Part B - States/Territories

Ideas for RWHAP Part B/ADAPs to support access to medications and tailor related services for Black/African American men living with HIV.

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.

The Oregon Health Authority awarded contracts to local public health authorities across the state to work with community partners to integrate early intervention services and outreach services, link people to HIV care, and provide support to help clients reach viral suppression. Quick linkage to care resulted in a median of 57 days to viral suppression for Early Intervention Services and Outreach clients in 2019.

The Enhanced Patient Navigation for Women of Color with HIV intervention uses patient navigators, who are non-medical staff in clinical settings, to reduce barriers to health care and optimize care. The intervention was effective in improving linkage to and retention in care, as well as viral suppression.

Extramural dental clinics implemented the medical home model, with integrated trauma-informed care, to expand oral health care services for people with HIV, and saw increases in referrals from partner organizations and the number of new clients.

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.

Caracole, an AIDS Service Organization, uses three interconnected approaches to improve retention in HIV care: housing first, harm reduction, and motivational interviewing. Clients in permanent supportive housing had high rates of viral suppression, exceeding Caracole's goal of 75%.

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.

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.

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.

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.

LA Links is a combined data-to-care and client navigation approach that cross-references routinely collected HIV surveillance data with other secondary data sources to identify and locate people with HIV who are not in care, as well as those who are in care, but with high viral loads. Originally implemented in 2013 as part of the Care and Prevention in the United States Demonstration Project, LA Links improved linkage to care, reengagement in care, and viral suppression. Louisiana expanded the program statewide in 2016.

Link-Up Rx is a pharmacy-data-based Data to Care program implemented by the Detroit Health Department in partnership with the Michigan Department of Health and Human Services and a specialty pharmacy. Using pharmacy data to identify clients in need of follow-up greatly reduced the amount of time for clients to appear on “not in care” lists compared to traditional D2C approaches. Protocols for a three-tiered outreach and reengagement approach were developed to connect clients back to antiretroviral therapy and HIV care following a missed pharmacy pick-up. Nearly half of identified clients were linked back to their pharmacy or other HIV medical services.

This data-to-care (D2C) initiative, implemented by the San Francisco Department of Public Health and its affiliated clinics from 2015–2017, used three sources of data to identify people not in care: HIV surveillance data, healthcare provider referrals, and electronic health record (EHR) data. LINCS navigators then used disease intervention searching tools and EHR data to locate clients and connect them to an HIV care provider. LINCS navigators followed up with clients for 90 days to support engagement in care. LINCS participants were more likely to be retained in care and virally suppressed after the intervention than before.

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.

The Utah Department of Health and Human Services collaborated with RWHAP Part B-funded medical case managers to improve care and outcomes for clients following Franklin Covey’s 4 Disciplines of Execution: 1) focus on the wildly important goal; 2) act on the lead measures; 3) keep a compelling scoreboard; and 4) create a cadence of accountability. Through intensive case management, regular monitoring, and feedback sessions, the state's RWHAP Part B program's overall viral suppression rate increased from 88.9% in 2020 to 90.4% by December 2021.

MORE focuses on people who are not virally suppressed and/or who have not attended an HIV medical appointment in six months. Participants can choose from one of three MORE programs, depending on the intensity of services they want. Based on initial evaluation findings, participants who received more intensive MORE services were more likely to be virally suppressed and less likely to be lost to follow-up than those who received less intensive services.

The Navigator Case Management intervention helps people with HIV who are incarcerated and are leaving to return to the community. The intervention uses harm reduction, case management, and motivational interviewing techniques to promote healthy behaviors. Enhanced case management including peer support and connection to other needed services both immediately before and after release supports increased linkage to and retention in HIV care for people transitioning to the community from jail.

The University of Pittsburgh Medical Center, Center for Care of Infectious Diseases, Pittsburgh Area Center for Treatment (PACT) began implementing the Food Assistance Program in August 2017 to serve as a supplemental resource for people with HIV receiving care who experience food insecurity. The program helps bridge gaps in Supplemental Nutrition Assistance Program (SNAP) benefits and monthly food costs while promoting access to healthy foods and retention in HIV care.

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.

PositiveLinks is a mobile platform deployed by clinics or community-based organizations to connect people with HIV to a digital support community. The client-facing app helps people with a new diagnosis of HIV become engaged in care and helps people at risk of being lost to care overcome barriers related to geographic or social isolation. From the app, people can access Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant patient dashboards, secure messaging, and patient lab records. People who used PositiveLinks had increased rates of retention in care and viral suppression.

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.

San Joaquin County Public Health Services Department partnered with the California Department of Public Health, Office of AIDS to help clients get to medical appointments via ridesharing. Representing the first partnership between a jurisdiction and a ridesharing company, this program addresses transportation barriers, promotes engagement in medical care, and leads to cost savings.

This nine-month program tailored services for people with HIV by bundling three to five evidence-informed care strategies for each client, such as mental health referrals, transportation assistance, appointment reminders, and pill boxes. A primary care physician, case manager, and pharmacist coordinated with each client to address their specific needs. After the intervention, 70.1% of previously non-suppressed clients were virally suppressed.

TAVIE Red is a mobile application that aims to improve retention in HIV care and address social determinants of health. It helps case managers connect with clients and uses gamification, a technique with elements of gameplay such as earning points and completing quests, to increase engagement with HIV care and psychological self-care management tools. TAVIE Red participants overwhelmingly reported that the technology helped them manage their HIV diagnosis.

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.

The Max Clinic, located within the University of Washington’s Harborview Medical Center complex in Seattle, offers walk-in services and incentives to clients reengaging in HIV care, especially those who have not been well served by the traditional health care model—including clients who are experiencing homelessness, or who have mental health and substance use issues. The Max Clinic offers rapid antiretroviral therapy, incentives, a flexible clinical model, and access to comprehensive support services. Max Clinic clients were significantly more likely to reach viral suppression after 12 months than a comparable control group.

The Tobacco Use Reduction in People Living with HIV Project was initiated in 2015 by the Michigan Department of Health & Human Services' Tobacco Section. Tobacco cessation services were integrated into the clinical care delivered at various AIDS Service Organizations, and also offered outside of regularly scheduled medical appointments, such as during support groups and educational classes. The percentage of people with HIV who reported using tobacco products saw a statistically significant reduction from 2015 to 2017.

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.

Instructions on how all Ryan White HIV/AIDS Program (RWHAP) Part B recipients can access, complete, and submit the RWHAP Part B Expenditures Report.

Instructions on how RWHAP) Part B Supplemental recipients can access, complete, and submit the RWHAP Part B Supplemental Expenditures Report.

Instructions on how (RWHAP Part B Supplemental recipients can access, complete, and submit the RWHAP Part B Supplemental Program Terms Report (PTR).

Instructions for RWHAP Part B recipients on the Part B Program Terms Report/Allocations and Expenditure Reports.

Series of manuals for Parts (programs) under HRSA's Ryan White HIV/AIDS Program (RWHAP).

Federal agency that administers the Ryan White HIV/AIDS Program (RWHAP), which helps low-income people with HIV receive care.

This guidance outlines the planning requirements for Ryan White HIV/AIDS Program (RWHAP) Parts A and B recipients and all DHAP-funded state and local health departments.

Performance measures to help Ryan White HIV/AIDS Program agencies monitor and improve the quality of care they deliver.

Instructions on how RWHAP Part B recipients on the RWHAP Part B PTR.

Step-by-step instructions for completing the RWHAP Parts B and B Supplemental Expenditures Reports.

Instructions on how all EHE recipients can access, complete, and submit the EHE Allocations Report.

Instructions on how all EHE recipients can access, complete, and submit the EHE Expenditures Report.

Toolkit to assist health departments, specifically RWHAP Part B and ADAPs, to prepare succession plans for staff as they take on new roles.

Toolkit for HRSA RWHAP Part B and ADAP recipients to guide design of systems and processes for eligibility determination and recertification.

List of local and state EHE points of contact.

Update to the Unmet Need Methodology for RWHAP Part A and B recipients.

Review of how RWHAP Part B programs develop, maintain, and evaluate service standards for all funded services, per Policy Clarification Notice (PCN) 16-02.

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

Resources for RWHAP recipients on administering their grants, including reverse site visit materials.

Webinars and other special events by HRSA's HIV/AIDS Bureau.

Review of what RWHAP Part B and Part B Supplemental recipients need to know to submit their 2018 Program Terms Reports (PTR).

Review of strategies to support Ryan White core medical and support service access/delivery within and/or in combination with local syringe services programs (SSPs).