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 goals of the Emergency Department and Hospital-Based Data Exchange for Real-Time Data to Care (ED Alert) intervention are to reengage people with HIV in care and to improve viral suppression rates. This is achieved using a real-time data exchange system that connects clients presenting to the emergency department with health department linkage specialists. ED Alert increased viral load testing and viral suppression over six months following a provider visit in the post-intervention period.
Evidence-Informed Intervention
People with HIV who are not in care
Linkage to HIV medical care; Viral suppression
Clinical service delivery model; Data utilization approach
Seattle, WA
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.
Emerging Intervention
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
Dallas, TX
The Adolescent Quality Learning Network (AQLN) identified barriers to sexual health care in four areas: sexual health assessment; receipt of sexual health counseling; three-site STI testing; and receipt of STI treatment. The AQLN then tested approaches to address the identified barriers including opt-out testing, self-rectal swabs, and creating a sex positive environment in the clinic. After one year, the AQLN found improvements in the percentage of clients assessed for sexual health risks, as well as improvements in testing and treatment of STIs.
Emerging Intervention
Youth ages 13 to 24
Beyond the care continuum
Clinical service delivery model; Quality improvement
NY
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
The Positive Peers app motivates youth and young adults with HIV to stay engaged in HIV care through self-management tools and virtual support. Although specific outcomes vary by age group, individuals who used the app were more likely to attend their medical appointments, receive labs, and reach viral suppression.
Emerging Intervention
Youth ages 13 to 24; Young adults ages 25 to 34
Retention in HIV medical care; Viral suppression
Use of technology and mobile health
Cleveland , OH
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 University of Nebraska Medical Center/Nebraska Medicine (UNMC/NM) Specialty Care Center (SCC) is the largest provider of comprehensive HIV care—including primary and HIV-focused medical services as well as multiple support services—in Nebraska. In March 2020, at the onset of the COVID-19 pandemic, the clinic integrated telehealth into its care delivery model to continue serving patients beyond the clinic structure, and developed algorithms that allowed any team member to quickly identify a patient's eligibility for a telehealth visit. The algorithms include the date of the most recent office visit, stability of HIV disease, most recent viral load and CD4 count, and antiretroviral therapy (ART) refill histories as a proxy for medication adherence. Overall, viral suppression rates remained high for all patients regardless of visit type, indicating that telehealth is a successful alternative to in-person visits for providing HIV care.
Evidence-Informed Intervention
All clients
Viral suppression
Clinical service delivery model; Use of technology and mobile health
Omaha, NE
The Louisiana Public Health Information Exchange is a bidirectional exchange that connects hospital system electronic health records with state surveillance data. Providers use the exchange to identify and relink people with HIV who are out of care to clinical and supportive services. Since LaPHIE was implemented in 2009, thousands of people with HIV who were out of care have been identified, with a significant number being successfully linked to care.
Evidence-Informed Intervention
People with HIV who are not in care
Linkage to HIV medical care
Data utilization approach
LA
ERASE was developed to address the unique needs of Black MSM. Through an intensive case management intervention, peer case managers provide health education and wellness support, and connect clients to medical and behavioral healthcare. ERASE also offers a physical “safe space” for Black MSM to meet with a case manager, access medical services, or connect with peers. Enrollment in ERASE improved retention in HIV care for clients.
Emerging Intervention
Black gay and bisexual men; People with HIV who are not in care; People with a new diagnosis of HIV
Retention in HIV medical care
Outreach and reengagement activities
Oakland, CA
Nine sites implemented four evidence-based interventions, collectively known as Addressing STIs: Ask.Test.Treat.Repeat. The four intervention components are audio computer-assisted self-interview sexual history taking, patient self-collection of urogenital and extragenital site chlamydia/gonorrhea nucleic acid amplification test specimens, sexual and gender minority welcoming indicators, and provider training, with the overall goal to routinize STI screening, testing, and treatment in primary care. The interventions increased routine STI screening and testing of bacterial STIs based on reported behavioral risk.
Evidence-Informed Intervention
All clients
Beyond the care continuum
Clinical service delivery model
Washington, DC
FL
LA