new diagnosis of HIV become engaged in care and helps people at risk of being lost to care overcome barriers related to geographic or social isolation. From the app, people can access Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant patient dashboards, secure messaging, and patient lab records. People who used PositiveLinks had increased rates of retention in care and viral suppression.
Evidence-Based Intervention
People with a new diagnosis of HIV; People living in rural areas
Retention in HIV medical care; Viral suppression
Use of technology and mobile health
VA