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Enhanced Housing Placement Assistance
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.Resource from the RWHAP Best Practices Compilation updated on 11/02/2023
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Positively Connected for Health (PC4H)
The PC4H initiative employs a mobile app and a digital literacy workshop to improve engagement, retention in care, and medication adherence for young people with HIV. These strategies aim to reach young people who are disproportionately affected by HIV, including young men who have sex with men, young transgender women, and youth of color, with a focus on serving people who know their status but are inconsistently engaged in care. Developed by Children’s Hospital of Philadelphia and Philadelphia FIGHT, PC4H was evaluated through the RWHAP Part F SPNS Social Media Initiative. The evaluation found that PC4H had positive impacts on retention in care and viral suppression.Resource from the RWHAP Best Practices Compilation updated on 11/17/2023
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HIV Clinical Pharmacist Services
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.Resource from the RWHAP Best Practices Compilation updated on 11/01/2023
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Postpartum Retention and Engagement Quality Improvement Initiative
The University of Mississippi Medical Center implemented a Postpartum Retention and Engagement Quality Improvement Initiative in 2017 to improve linkage to care, retention in care, and viral suppression among postpartum women with HIV. This intervention uses a combination of care coordination, printed materials, case management services, and improved collaboration and coordination between the Adult Special Care Clinic, which provides comprehensive HIV medical care, and a Perinatal HIV Program. The comprehensive intervention significantly improved retention in HIV care and increased viral suppression at both six and 12 months postpartum.Resource from the RWHAP Best Practices Compilation updated on 11/14/2023
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TAVIE Red: Mobile Application for Self-Management
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.Resource from the RWHAP Best Practices Compilation updated on 01/07/2024
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MORE: Mobile Outreach Prevention and Engagement
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.Resource from the RWHAP Best Practices Compilation updated on 04/15/2024
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LA Links (Louisiana Links)
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.Resource from the RWHAP Best Practices Compilation updated on 11/01/2023
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Applying technological innovation: Harnessing an electronic patient portal to achieve a patient-centered approach to recertification
Using a multidisciplinary approach to harness the electronic patient portal for completion of RWHAP six-month recertification documents, we were able to create a more patient-centered method that complies with program requirements. We will discuss the challenges, opportunities, and results of using such technology in program recertification.
Resource (Conference Presentation) updated 09/14/2023
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Assessing programmatic impact of movement between geographically clustered Part A service areas in Florida
RWHAP Part A programs in Florida are housed within county governments, not the state department of health. This prevents direct data sharing, leading to outdated out-of-care (OOC) lists. Migration of residents between counties complicates the management of OOC lists, creating a need for streamlined data exchange and matching.
Resource (Conference Presentation) updated 09/14/2023
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A Call for Enhanced Data Collection
The syndemic of opioid use disorder, HCV and HIV and stigma causes burdens on individuals and the system. Integrating siloed systems of care is critical to addressing this crisis. Overlapping cascades of care are key to understanding the empirical relationships of these diseases and opportunities to identify, prevent and co-treat.
Resource (Conference Presentation) updated 09/14/2023
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Two States’ Journeys to integrate programs and utilize innovative approaches to improve data quality
Data Systems are often black holes, where agencies enter in data, but are not able to efficiently access useful and actionable data back out to take actions to improve services. Learn how panel participants are using innovation and participatory design to provide useful tools and data to the front lines.
Resource (Conference Presentation) updated 09/14/2023
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Linkage, Integration, Navigation, and Comprehensive Services (LINCS)
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.Resource from the RWHAP Best Practices Compilation updated on 01/03/2024
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The Max Clinic
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.Resource from the RWHAP Best Practices Compilation updated on 01/07/2024
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EMR Data Collection and Infrastructure Improvement
Positive Health Clinic successfully completed a quality improvement project related to our EMR, EPIC. The focus of this project was streamlining data collection, data utilization, and reporting processes in the EMR. The enhancements to our EMR yielded improvements in three areas: communication across disciplines, formalized treatment plans, and data reporting.
Resource (Conference Presentation) updated 09/14/2023
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Assessing Medication Access Barriers in Patients Living with HIV
Virginia quality improvement program that identifies access to medication barriers and provides emergency medication supplies to people with HIV if no timely access is secured.
Resource (Conference Presentation) updated 09/14/2023
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Strengthening the safety net: Testing a data-to-suppression (D2S) intervention in the Ryan White HIV/AIDS Program
We will describe the development, early implementation, and simultaneous stepped-wedge evaluation of a novel structural intervention to promote viral suppression and reduce health disparities. The “data-to-suppression (D2S)” intervention involves enhanced Health Department data sharing and capacity building with providers of RWPA mental health, harm reduction, supportive counseling, and housing services.
Resource (Conference Presentation) updated 09/14/2023
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Impact of a Bilingual COVID-19 Vaccination Campaign in People Living with HIV
After language-specific outreach on getting a COVID-19 vaccination, project saw a high rate of vaccine uptake in Spanish-speaking patients (81%) compared to English-speaking patients (4%).
Resource (Conference Presentation) updated 09/14/2023
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Leveraging a Data to Care Approach to Cure HCV: Jurisdiction Perspectives
Review of the data to care project and lessons learned on HCV micro-elimination activities from the Arizona Department of Health Services.Resource updated 05/15/2024
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Leveraging a Data to Care Approach to Cure HCV among People with HIV: Implementation Manual and Data-to-Care Tools
Activities of jurisdictions and their partner clinics to implement Hepatitis C Virus (HCV) Data to Care project activities, based on their previous experience, data management infrastructure, ability to share data, and staffing resources.
The implementation manual summarizes approaches, lessons learned, and best practices for supporting the replication of efforts, and lists key resources for health department jurisdictions to start implementation.
Resource updated 05/15/2024