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 University of Mississippi Medical Center implemented a Postpartum Retention and Engagement Quality Improvement Initiative in 2017 to improve linkage to care, retention in care, and viral suppression among postpartum women with HIV. This intervention uses a combination of care coordination, printed materials, case management services, and improved collaboration and coordination between the Adult Special Care Clinic, which provides comprehensive HIV medical care, and a Perinatal HIV Program. The comprehensive intervention significantly improved retention in HIV care and increased viral suppression at both six and 12 months postpartum.
Evidence-Informed Intervention
Women; Pregnant and postpartum people
Retention in HIV medical care; Viral suppression
Support service delivery model
Jackson, MS
The Michigan Department of Health and Human Services was one of seven health departments funded by Leveraging a Data to Care Approach to Cure Hepatitis C Virus (HCV) Within the RWHAP Part F SPNS initiative implemented from 2020–2022. With the support of the Yale University School of Medicine, which served as the Technical Assistance Provider, MDHHS matched RWHAP and HIV and HCV surveillance data, calculated HCV viral clearance cascades for coinfected populations, and worked with three RWHAP clinics to generate clinic-based lists of coinfected clients and conduct outreach and linkage to HCV treatment.
Emerging Intervention
People with HCV
Beyond the care continuum
Data utilization approach; Outreach and reengagement activities
MI
The HIV Clinical Pharmacist Services intervention shortens the time between referral to and engagement in care by allowing newly referred clients to see pharmacists in addition to other clinical providers for their initial appointment. This intervention is supported by findings from a retrospective cohort study that took place from 2013 to 2017 at a RWHAP-funded clinic. In addition to significantly decreasing the time between referral and initial visit, clients who saw a pharmacist also experienced shortened time to antiretroviral therapy initiation and viral suppression compared to those who only saw non-pharmacist providers.
Evidence-Informed Intervention
People with HIV; People with a new diagnosis of HIV
Linkage to HIV medical care; Prescription of antiretroviral therapy; Viral suppression
Clinical service delivery model; Systems/structural interventions
Oklahoma City, OK
The Undetectables is a client-centered model of integrated care that uses innovative, superhero-themed, anti-stigma social marketing, agency cultural change, and a toolkit of evidence-based antiretroviral therapy adherence strategies to support treatment adherence and viral suppression among people with HIV. A two-year demonstration project evaluation showed a significant increase in the proportion of clients who were virally suppressed from 39% to 62%.
Emerging Intervention
People with diagnosed mental illness; People who are unstably housed; People experiencing food insecurity; People who use drugs; People with a history of trauma
Viral suppression
Clinical service delivery model; Systems/structural interventions
New York City, NY
The PC4H initiative employs a mobile app and a digital literacy workshop to improve engagement, retention in care, and medication adherence for young people with HIV. These strategies aim to reach young people who are disproportionately affected by HIV, including young men who have sex with men, young transgender women, and youth of color, with a focus on serving people who know their status but are inconsistently engaged in care. Developed by Children’s Hospital of Philadelphia and Philadelphia FIGHT, PC4H was evaluated through the RWHAP Part F SPNS Social Media Initiative. The evaluation found that PC4H had positive impacts on retention in care and viral suppression.
Emerging Intervention
Black/African American people; Youth ages 13 to 24; Young adults ages 25 to 34; Gay, bisexual, and other men who have sex with men (MSM); Transgender men
Retention in HIV medical care; Viral suppression; Beyond the care continuum
Use of technology and mobile health
Philadelphia, PA
The RWHAP Part F SPNS program funded the Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations initiative from 2012–2017, to provide coordinated housing supports and HIV, behavioral and mental health care to people experiencing homelessness. Nine funded demonstration sites created partnerships with housing providers, integrated behavioral health and HIV care, and provided intensive patient navigator services. A multi-demonstration site evaluation found that, compared to baseline, participants were more likely to be virally suppressed after 12 months in the intervention.
Evidence-Based Intervention
People who are unstably housed
Retention in HIV medical care; Prescription of antiretroviral therapy; Viral suppression; Beyond the care continuum
Support service delivery model
Pasadena, San Diego County, San Francisco, CA
New Haven, CT
Jacksonville, FL
Cumberland, Hoke, Harnett, Johnston, and Sampson Counties, NC
Multnomah County, OR
Dallas and Harris Counties, TX
Bienestar developed TransActivate to improve timely engagement and retention in HIV care among Latina transgender women. Linkage coordinators/peer navigators use a strengths-based approach to help clients reach their goals of entering and staying in medical care to ultimately reach viral suppression.
Emerging Intervention
Transgender women; Hispanic/Latina(o/x) people
HIV diagnosis; Linkage to HIV medical care; Retention in HIV medical care; Viral suppression
Support service delivery model
Los Angeles, CA
E-VOLUTION is a two-way text messaging intervention, originally developed by Washington University School of Medicine and piloted at Project ARK. The intervention focuses on improving health outcomes for youth, particularly young Black men who have sex with men. E-VOLUTION was designed for people ages 18-29 who have HIV and are receiving clinical care but require support to remain adherent. E-VOLUTION was evaluated and found to improve viral suppression and retention in care rates.
Evidence-Informed Intervention
Youth ages 13 to 24; Young adults ages 25 to 34; Black gay and bisexual men
Retention in HIV medical care; Viral suppression
Use of technology and mobile health
St. Louis, MO
The Patient-Centered HIV Care Model (PCHCM) integrates the services of community-based HIV specialized pharmacists and HIV medical providers to deliver patient-centered care for people with HIV. PCHCM expands upon the medication therapy management model by including information sharing between partnered pharmacy and clinic teams; collaborative medication-related action planning between pharmacists, medical providers, and patients; and quarterly follow-up pharmacy visits. Patients participating in the intervention had improved retention in care and viral suppression rates.
Evidence-Informed Intervention
People with HIV
Retention in HIV medical care; Viral suppression
Clinical service delivery model
Palm Springs, CA
Washington, DC
Fort Lauderdale, FL
Miami, FL
Albany, GA
Chicago, IL
Howard Brown Health established a specialized drop-in clinic and support groups, and implemented organizational initiatives to provide culturally relevant and gender-affirming services for transgender and non-binary people, including transgender women of color. The goal of this intervention was to optimize engagement in HIV services and primary care. From 2012-2021, the number of transgender and non-binary people served in primary care at Howard Brown Health more than tripled. In addition, after 24 months, participants were more likely to have been prescribed ART and to be virally suppressed than at baseline.
Evidence-Informed Intervention
Transgender women
Prescription of antiretroviral therapy; Viral suppression
Clinical service delivery model
Chicago, IL