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 intervention integrated supportive employment services, housing services, and HIV care for clients receiving case management services and with unmet housing and employment needs. Evaluation of the program showed improvements in employment rates, participant confidence in being able to hold onto a job, household median income, participants’ living situations, and self-perception of homelessness status.
Emerging Intervention
People who are unstably housed
Beyond the care continuum
Support service delivery model; Data utilization approach
Paterson, NJ
The Arizona Department of Health Services partnered with three clinics to identify people with a dual diagnosis of HIV and HCV, determine their care needs, and link them to HCV treatment.
Emerging Intervention
People with HCV
Beyond the care continuum
Data utilization approach; Outreach and reengagement activities
AZ
The Bottom-Up Project is a multi-organizational initiative focused on leveraging health information exchange data and peer navigation. Using real-time clinical data, in combination with linkage to HIV care and social services, the Bottom-Up Project locates and reengages people with HIV who are not currently in medical care and are not virally suppressed. Through this collaboration, over half of patients on the lost-to-follow-up list were found and invited to enroll in the linkage to care/reengagement program.
Emerging Intervention
People with HIV who are not in care
Retention in HIV medical care
Data utilization approach; Outreach and reengagement activities
NY
The Utah Department of Health and Human Services collaborated with RWHAP Part B-funded medical case managers to improve care and outcomes for clients following Franklin Covey’s 4 Disciplines of Execution: 1) focus on the wildly important goal; 2) act on the lead measures; 3) keep a compelling scoreboard; and 4) create a cadence of accountability. Through intensive case management, regular monitoring, and feedback sessions, the state's RWHAP Part B program's overall viral suppression rate increased from 88.9% in 2020 to 90.4% by December 2021.
Emerging Intervention
All clients
Viral suppression
Data utilization approach; Outreach and reengagement activities
UT
Link-Up Rx is a pharmacy-data-based Data to Care program implemented by the Detroit Health Department in partnership with the Michigan Department of Health and Human Services and a specialty pharmacy. Using pharmacy data to identify clients in need of follow-up greatly reduced the amount of time for clients to appear on “not in care” lists compared to traditional D2C approaches. Protocols for a three-tiered outreach and reengagement approach were developed to connect clients back to antiretroviral therapy and HIV care following a missed pharmacy pick-up. Nearly half of identified clients were linked back to their pharmacy or other HIV medical services.
Emerging Intervention
People with HIV who are not in care
Retention in HIV medical care; Viral suppression
Data utilization approach; Outreach and reengagement activities
Detroit, MI
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
Gay Men’s Health Crisis updated its data management process to better document housing and employment service outcomes. Enhancements to the Electronic Health Record contributed to positive housing, employment, and viral suppression outcomes for clients.
Emerging Intervention
All clients
Viral suppression
Data utilization approach
New York, NY