Clínica Bienestar (Spanish for “Wellness Clinic”) was developed to provide comprehensive, integrated HIV primary care services to Spanish-speaking and bilingual people of Puerto Rican ancestry, with HIV who inject drugs. Clínica Bienestar is a multilevel, multipronged intervention combining evidence-based practices in behavioral health and HIV medical care with a transnational approach to care. Clínica Bienestar positively impacted retention in HIV medical care and viral suppression.
Evidence-Informed Intervention
Hispanic/Latina(o/x) people
Retention in HIV medical care; Viral suppression
Clinical service delivery model; Support service delivery model
The Alexis Project used social network recruiting and engagement, peer navigation, and contingency management to reach and engage transgender women of color with HIV who were not engaged in HIV care. Participation in the 18-month intervention improved linkage to care and viral suppression.
Transgender women; Women of color; Women
Linkage to HIV medical care; Viral suppression
Support service delivery model; Outreach and reengagement activities
The Village Project is an intensive case management-based intervention that harnesses peer navigation and integrated behavioral health services to improve the health outcomes of young Black gay, bisexual, and men who have sex with men. The Village Project was associated with increased retention in care and viral suppression.
Black gay and bisexual men; Youth ages 13 to 24; Young adults ages 25 to 34; Black/African American people
Retention in HIV medical care; Viral suppression
Support service delivery model; Clinical service delivery model
Enlaces Por La Salud is an HIV linkage, navigation, and education program for Mexican men and transgender women. The intervention is grounded in a transnational framework for providing cultural context to support the delivery of one-on-one educational sessions to Latina(o/x) people with a new HIV diagnosis, as well as people with HIV who are not yet retained in care. After 12 months, the majority of people participating in Enlaces Por La Salud were retained in care and reached viral suppression.
Hispanic/Latina(o/x) people; Gay, bisexual, and other men who have sex with men (MSM); Transgender women; People with a new diagnosis of HIV; People with HIV who are not in care
Retention in HIV medical care; Viral suppression
Support service delivery model; Outreach and reengagement activities
Wake County, NC
Mecklenburg County, NC
HHOME offers mobile HIV primary care, behavioral health care, and connection to housing services to people with HIV experiencing homelessness. A centralized HHOME team acts as a hub to meet clients where they are, refer them to housing and support services, and provide ongoing case management and HIV primary care services. Clients participating in HHOME experienced increased retention in care, viral suppression, and connection to stable housing.
Evidence-Informed Intervention
People who are unstably housed; People with substance use disorder; People with diagnosed mental illness
Retention in HIV medical care; Viral suppression; Beyond the care continuum
Clinical service delivery model; Support service delivery model
2BU is a case management intervention designed to engage and reengage Black men who have sex with men with HIV into HIV care services. Peer case managers work closely with clients to increase HIV health literacy, troubleshoot accessibility issues to HIV care, and connect clients directly to behavioral health and support services. Clients who participated in 2BU had increased retention in care and viral suppression 12 months after enrollment.
Evidence-Informed Intervention
Black gay and bisexual men; Black/African American people; Gay, bisexual, and other men who have sex with men (MSM); People with HIV who are not in care
Retention in HIV medical care; Viral suppression
Support service delivery model
The Enhanced Patient Navigation for Women of Color with HIV intervention uses patient navigators, who are non-medical staff in clinical settings, to reduce barriers to health care and optimize care. The intervention was effective in improving linkage to and retention in care, as well as viral suppression.
Evidence-Informed Intervention
Women of color; Transgender women; Women
Linkage to HIV medical care; Retention in HIV medical care; Viral suppression
Outreach and reengagement activities; Support service delivery model
Atlanta, GA
Los Angeles, CA
Newark, NJ
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
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
Support service delivery model
Los Angeles, CA
Ft. Lauderdale, FL
Baltimore, MD
Detroit, MI
Philadelphia, PA
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.
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