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Link-up Rx
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.Resource updated 09/14/2023
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Maricopa County: Expanding Jail Services & Improving Health for Incarcerated People with HIV
The Maricopa County Jail Project was implemented by five jails and uses a nurse practitioner to manage service access and case management across the jail system.Resource updated 10/13/2023
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Collaborative Care Management: E2i
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.Resource from the RWHAP Best Practices Compilation updated on 01/03/2024
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Patient-Centered HIV Care Model
The Patient-Centered HIV Care Model (PCHCM) integrates the services of community-based HIV specialized pharmacists and HIV medical providers to deliver patient-centered care for people with HIV. PCHCM expands upon the medication therapy management model by including information sharing between partnered pharmacy and clinic teams; collaborative medication-related action planning between pharmacists, medical providers, and patients; and quarterly follow-up pharmacy visits. Patients participating in the intervention had improved retention in care and viral suppression rates.Resource from the RWHAP Best Practices Compilation updated on 11/26/2023
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The New York HIV and Aging Service Directive: A New Model Developed by Aging People with HIV
In response to data showing suboptimal outcomes for aging people with HIV, the HIV Health and Human Services Planning Council Consumers Committee developed a new service directive aimed at addressing the unique and intersectional needs of aging people with HIV.Resource (Conference Presentation) updated 09/14/2023
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HIV/Aging Institute 101: Understanding the Medical Conditions and Psychosocial Needs of Older Adults with HIV Who Are Aging in the Ryan White HIV/AIDS Program
Review of medical conditions and psychosocial needs facing aging clients who are living with HIV and HRSA initiatives.
Resource (Conference Presentation) updated 09/14/2023
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HIV/Aging Institute 201: Integrating Geriatric Services into the RWHAP Clinic
The role of the geriatrician and various staff roles in conducting screenings/assessments and integration of aging services in a clinic.
Resource (Conference Presentation) updated 09/14/2023
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HIV/Aging Institute 301: Accessing Community Resources for People Aging with HIV
Review of community aging resources and partnerships.
Resource (Conference Presentation) updated 09/14/2023
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Living Longer, Living Better: Improving Mental Fitness for People over 50 with HIV at Ryan White Clinic
Model developed by an agency to identify and address neuropsychological challenges of older clients living with HIV.
Resource (Conference Presentation) updated 09/14/2023
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Cap on Charges: Lessons Learned and Efforts to Improve Efficiency
Overview of successes and challenges of implementing a sliding fee scale and an efficient cap-on-charges process by a RWHAP clinic.
Resource (Conference Presentation) updated 09/14/2023
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Basics of Medicare Eligibility/Enrollment for RWHAP Clients: Training/Partnerships
Overview of Medicare eligibility and enrollment for people with HIV and support and training options available to agencies and people with HIV, including persons aging with HIV.
Resource (Conference Presentation) updated 09/14/2023
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Creating Fiscally Innovative Approaches to End the HIV Epidemic
Review of innovative financial and administrative processes adopted during the COVID-19 pandemic to ensure continuation of operations by RWHAP sub-recipients.
Resource (Conference Presentation) updated 09/14/2023
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Building Equity for Older Adults
Review of an initiative that identifies common barriers to client access and engagement and develops customized care interventions for adults aged 50 and older.
Resource (Conference Presentation) updated 09/14/2023
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Cultivating Growth: Home-based Behavioral Health and Supportive Housing across Oregon's Balance of State
Review of the Oregon model of integrating intensive case management, behavioral health, in-home and other wrap-around services with housing assistance and its replication potential in other jurisdictions.
Resource (Conference Presentation) updated 09/14/2023
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Incorporation of Nested Multidisciplinary Clinics into an HIV Primary Care Clinic for Emerging Co-morbidities
New Orleans clinic experiences with nested multidisciplinary clinics to serve older patients living with HIV.
Resource (Conference Presentation) updated 09/14/2023
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State Strategies in Action: Building Relationships with Your State Medicaid Agency to Support Peer Services
Description of the role of peers in care for people with HIV and OUD and how a state’s Medicaid program can fund peer services.Resource updated 09/19/2023
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Enhanced Patient Navigation for Women of Color
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.Resource from the RWHAP Best Practices Compilation updated on 02/28/2024
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Use of RWHAP Funds for Health Care Coverage Costs
Overview of RWHAP payment for clients’ health care coverage costs (insurance assistance).Resource updated 09/19/2023
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Hosting a CAREWare Network
Options for outlining roles and responsibilities in hosting a CAREWare network as part of the planning process.Resource updated 09/19/2023