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Innovative HIV Care Strategies to Support Individuals Who Are Unstably Housed
Two interventions (KC Life 360 and HHOME) that provide layers of supportive services for people with HIV who are unstably housed.Resource updated 05/15/2024
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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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Integration of HCV Treatment within an HIV Clinic
The University of California San Francisco, San Francisco General Hospital HIV Clinic developed a care model to enhance access to hepatitis C virus (HCV) treatment among people with HIV by co-locating care and creating a multidisciplinary team. Developed as part of the RWHAP Part F SPNS Hepatitis C Treatment Expansion Initiative, this model of care led to a considerable decrease in the number of people with HIV who were coinfected with HCV among the patients served by San Francisco General Hospital during the 2010 and 2011 demonstration years.Resource from the RWHAP Best Practices Compilation updated on 05/15/2024
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Project CORE: Coordination of Resources and Employment
Avenue 360 Health and Wellness, a Federally Qualified Health Center, and AIDS Foundation Houston, a community-based AIDS Service Organization, implemented Project CORE. This intervention aimed to improve health outcomes for people with HIV through the coordination of supportive employment and housing services. Through Project CORE, 39% of participants were placed in housing and 39% gained employment.Resource from the RWHAP Best Practices Compilation updated on 01/03/2024
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No Wrong Door for High-Acuity Care
Fenway Health, Fenway AIDS Action Committee, and MassHire Downtown Boston provided housing and employment supports to clients who were unstably housed and were un- or under-employed, in order to improve health outcomes as part of the RWHAP Part F SPNS initiative Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services. Almost 70 percent of clients who participated in this intervention and received medical care at Fenway Health were virally suppressed, despite facing considerable barriers to care.Resource from the RWHAP Best Practices Compilation updated on 11/14/2023
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Community Health Workers: Improving Linkage and Retention in HIV Care
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.Resource from the RWHAP Best Practices Compilation updated on 01/03/2024
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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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HOME: Homeless Health Outreach Mobile Engagement
HHOME is a mobile care and systems intervention that helps connect vulnerable and homeless individuals in San Francisco to rapid HIV treatment.Resource updated 02/12/2024
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KC Life 360: Employment-Focused Intervention to Link Clients to Support Services and Housing
KC Life 360 is an employment-focused intervention that utilizes the intersection between employment services, HIV care and treatment, and housing to improve health outcomes of people with HIV.Resource updated 10/13/2023
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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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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 Time is Now: Implementing Innovative Housing Model for People with HIV to Improve Health Outcomes
Review of a SPNS data integration project that opened the door for innovating how people with HIV are being prioritized through the new HUD housing prioritization mandates.
Resource (Conference Presentation) updated 09/14/2023
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Housing, Employment, and HIT Improve Access for Vulnerable Populations in Paterson, New Jersey, and Puerto Rico
Discussion of a holistic process and a health information technology solutions-based approach for increasing access to housing and employment services for vulnerable populations, including people with a history of incarceration.
Resource (Conference Presentation) updated 09/14/2023
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Improving HIV Health Outcomes through Coordinated HIV Care, Housing, and Employment Services
Results of a study demonstrating the impact that coordinated care, housing, and employment can have on the HIV health outcomes of unstably housed and under/unemployed people with HIV.
Resource (Conference Presentation) updated 09/14/2023
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HIV Outbreak in West Virginia: The Importance of Collaboration and Partnerships
Discussion of diverse partnerships developed to successfully treat a homeless population with addiction and newly diagnosed HIV as well as the service delivery challenges faced by an out-of-state Part C clinic.
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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Leveraging Data to Care Models to Respond to an HIV Outbreak among People Who inject Drugs and Are Experiencing Homelessness
Review of data-to-care Hennepin County, Minnesota data-to-care models to address an HIV outbreak among people who inject drugs within a housing-first, cross-sector framework.
Resource (Conference Presentation) updated 09/14/2023
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The Intersection of Housing and HIV Institute 101: Addressing Housing in HIV Prevention and Care
Description of the impact of unstable housing and homelessness on HIV health outcomes, including lessons learned from HIV outbreak response efforts.
Resource (Conference Presentation) updated 09/14/2023
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The Intersection of Housing and HIV Institute 201: Integrating Housing Services with HIV Services
Resources for housing, HIV prevention, and HIV care and treatment, including funding structures and partnerships that address barriers that impact HIV health outcomes.
Resource (Conference Presentation) updated 09/14/2023