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Overview of implementation science activities for the Ryan White HIV/AIDS Program (RWHAP) and feedback on future directions.News Article updated on 04/14/2023
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Telehealth Implementation at a Midwest HIV Clinic
The University of Nebraska Medical Center/Nebraska Medicine (UNMC/NM) Specialty Care Center (SCC) is the largest provider of comprehensive HIV care—including primary and HIV-focused medical services as well as multiple support services—in Nebraska. In March 2020, at the onset of the COVID-19 pandemic, the clinic integrated telehealth into its care delivery model to continue serving patients beyond the clinic structure, and developed algorithms that allowed any team member to quickly identify a patient's eligibility for a telehealth visit. The algorithms include the date of the most recent office visit, stability of HIV disease, most recent viral load and CD4 count, and antiretroviral therapy (ART) refill histories as a proxy for medication adherence. Overall, viral suppression rates remained high for all patients regardless of visit type, indicating that telehealth is a successful alternative to in-person visits for providing HIV care.Resource from the RWHAP Best Practices Compilation updated on 03/23/2024
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Viviendo Valiente
Viviendo Valiente aims to reduce ethnic disparities in HIV care and outcomes by providing culturally responsive services to the Latino/a community, specifically to people of Mexican descent. It is a multi-level intervention, featuring individual-, group-, and community-level activities, that links people to HIV care, offers HIV education and health literacy in group sessions, and promotes community-level testing for HIV and other sexually transmitted infections (STIs). Viviendo Valiente had positive impacts on HIV testing, retention in care, viral suppression, and client satisfaction.Resource from the RWHAP Best Practices Compilation updated on 04/15/2024
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Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations
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.Resource from the RWHAP Best Practices Compilation updated on 11/13/2023
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SPNS Initiative: Accelerating Implementation of Long-Acting Injectables (2022-2026)
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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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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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The Undetectables Program to Support Viral Suppression
The Undetectables is a client-centered model of integrated care that uses innovative, superhero-themed, anti-stigma social marketing, agency cultural change, and a toolkit of evidence-based antiretroviral therapy adherence strategies to support treatment adherence and viral suppression among people with HIV. A two-year demonstration project evaluation showed a significant increase in the proportion of clients who were virally suppressed from 39% to 62%.Resource from the RWHAP Best Practices Compilation updated on 01/07/2024
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Project nGage
Project nGage is a support intervention approach that offers participants an initial 90-minute session with a social work interventionist and a participant support confidant to develop a tailored care and support plan. The social work interventionist then offers four follow-up sessions to each participant to discuss progress on the care and support plan. Project nGage was evaluated in a randomized controlled trial from 2012 to 2015: participants in the intervention were more likely to have at least three HIV primary care visits in the last 12 months than those who received usual care.Resource from the RWHAP Best Practices Compilation updated on 11/30/2023
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Wellness Web 2.0
Wellness Web 2.0 is a text message-based intervention that offers health education tools, appointment reminders, and navigation services to increase linkage to and retention in care for youth and young adults with HIV. Clients across 27 counties in South Texas enrolled in the Wellness Web 2.0 program had improvements in linkage to HIV medical care and viral suppression.Resource from the RWHAP Best Practices Compilation updated on 06/21/2024
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LINK LA
LINK LA is a 12-session, 24-week peer navigation intervention for people with HIV who are scheduled to be released from incarceration. LINK LA peer navigators focus on behavioral changes that promote medication adherence and retention in care, while providing social support and facilitating communication with medical providers. LINK LA showed improvements in linkage to and retention in HIV care and viral suppression among people with HIV re-entering the community after incarceration.Resource from the RWHAP Best Practices Compilation updated on 01/03/2024
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Tailored Motivational Interviewing for Youth
Five clinics implemented Tailored Motivational Interviewing (TMI) to better serve young people with HIV as part of a RWHAP Part F SPNS initiative. Motivational interviewing is a well-documented approach to engage youth in care and facilitate behavior change in a variety of contexts. Clients participating in TMI received integrated HIV medical care and TMI, and demonstrated improved engagement in care and health outcomes.Resource from the RWHAP Best Practices Compilation updated on 01/07/2024
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Simplifying Salvage Antiretroviral Regimens in Treatment-Experienced PLWH
In a single-center restrospective cohort study, patients with extensive treatment experience and history of virologic failure and multi-drug resistance underwent simplification of ARV salvage regimens with a median pill burden reduction of six pills per day. This strategy led to high rates of virologic suppression.
Resource (Conference Presentation) updated 09/14/2023
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HIV Clinic Staff and Community Perspectives on Long-Acting Injectable ART in New York City
The first long-acting injectable antiretroviral therapy (LAI ART) formulation was FDA-approved January 2021. Drawing on the Consolidated Framework on Implementation Research, this mixed methods study assessed knowledge, attitudes, practices, and perceived barriers and facilitators related to implementation of LAI ART in NYC among HIV clinic staff and people with HIV.
Resource (Conference Presentation) updated 09/14/2023
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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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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