Adolescents & Youth

3% of RW clients are aged 13-24, 65% of them live below poverty level, 5% experience unstable housing, 84% are virally suppressed

The proportion of RWHAP clients 13-24 years of age who have achieved viral suppression has increased steadily and significantly, from 46.6% to 83.8% over the time frame 2010-2022. The rate improvement tracks but slightly lags that for the overall RWHAP population. 

Best Practices

  • Center for Innovation and Engagement
    Collection of implementation guides on evidence-informed best practices in HIV care delivery.
  • AIDS Action Foundation

    Workbooks describing ways to help connect people living with HIV/AIDS to medical care. Estos cuadernos describen la manera de asistir a conectar personas que viven con VIH/SIDA con el sistema médico.  

  • SPNS Latino Access Initiative, UCSF Center for AIDS Prevention Studies

    Monographs describing interventions for the engagement and retention of Latinos in HIV care.

  • SPNS Social Media Initiative

    Social media tools developed by demonstration sites (e.g., text messaging, apps).

  • Next Step and Mass CARE

    Guidebook for multiple audiences that outlines steps for transitioning youth from pediatric care to adult services.

  • AIDS Alliance for Children Youth and Families

    Resource for programs interested in developing or expanding outreach services to identify HIV-positive youth and engage and retain them in care.

  • Best Practices Compilation
    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.
  • Best Practices Compilation
    The AIDS Institute is committed to promoting, monitoring, and supporting the quality of clinical services for people with HIV in New York State. The Adolescent Quality Learning Network (AQLN) is a collaborative of 16 HIV Adolescent/Young Adult Specialized Care Center (SCC) programs. In collaboration with the AIDS Institute, SCC providers selected a quality improvement project aimed to raise viral suppression rates by improving access to mental health services.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    INFINI-T is a program designed to reach young transgender women of color with HIV and retain them in care through peer advocates who provided case management. These peer advocates facilitated social support sessions with the goal of alleviating the negative impacts of psychosocial factors like history of trauma, stigma, and discrimination. Clients were more likely to be virally suppressed and retained in care after 12 months of participating in the intervention.
  • Best Practices Compilation
    OPT-In For Life is a social media-based intervention that promotes advancement along the HIV care continuum for young adults (ages 18 to 34) with HIV. During the 18-month intervention, OPT-In For Life used multiple social media platforms and a mobile application to provide HIV-related and positive lifestyle resources. Young adults enrolled in OPT-in For Life demonstrated improved retention in HIV care and higher rates of viral suppression after participation.
  • Best Practices Compilation
    University Health uses peers and patient navigators to provide support, reduce barriers, and improve linkage and retention to care for women and youth with HIV. Two peers with lived experience were hired as Outreach Specialists to spearhead the program, 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.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    Project ACCEPT is designed to improve engagement and retention in medical care for youth ages 16 to 24 years with newly diagnosed HIV. The educational and skill-building intervention was deployed at four demonstration sites and increased rates of medication use and appointment adherence in comparison to a control group. Although originally developed for cisgender youth, Project ACCEPT may be adapted for gender-diverse people.
  • Center for Innovation and Engagement
    Intervention leverages both individual and group sessions to address issues that influence youth engagement in HIV care, including stigma, disclosure, healthy relationships, substance use, and future life planning.
  • Best Practices Compilation
    Project CONNECT uses linkage coordinators to effectively engage people in HIV medical care. It focuses on people with newly diagnosed HIV or people with HIV who are transferring their care or have been out of care. AIDS Taskforce of Greater Cleveland implemented Project CONNECT as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. Project CONNECT was successful in increasing the number of clients retained in HIV care and who reached viral suppression.
  • Best Practices Compilation
    Project nGage is a support intervention approach that offers participants an initial 90-minute session with a social work interventionist and a participant support confidant to develop a tailored care and support plan. The social work interventionist then offers four follow-up sessions to each participant to discuss progress on the care and support plan. Project nGage was evaluated in a randomized controlled trial from 2012 to 2015: participants in the intervention were more likely to have at least three HIV primary care visits in the last 12 months than those who received usual care.
  • Best Practices Compilation
    STYLE 2.0 is a multi-component intervention designed to help reduce stigma and social isolation for Black gay, bisexual, and other men who have sex with men. The intervention relies on health care navigators who facilitate linkage and engagement activities. They also connect clients to behavioral health providers who conduct motivational interviewing, as well as to a mobile application that supports all intervention activities. STYLE 2.0 participation has been associated with positive trends across HIV care continuum outcomes, including retention in care and increased viral suppression.
  • Center for Innovation and Engagement
    Project to increase HIV awareness through outreach and testing events on college campuses and in the larger community through partnerships and care linkages.
  • Best Practices Compilation
    The Virginia Commonwealth University implemented a clinical quality improvement project to increase linkage to HIV medical care within 30 days and initiation of antiretroviral therapy (ART) at the first visit by making “Rapid Access” appointments available each week for people with newly diagnosed HIV.
  • Best Practices Compilation
    Southeast Mississippi Rural Health Initiative, Inc., a network of community health centers serving Southern Mississippi, uses data-driven quality improvement techniques to identify youth who are not virally suppressed or have missed appointments. Medical case managers use a client checklist to identify and address barriers to antiretroviral therapy (ART) and medical care adherence. They also use a health literacy visual illustration tool to help youth understand the effects of ART on viral suppression. The intervention strategy was successful in improving viral suppression rates for youth.
  • Best Practices Compilation
    The STEP Program is a multidisciplinary intra-campus health care transition program to support youth with HIV as they transition from pediatric to adult HIV care using individualized transition plans. Ninety-five percent of youth enrolled in STEP were still retained in adult care at 12 months compared to only 50% of a pre-STEP cohort.
  • Center for Innovation and Engagement
    Description of a communication-centered approach to service delivery that provides a compassionate and supportive environment to promote intrinsic behavior change among youth 16 to 29 with newly diagnosed HIV.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    Tailored Motivational Interviewing (TMI) delivers brief motivational interviewing counseling sessions customized to encourage people with HIV to engage in HIV care, take HIV medications as prescribed, and improve other health-related behaviors. Three sites implemented TMI as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017 to 2021. Clients who participated in TMI had significant improvement in engagement in care, prescription of antiretroviral therapy, retention in care, and viral suppression.
  • Best Practices Compilation
    The Text Messaging Intervention to Improve Antiretroviral Adherence among HIV-Positive Youth (TXTXT) is designed to keep young people, particularly young, Black, gay, bisexual, same-gender loving, and other men who have sex with men, engaged in HIV medical care, by delivering personalized, daily, interactive text messages that remind them to take their antiretroviral therapy as prescribed. Two sites implemented TXTXT as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. The intervention resulted in a statistically significant improvement in engagement in HIV care.
  • Best Practices Compilation
    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.
  • Evidence-Informed Interventions (E2i)
    Text Messaging Intervention to Improve Antiretroviral Adherence among HIV-Positive Youth (TXTXT) is an evidence-informed intervention that provides personalized text messages to remind and encourage young people with HIV to take their HIV medication as prescribed. 
  • Best Practices Compilation
    In weCare, a cyber health educator sent personalized messages through text, web-based apps, and Facebook to enrolled youth who identified as gay, bisexual, or other men who have sex with men (MSM), or transgender women, and who either had a new diagnosis of HIV or were not in care at the time of enrollment. Messages were personalized to each participant’s needs and were designed to support them as they navigated complicated health care systems as well as other challenges that affect care engagement (e.g., transportation, disclosure). The cyber health educator also moderated and posted information about health and well-being on an optional secret Facebook page that some participants chose to join. Participants were less likely to miss medical appointments and more likely to be virally suppressed after 12 months of the intervention.
  • Best Practices Compilation
    Wellness Web 2.0 is a text message-based intervention that offers health education tools, appointment reminders, and navigation services to increase linkage to and retention in care for youth and young adults with HIV. Clients across 27 counties in South Texas enrolled in the Wellness Web 2.0 program had improvements in linkage to HIV medical care and viral suppression.
  • Best Practices Compilation
    The YGetIt? Program engaged youth and young adults with HIV in care through three components: a health management mobile application (GET!), Peer Engagement Educator Professionals (PEEPs), and a graphic serial (Tested). Tested received over 200,000 views, and viral suppression rates among YGetIt? participants increased from 79% to 86% over the course of the program.

Resources

Conference Presentations

Elon University
Cynthia Fair, Michelle Turner, Jess Wiederholt, Morénike Giwa Onaiwu, Faith Glover, Ari Wolgin
2022 National Ryan White Conference on HIV Care & Treatment
HRSA
Taria Poteat, Barbara Kosogof, Kristin Athey, Keristen Mazyck, Tonya Green, Laurali Riley
2022 National Ryan White Conference on HIV Care & Treatment
Agwu
2021 Ryan White HIV/AIDS Program Clinical Conference
Johns Hopkins University
Allison L Agwu, MD, ScM
2020 Ryan White HIV/AIDS Program Clinical Conference
El Rio Health
Sharon Dipasupil
2020 National Ryan White Conference on HIV Care & Treatment

Technical Assistance

  • The central hub of the AETC Program, the clinical training arm of the RWHAP, through HIV curricula, technical support to regional AETCs on practice transformation and best practices, and housing of all AETC-developed tools for HIV clinical staff. Project period: 2019-2024.
  • TA/training for RWHAP agencies to improve the quality of HIV/AIDS care they provide. Project period: 2020-2024.

  • ELEVATE will prepare people with HIV to meaningfully engage and take on leadership roles in planning bodies, advocacy actions, and the HIV workforce. Project period: 2020-2024.

  • The NHC provides ongoing, up-to-date information needed to meet the core competency knowledge for HIV prevention, screening, diagnosis, and ongoing treatment and care to healthcare providers in the United States. Project period: 2020-2022.
  • Platform for RWHAP Part D recipients to increase the delivery of care innovations; increase the skills of staffing working with women, infant, children and youth; and support partner collaboration for dissemination of best practices.
  • Initiative documenting best practice strategies and interventions that have been shown to improve HIV outcomes in a "real world" setting and can be replicated by other programs. Project period: 2021-2024.
  • Interactive data tool to visualize the reach, impact, and outcomes of the RWHAP. HRSA offers office hours and webinars to help use the tool.
  • HRSA SPNS project applying the implementation science framework to identify innovative HIV interventions for three priority populations (people with substance use disorder, sexual minority youth, people involved in criminal justice system) and use of telehealth. Project period: 2021-2025.