Part A - Hard Hit Urban Areas

Ryan White Part A funds HIV/AIDS care in metropolitan areas hardest hit by the epidemic. Medical and support services for underserved individuals are put into place through a sequence of activities. First is planning, which sets the framework for funding decisions. Next, Part A recipients (local governments) advertise for and award contracts to service agencies. Care is then delivered by funded agencies, which follow Ryan White standards that cover areas like quality of care and data reporting. Part A recipients monitor and manage grant funds to ensure services are delivered according to standards. Learn more about Part A, formula and supplementary grants, eligible services, and more.

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Best Practices

  • Best Practices Compilation
    To better integrate primary care with behavioral health services, providers were trained on trauma-informed care and contracts and standards of care were modified to require that medical providers conduct mental health screenings. As a result, receipt of mental health services and care retention rates improved.
  • Best Practices Compilation
    Hispanic and Latino clients served by the team received culturally responsive care and linkages to external community resources, with resulting greater retention in care and improved viral suppression rates.
  • Best Practices Compilation
    This medical-community partnership worked to link clients to care and decrease missed appointments and used peer navigators to successfully re-engage clients in care.
  • 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
    This intervention to rapidly re-house people with HIV was implemented at multiple New York City shelters and was associated with significant improvements in viral suppression.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    A broad population of men who have sex with men (MSM) reached viral suppression through intensive case management by applying tools and lessons learned in the Center for Quality Improvement Innovation end+disparities ECHO Collaborative.
  • Best Practices Compilation
    By integrating comprehensive HIV medical care with addiction services and medication protocols for substance use disorder (SUD), clients with HIV and SUD saw improvements in retention in care and viral suppression.
  • Best Practices Compilation
    This referral-based oral health model used dental navigators to connect clients to a large network of dentists, which facilitated scheduling of appointments.
  • Best Practices Compilation
    Expanded housing and employment opportunities for people with HIV contributed to positive housing, earned income, and viral suppression outcomes for clients.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    The New York City HIV Care Coordination Program is a structural intervention that combines multiple strategies, including multidisciplinary care coordination, patient navigation, and personalized health education to address client medical and social needs. Multiple evaluations of the program consistently show improvements in viral suppression and engagement in care, especially for people with a new diagnosis of HIV or who are out of care.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    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.
  • 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.
  • Best Practices Compilation
    The Maricopa Jail Project was implemented by five jails to decrease the wait time between incarceration and/or diagnosis to the start of treatment, and to better support clients to reach viral suppression. Maricopa hired a nurse practitioner to manage access and case manage across the jail system. The initiative was successful in increasing the number of clients who were virally suppressed.
  • Best Practices Compilation
    Routine Universal Screening for HIV (RUSH) provides non-medical case management services, opt-out HIV testing, and linkage to care for emergency department patients. The intervention automatically screens patients for HIV if they are aged 16 years or older, are having an IV inserted, or are having blood drawn for other reasons, unless the patient opts out. RUSH provides access to testing earlier in disease progression, bridging disparities that primarily impact people of color. It also promotes linkage to and retention in care for those with a positive HIV test result. Clients with a positive HIV test in the emergency department who had a prior diagnosis of HIV were more likely to be retained in care and to reach viral suppression.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    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.
  • Best Practices Compilation
    MacGregor Infectious Diseases, a hospital-based clinic affiliated with the Hospital of the University of Pennsylvania, implemented a multidisciplinary approach to strengthen outreach to clients and improve care retention. As compared to clients in standard care, clients served with the multidisciplinary approach had higher rates of retention in care, particularly among clients who were not virally suppressed.

Resources

Webinars

Conference Presentations

HRSA HIV/AIDS Bureau, Division of Metropolitan HIV/AIDS Programs
Presenters:
2022 National Ryan White Conference on HIV Care & Treatment
HRSA HIV/AIDS Bureau, Division of Metropolitan HIV/AIDS Programs
Presenters:
Chrissy Abrahms Woodland, Monique G. Hitch
2022 National Ryan White Conference on HIV Care & Treatment
AIDS Foundation Chicago
Presenters:
Anthony Guerrero, Jill Dispenza, Carmen Corredor
2022 National Ryan White Conference on HIV Care & Treatment
HRSA HIV/AIDS Bureau
Presenters:
Division Staff
2020 National Ryan White Conference on HIV Care & Treatment
Massachusetts Department of Public Health
Presenters:
Dennis Canty, Randie Kutzen, Alyssa Harrington
2020 National Ryan White Conference on HIV Care & Treatment

Technical Assistance

  • HRSA recipients first point-of-contact for managing federal grants and accessing training and technical assistance.

  • TAP-in supports the 47 EHE jurisdictions funded by HRSA to strengthen their EHE work plans, promote cross-jurisdictional learning, and ensure jurisdictions have access to the resources they need. Project period: 2020-2025.

  • Help with the RSR, ADR, CDR, EHE, HIVQM, and AETC data systems. Project period: 2020-2025.

  • The SCP delivers TA aimed at strengthening healthcare system engagement in local EHE efforts by supporting the coordination of planning activities, alignment of funding sources, and program implementation. Project period: 2020-2025.
  • Help with HRSA Electronic Handbooks (EHB) - 877-464-4772 - 8am-8pm ET, M-F - Contact HRSA About the EHB

  • Support for Part A and B recipients and their planning bodies around integrated HIV/AIDS planning efforts. Project period: 2016-2023.

  • RSR, ADR, HIVQM, PTR, AETC, DSR, GCMS, EHE - 888-640-9356 - 10am-6:30pm ET, M-F [email protected] Project period: 2022-2026.

  • 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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