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SPNS Initiative: SURE Housing Initiative (2022-2026)
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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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Tailored Motivational Interviewing: E2i
Tailored Motivational Interviewing (TMI) delivers brief motivational interviewing counseling sessions customized to encourage people with HIV to engage in HIV care, take HIV medications as prescribed, and improve other health-related behaviors. Three sites implemented TMI as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017 to 2021. Clients who participated in TMI had significant improvement in engagement in care, prescription of antiretroviral therapy, retention in care, and viral suppression.Resource from the RWHAP Best Practices Compilation updated on 01/07/2024
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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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Text Messaging Intervention to Improve Antiretroviral Adherence among HIV-Positive Youth: E2i
The Text Messaging Intervention to Improve Antiretroviral Adherence among HIV-Positive Youth (TXTXT) is designed to keep young people, particularly young, Black, gay, bisexual, same-gender loving, and other men who have sex with men, engaged in HIV medical care, by delivering personalized, daily, interactive text messages that remind them to take their antiretroviral therapy as prescribed. Two sites implemented TXTXT as part of E2i, an initiative funded by the RWHAP Part F SPNS program from 2017–2021. The intervention resulted in a statistically significant improvement in engagement in HIV care.Resource from the RWHAP Best Practices Compilation updated on 01/07/2024
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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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E-VOLUTION
E-VOLUTION is a two-way text messaging intervention, originally developed by Washington University School of Medicine and piloted at Project ARK. The intervention focuses on improving health outcomes for youth, particularly young Black men who have sex with men. E-VOLUTION was designed for people ages 18-29 who have HIV and are receiving clinical care but require support to remain adherent. E-VOLUTION was evaluated and found to improve viral suppression and retention in care rates.Resource from the RWHAP Best Practices Compilation updated on 02/12/2024
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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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Project Strength Through Youth Livin' Empowered (STYLE) 2.0
STYLE 2.0 is a multi-component intervention designed to help reduce stigma and social isolation for Black gay, bisexual, and other men who have sex with men. The intervention relies on health care navigators who facilitate linkage and engagement activities. They also connect clients to behavioral health providers who conduct motivational interviewing, as well as to a mobile application that supports all intervention activities. STYLE 2.0 participation has been associated with positive trends across HIV care continuum outcomes, including retention in care and increased viral suppression.Resource from the RWHAP Best Practices Compilation updated on 11/30/2023
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weCare Social Media Intervention
In weCare, a cyber health educator sent personalized messages through text, web-based apps, and Facebook to enrolled youth who identified as gay, bisexual, or other men who have sex with men (MSM), or transgender women, and who either had a new diagnosis of HIV or were not in care at the time of enrollment. Messages were personalized to each participant’s needs and were designed to support them as they navigated complicated health care systems as well as other challenges that affect care engagement (e.g., transportation, disclosure). The cyber health educator also moderated and posted information about health and well-being on an optional secret Facebook page that some participants chose to join. Participants were less likely to miss medical appointments and more likely to be virally suppressed after 12 months of the intervention.Resource from the RWHAP Best Practices Compilation updated on 01/07/2024
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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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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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Innovative HIV Care Strategies for Priority Populations: Housing First and Positive Peers Interventions
Review of two interventions that focus on priority populations affected by the HIV epidemic: youth and people with HIV who are experiencing homelessness or unstable housing.Resource updated 06/25/2024
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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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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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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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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