Peer Engagement to Improve Linkage to Care and Retention in Care for Youth, Women, Infants, and Children

University Health (UH) uses peers and patient navigators to provide support, reduce barriers, and improve linkage and retention to care for women, infants, children, and youth with HIV (WICY). Two peers with lived experience were hired as Outreach Specialists to spearhead the program, which is named FAM210. Their duties include planning and facilitating support groups, connecting clients to patient navigators, and developing innovative ways to engage youth and women. Outreach Specialists also share similar experiences, encourage medication adherence and use of services, and provide mentoring. The intervention was successful in moderately improving the numbers of clients linked to care, retained in care, and virally suppressed.

San Antonio, TX

Emerging Intervention
Outreach and reengagement activities
Linkage to HIV medical care; Retention in HIV medical care; Viral suppression
Treat
Youth ages 13 to 24; Women
RWHAP Part D
RWHAP-funded clinic or organization
Need Addressed

In previous years, there has been a strong focus on women in the UH program; 82% of the population being served were aged 25 to 65 and older while only 17% were aged 13 to 24. Data revealed the need to focus more on the youth population in efforts to improve engagement and retention in care. UH decided to focus on non-traditional ways to engage youth and women, using a peer outreach approach.

Core Elements
Hiring criteria

Look to hire staff who have outreach experience and are relatable to the populations of focus for the program. The Youth Outreach Specialist hired by UH was an active member and leader of youth initiatives in the community that focused on HIV/AIDS awareness including the End Stigma End HIV Alliance and the Health Justice Youth Council. The Women, Infants, and Children (WIC) Outreach Specialist hired brought experience as a longtime member of the Family to Family Network support group, and advocate for women with HIV in the community.

Outreach Specialist job description

The job of the Youth and WIC Outreach Specialists is to provide peer support and improve linkage to and retention in care for youth, women, infants, and children. Specific duties include:

  • Facilitate and plan support groups
  • Connect clients to the Patient Navigator (Licensed Vocational Nurse)
  • Develop innovative ways to engage youth and women through social media and community awareness events
  • Provide peer mentoring with clients—by phone and in person—in which they share similar experiences, and encourage adherence and use of services by:
    • Providing support and encouragement
    • Accompanying clients to some medical visits
    • Making them aware of available services
    • Identifying and overcoming barriers to care

“[The clients] just feel so empowered with [the Youth Outreach Specialist]. So, that's part of the mentorship. It's just that ‘I have someone I can relate to, I have someone I can talk to, I have someone I can vent to…I have a person that can just hear me out’. Especially going through COVID and this storm that just hit us, people are frustrated and they don't want to go to their case manager and they don't want to go to their social worker and get the run around on the forms and all that. They literally would just call and text [the Outreach Specialist] and just, "I need to talk." And that's serving them, that's what they needed, they needed someone just to listen.”

Dedicated social media and marketing strategy

UH created a social media, outreach, and marketing plan to help promote their FAM210 program. The program maintained an ongoing social media presence through a dedicated website with a chat function, as well as Instagram and Facebook accounts, including dedicated Facebook accounts for the youth cohort (FAMYOU210) and for the women cohort (WISEUP210).

Outcomes

The intervention strategy was successful in improving the numbers of clients linked to care, number of clients retained in care, and viral suppression rates.

Category Information
Evaluation data ARIES client management data system data for Ryan White HIV/AIDS (RWHAP) Part D clients
Measures

Number of:

  • Clients
  • Clients linked to care
  • Clients retained in care
  • Clients virally suppressed
Results

From 2017 to 2019, increase in clients:

  • Served from 418 to 623 (including increase in the number of youth served from 24 to 95)
  • Linked to care from 39% to 43%
  • Retained in care from 16% to 23%
  • Virally suppressed from 13% to 18%

"Youth don’t want to go anywhere [for services] where they don't feel comfortable. They don't want to go anywhere where they feel as if their sexuality is going to be questioned, their judgment, their decisions, where things like that are going to be questioned. So we know that the HIV numbers are going up in the youth 18 to 24, but there's nobody there to help guide them as to where they can go for support and services they feel comfortable with.”

Planning & Implementation
  • The FAM210 staffing model includes:
    • WIC Outreach Specialist (30 hours per week)
    • Youth Outreach Specialist (40 hours per week)
    • Program Manager (40 hours per week)
    • Program Coordinator (20-25 hours per week)
    • Data Analyst (10-15 hours per month)
    • Patient Navigator (40 hours per week)
  • Identify community events to attend and community partners to collaborate with to promote the program and make initial connections with potential clients.
  • Develop and implement a social media and marketing strategy to promote the program. 
  • Include in the program budget, funding for: dedicated cell phones or phone lines to reach Outreach Specialists, transportation for Outreach Specialists, program participation incentives (e.g., bus passes, grocery store gift cards) for clients, and marketing materials (website, business cards, flyers, posters, event supplies).
  • Arrange for regular meeting space for support groups and mentoring.
Sustainability

While UH received a one-time supplemental RWHAP Part D grant to hire the two Outreach Specialists, the positions are now funded through their base RWHAP Part D funding.

"It works because we're listening to our population that we're serving. It's not us saying, "Oh, well we think this is going to work." No, we really are listening to the population that we're serving about what they want. What do they need? We're putting our bias to the side and going exactly to the source [the client].”

Lessons Learned
  • Be open to non-traditional methods of outreach, especially with the youth population.
  • Stay in the loop by seeking community input about needs of the populations the program is trying to reach.
  • Develop and foster good working relationships with providers and community organizations that serve the same populations of focus. Some potential partners were hesitant to collaborate with the FAM210 program, due to the fear of losing clients or not understanding the aims of the program.
  • Maintain constant communication between program administrators and the peer outreach staff to ensure that the larger program is enhancing and supporting their efforts, not dictating or overshadowing their efforts.
  • Stay flexible and have a plan in place for adapting to organizational changes and/or staff turnover. Have more than one person trained on how to run and maintain the program.
  • Collaborate with community partners serving the youth and WIC populations. Participate with and enhance already established interventions by adding the peer experience. Provide additional resources to enhance, support and offer additional mentorship to already existing support groups for youth and women. Work together on HIV-related health awareness days.
Resources & Tools
  • Peer Engagement to Improve Linkage to Care & Improve Retention for Youth, Women, Infants, and Children presentation from the 2020 National Ryan White Conference on HIV Care and Treatment (see video below)

Contact the Innovator
FAM210
Leah Meraz
Senior Director, University Health System Ryan White HIV/AIDS Program Part D

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