Antiretroviral Treatment

Howard Brown Health established a specialized drop-in clinic and support groups, and implemented organizational initiatives to provide culturally relevant and gender-affirming services for transgender and non-binary people, including transgender women of color. The goal of this intervention was to optimize engagement in HIV services and primary care. From 2012-2021, the number of transgender and non-binary people served in primary care at Howard Brown Health more than tripled. In addition, after 24 months, participants were more likely to have been prescribed ART and to be virally suppressed than at baseline.

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.

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.

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.

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.

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.

The Huntridge Family Clinic launched the Rapid Start Initiative to provide same-day ART treatment and comprehensive case management to clients with a new diagnosis of HIV. Over 90% of clients received ART on the same day as diagnosis, and 78% of clients were retained in care within the first year of starting treatment.

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.

Kern County Rapid ART links people with a new diagnosis of HIV to ART. The Kern County Health Officer’s Clinic identifies people with a new diagnosis of HIV through onsite testing, surveillance data, and referrals from local hospital emergency departments. Kern County Rapid ART provides support services and refers clients to other community clinics for ongoing care. A study of clients with a new diagnosis of HIV in 2021 found that on average, Kern County Rapid ART clients were linked to care and provided ART within two days of diagnosis.

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.

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.

Positive Care Center implemented the Rapid Access program in 2018, providing clients with ART on the same day as HIV diagnosis. Pharmacists, embedded within Positive Care Center’s care team, help clients with their treatment plans and adherence strategies. Over 90% of clients served through Rapid Access in 2021 received ART on the same day as diagnosis, and 82% of clients were retained in care at six months.

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.

Rapid ART Program Initiative for New Diagnoses (RAPID) was designed to connect people with a new HIV diagnosis to ART within five days of diagnosis and within one day of their initial care visit. Linkage navigators counseled people on HIV care, identified an available clinician capable of immediately prescribing ART, scheduled the clinical appointment, and connected people to additional support services. RAPID led to a reduction in median time between initial diagnosis and both ART initiation and viral suppression.

The Rapid ART Start Protocol focuses on helping veterans with a new HIV diagnosis access ART and comprehensive treatment as soon as possible. A retrospective cohort study showed positive outcomes, including decreases in the time to first appointment, the time to ART initiation, and the time to reach viral suppression. In addition, patients receiving the intervention were more likely to reach viral suppression compared to patients seen pre-intervention at the same clinic.

Rise was implemented to address ART adherence issues among Black people with HIV. Through Rise, peer counselors used motivational interviewing techniques, leveraged Medication Event Monitoring System data to monitor and promote adherence, and connected participants to support services to address unmet needs. A randomized controlled trial showed that Rise participants were more likely to be adherent to ART than non-participants.

SBIRT is designed to screen clients for drug and alcohol use, educate clients on the risks of use, and connect them to substance use treatment services if necessary. SBIRT is an evidence-informed intervention that has been adapted by HIV experts in collaboration with community members to improve health outcomes among people with HIV. Two sites implemented SBIRT as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. Among the clients enrolled in SBIRT, the percentage with a prescription of antiretroviral therapy (ART) and who reached viral suppression both increased significantly.

Stronger Together uses counseling to increase engagement in and improve the quality of HIV care available for serodiscordant male couples. Through three in-person and additional “booster” sessions over an 18-month period, Stronger Together gave couples a space to work with an HIV professional to improve treatment adherence and keep both people healthy. Stronger Together participants were more likely to adhere to ART than those in a control group.

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.

Taking Care of Me is a video- and poster-based intervention to promote prompt ART initiation and medication adherence for people with HIV. The video and posters are designed for use in HIV clinics, drawing on the example of similar initiatives launched in public health clinic waiting rooms that aim to reduce incidence of sexually transmitted infections. A trial testing the efficacy of Taking Care of Me found that clients exposed to the video were more likely to be prescribed ART and reach viral suppression.

Through the Test & Treat Rapid Access (TTRA) Program, clients with a new HIV diagnosis in Miami-Dade County can access ART, receive other services and counseling, start enrolling in RWHAP, and connect to HIV primary care during the initial visit. At Borinquen Health Care Center, one of the clinical sites participating in TTRA, 76% of clients were virally suppressed within three months of receiving a rapid ART start, and 95% were retained in care for 12 months.

The Test and Treat initiative, implemented by Oklahoma State University, connects people to antiretroviral therapy (ART) within 14 days of HIV diagnosis through streamlined intake and initial clinic visit protocols and 30-day medication starter packs. Participants in Test and Treat are linked to care and reach viral suppression sooner, and are more likely to be retained in care, as compared with people in standard care.

Text Me, Girl! is a text messaging intervention that aims to improve linkage to and retention in HIV care, increase adherence to HIV medications, and improve viral suppression and other health outcomes among transgender women ages 18–34 years. The intervention supports young transgender women with HIV, particularly those experiencing barriers to care such as periods of homelessness and/or incarceration, substance misuse, or engaging in sex work. Text Me, Girl! participation was associated with statistically significant improvements in antiretroviral therapy uptake and adherence, and self-reported viral suppression.

The Brandy Martell Project aimed to engage adult transgender women of color in HIV care and increase retention in care by offering patient navigation services, workshop programming, and legal support. Evaluation results showed The Brandy Martell Project had a significantly positive effect on ART prescription for clients.

Trauma-Informed Approach & Coordinated HIV Assistance and Navigation for Growth and Empowerment (TIA/CHANGE) was developed by HIV experts in collaboration with community members to improve health outcomes among people with HIV. Using a strength-based approach to HIV service provision, TIA/CHANGE offers guidance and structure for an organization to become trauma-informed. TIA/CHANGE includes enrollment of clients in trauma-informed intensive case management services. The Alaska Native Tribal Health Consortium implemented TIA/CHANGE as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. Among clients participating in TIA/CHANGE there were improvements in prescription of ART and viral suppression.

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.

The Rutgers New Jersey Medical School created a transgender health program and integrated it into their Infectious Disease Practice. The program conducted community outreach to engage transgender men and women in care, trained all staff on gender affirming care, hired transgender staff, provided gender affirming care and hormone treatments onsite, and offered mental health support to patients.

T.W.E.E.T. aims to engage transgender women in HIV care by combining weekly peer-based education and discussion groups, leadership training, community building, and the provision of supportive services. Three sites implemented T.W.E.E.T. as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. Clients had improved outcomes across the HIV care continuum 12 months after enrollment in T.W.E.E.T.

Virginia Rapid Start launched with HIV care providers across the state with goals to initiate ART for clients within 14 days of HIV diagnosis and to improve access to, and retention in, high-quality HIV care and support services. Through Virginia Rapid Start, providers initiated ART medications within an average of four days of HIV diagnosis, as compared with the statewide average of 28 days. Virginia Rapid Start clients had higher rates of viral suppression compared to both the RWHAP Part B overall and Virginia overall. The success of Virginia Rapid Start led VDH to expand the program to the entire Virginia RWHAP Part B.

HIV clinical training resources for HRSA's AIDS Education and Training Centers Program.

CPAPA is no longer being updated by NASTAD and has been replaced by Pharmaceutical Company Patient Assistance Programs and Cost-Sharing Assistance Programs.

Guide for EHE jurisdictions on what they can do to enhance implementation of long-acting injectable antiretroviral therapy.

Healthcare providers can receive no-cost expert clinical consultation in HIV prevention & care, HCV treatment, and substance use management.

Online clinician training platform with evidence-based core competency training on HIV prevention, screening, diagnosis, care, and key populations.

U.S. HIV-related treatment guidelines, drug database, and glossary.

Federal guidelines for treatment, prevention and care of HIV disease, opportunistic infections, and common co-infections. 

Information on HRSA's Office of Pharmacy Affairs, which administers the 340b program, which provides drug discounts to certain federal grantees,

Online learning portal for clinicians on pre-exposure prophylaxis (PrEP) for prevention of HIV.

Fact sheet on the different coverage and cost-sharing considerations for LAI ART across public and private payers.

What HIV care providers can do to create a rapid ART program to get HIV clients on treatment the same day as a diagnosis.

Pre-application webinars for Notice of Funding Opportunity (NOFO) announcements from HRSA's HIV/AIDS Bureau for the Ryan White HIV/AIDS Program (RWHAP).

Role of health centers in increasing PrEP access and use among women.

Learn how to improve messaging about HIV prevention and care to improve acceptance of services among all Black women.

In 2021, the U.S. public was introduced to a bi-monthly injectable form of PrEP, which stands for Pre-Exposure Prophylaxis.

Review of types of injectable long lasting HIV prevention and treatment medications and their similarities and differences.

Review of concept of status neutral (access to HIV services regardless of HIV status).

Recordings of the TAP-in webinars on topics critical to the Ending the HIV Epidemic Initiative.