Antiretroviral Treatment

Antiretroviral treatment that results in full viral load suppression is clinically beneficial (making it possible to manage HIV as a chronic condition) and significantly reduces the risk of HIV transmission. Federal expert panels now recommend early treatment for anyone living with HIV, and though there are relatively simple regimens available, patients must adhere to them for a lifetime. Monitoring and managing treatment success is a complex task for clinicians. Finally, despite the many advances in recent years, there is still much that is not understood about the long term impact of HIV and HIV medications.

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Best Practices

  • Best Practices Compilation
    Collaborative Care Management (CoCM) integrates mental health and primary care, with a care team of a primary care provider, behavioral health care manager, and psychiatric consultant. Together they provide comprehensive and coordinated care to people with HIV who have co-occurring depression or other psychiatric disorders. Four sites implemented CoCM as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. CoCM led to statistically significant increases in antiretroviral therapy (ART) prescription and viral suppression.
  • Best Practices Compilation
    Ten organizations across the U.S. integrated Community Health Workers (CHWs) into their multidisciplinary care teams. Enrolled clients had statistically significant improvements in viral suppression, antiretroviral therapy prescription, and appointment attendance after six months in the program.
  • Best Practices Compilation
    Healthy Divas focuses on empowering transgender women with HIV to achieve their personal health goals. Three sites implemented the intervention as part of the E2i initiative funded through the RWHAP Part F SPNS program from 2017 through 2021. Both engagement in HIV care and having an antiretroviral therapy prescription improved significantly for clients 12 months after enrollment in Healthy Divas.
  • Best Practices Compilation
    The HIV Clinical Pharmacist Services intervention shortens the time between referral to and engagement in care by allowing newly referred clients to see pharmacists in addition to other clinical providers for their initial appointment. This intervention is supported by findings from a retrospective cohort study that took place from 2013 to 2017 at a RWHAP-funded clinic. In addition to significantly decreasing the time between referral and initial visit, clients who saw a pharmacist also experienced shortened time to antiretroviral therapy initiation and viral suppression compared to those who only saw non-pharmacist providers.
  • Best Practices Compilation
    JumpstART launched in 2016 as part of New York State’s Ending the Epidemic initiative, changing the service delivery model of eight sexual health clinics to include an initial prescription of ART after an HIV diagnosis and prior to linkage to the community provider. Between November 2016 and September 2018, 60% of JumpstART clients received ART on the same day as diagnosis. JumpstART clients were also more likely to reach viral suppression within three months compared to non-JumpstART clients.
  • Center for Innovation and Engagement
    Link-Up Rx is a data to care (D2C) program that aims to increase retention in care and viral suppression among people with HIV by using prescription refill information to decrease the length of time between refills and reduce antiretroviral therapy (ART) interruption.
  • Best Practices Compilation
    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.
  • 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.

Resources

Webinars

Conference Presentations

University of Virginia Health System
Presenters:
Hiba Alzouby, Lindsey Buscemi
2022 National Ryan White Conference on HIV Care & Treatment
University of Virginia Health System
Presenters:
Taylor Harris, Lindsey Buscemi
2022 National Ryan White Conference on HIV Care & Treatment
NYC DOHMH
Presenters:
Sarah Wiant, Erica D'Aquila, Elizabeth Garcia, and Katey King
2022 National Ryan White Conference on HIV Care & Treatment
BETAH Associates, Inc.
Presenters:
Tamara Henry, Tasneem Islam
2022 National Ryan White Conference on HIV Care & Treatment
NYC Dept. of Health and Mental Hygiene
Presenters:
Mary Irvine, Tyeirra Seabrook, Rebecca Zimba
2022 National Ryan White Conference on HIV Care & Treatment

Technical Assistance

  • Capacity building for the RWHAP community to navigate the changing health care landscape and help people with HIV to access and use their health coverage to improve health outcomes. Project period: 2022-2025.
  • 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.
  • Clinician consultation on HCV management, HIV management, perinatal HIV/AIDS, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis, substance use. Project period: 2016-2025.

  • 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.
  • Project to facilitate the implementation of Rapid ART initiation in RWHAP provider settings by compiling and disseminating implementation resources nationwide. Project period: 2020-2023.
  • 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.

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