SNAP: Status-Neutral, Whole-Person Approach

The SNAP Evaluation and Technical Assistance Provider (ETAP) team is supporting each funded jurisdiction to develop, implement, and evaluate a whole person approach that: 

• Creates “one door” for both HIV prevention and treatment services. 
• Addresses institutionalized HIV stigma by integrating HIV prevention and care. 
• Makes HIV testing, linkage to medical care, and testing for other medical conditions such as sexually transmitted infections (STIs) and hepatitis C virus (HCV) more accessible and routine.

Ryan White HIV/AIDS Program (RWHAP) Part A jurisdictions funded by HRSA for the SNAP initiative.

Bexar County - San Antonio, Texas

The Bexar All-Inclusive model of care aims to enhance whole person service delivery and reduce stigma by expanding access to syndemic testing and treatment, and providing navigation services to increase access to a range of sexual health and support services for those who would benefit from both prevention and care.

University Health implements the project in partnership with the Alamo Area Resource Center (AARC).

Priority Populations

• Hispanic men who have sex with men (MSM)  
• Black MSM 
• Young MSM of color aged 18-24 years old
   

Site Leads

• Tanya Khalfan-Mendez, Project Manager
• Carey Suehs, Evaluator 

Clark County - Las Vegas, Nevada

Through this project, the Las Vegas TGA aims to tackle the HIV epidemic and foster community involvement by using a whole person approach. Their program provides both preventive and treatment services, building upon the existing Rapid stART method for HIV care, and introducing the Rapid PREVENT approach. This method ensures that people who can benefit from HIV prevention services, particularly those from disproportionately affected groups, receive support through a coordinated healthcare system. This project ensures that all individuals have access to comprehensive healthcare options and supportive services for enhanced health and wellness. It also aims to broaden community involvement and create equitable service pathways for individuals testing positive for HIV, as well as those who can benefit from HIV prevention services.

Clark County Social Service, Office of HIV implements the project in partnership with the Southern Nevada Health District, Collaborative Research, and Pacific AIDS Education and Training Center-Nevada.

Priority Populations

• Hispanic individuals
• Men who have sex with men (MSM)
• Black individuals
• Other racial and ethnic minorities 
• Transgender individuals 
• People who use substances 
• Young people between the ages of 18-30 

Site Leads

• Mary Duff, Project Director

Hennepin County - Minneapolis, Minnesota

Through this project, Hennepin County will utilize the Ryan White HIV/AIDS Program non-medical case management model to provide comprehensive services in Hennepin County. The project will provide more opportunities for effective service delivery by enabling a “one door” approach to care that continually assesses clients’ needs as a way to retain individuals in prevention and care services. HIV prevention and other critical services will be accessed in the same place and as a result, healthcare delivery will improve, new HIV diagnoses will decrease, and clients will have better overall health and social stability.

Hennepin County implements the project in partnership with Red Door Clinic (RDC) and Youth and AIDS Projects (YAP) at the University of Minnesota (UMN).

Priority Population

• Black men aged 18-34 years old

Site Leads

• Brenda Senyana, Project Director
• Cody Raasch, Database Manager

County of San Diego - San Diego, California

The County of San Diego is implementing the project to expand existing non-medical case management services to include people who could benefit from HIV prevention services. The project will deploy a Social Network Strategy to expand the County’s outreach and testing services to include communities that have not previously been reached, and revise service standards co-created by the HIV Planning Group and County staff to reflect a whole person approach to services.

Priority Populations

• Monolingual Spanish speaking men who have sex with men (MSM)
• Transgender individuals in the Southeastern region of the county

Site Leads

• Felipe Ruiz, Implementation Lead
• Dustin Walker, Database Manager 

Whole person approaches to HIV prevention and care emphasize comprehensive and high-quality care to engage and retain people in services. A whole person approach continually addresses the healthcare and social service needs of all people who can benefit from HIV prevention and care services so that they can achieve and maintain optimal health and well-being. 

Ensuring whole person health and well-being

Person-centered care acknowledges people’s essential human dignity, treats people as individuals, and finds out what is important to them regarding their treatment and care. At JSI, we put people at the center of health programs at all levels—individual, community, health facility, system, policy—because we know that each part of the ecosystem bears a responsibility to enable person-centered care. We use behavioral science to understand people’s motivations and preferences and to learn what system and service delivery changes are needed to transform people’s experiences and improve health outcomes.

Person-centered systems and services provide many benefits:

• Improved access to care
• Increased health literacy
• Higher rates of patient satisfaction
• Improved job satisfaction among the health workforce
• More efficient and cost-effective services
• Improved health outcomes

Our person-centered care framework uses a human-rights-based approach that focuses on the rights holder (person) and the obligations of duty bearers (e.g., providers, policymakers, caregivers). The five principles that surround the rights holder (at the center) establish a common vision for person-centered care.

The principles can be operationalized and assessed at each socio-ecological level (i.e., policy and environment, health system, facility, community, and individual and family) through interventions within six domains, as labeled on the outside of the framework:

• Service design and delivery
• Policy and financing
• Monitoring, learning, and accountability
• Workforce environment and development
• Point of care access and experience
• Leadership and governance

The SNAP resource library features a curated collection of resources that support the development, implementation, and evaluation of a whole person approach, as well as provide background on the evolution of the status neutral and whole person frameworks. The New York City Department of Health and Mental Hygiene first reframed the HIV care continuum as status neutral approaches to HIV prevention and care that include all people affected by HIV. Over time, the language and focus has evolved to a whole person approach that continually addresses the healthcare and social service needs of all people who can benefit from HIV prevention and care services so that they can achieve and maintain optimal health and well-being.

Please check back regularly as new resources will be added.

• HRSA and CDC Status Neutral Approach Framework Program Letter
  The Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) issued joint guidance on January 1, 2023 encouraging the implementation of a status neutral approach for HIV prevention and care. (CDC/HRSA, 2023)
• A Guide to Implementing a Community Health Worker (CHW) Program in the Context of HIV Care
  The guide provides detailed steps for implementing a community health worker (CHW) program in HIV care settings, covering aspects such as organizational infrastructure, recruiting, training, supervision, service delivery, and evaluation. (Boston University, 2020)
• HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit: Resource Library
  The American Medical Association (AMA) provides a comprehensive toolkit aimed at supporting routine screening for HIV, sexually transmitted infections (STIs), viral hepatitis, and latent tuberculosis infection (LTBI). (American Medical Association, 2021)
• Person-Centered Care
  Ensuring whole person health and well-being through the delivery of person-centered care. (JSI, 2024)
• Hear from Your Peers: Status Neutral Approaches in Action
  In this 60-minute presentation the Oregon Health Authority and the City of San Antonio, Metropolitan Health District described how they have implemented status neutral approaches in their respective jurisdictions. (IHAP TA Center, 2023)
• Status Neutral HIV Prevention and Care - CDC Train
  This 20-minute course provides the HIV prevention and treatment workforce and community partners with a working definition of status neutral services, key characteristics of a status neutral approach, benefits of using a status neutral approach, and examples of how a status neutral approach is being applied in practice. (CDC, 2022)
• Implementation Science and the Health Resources and Services Administration’s Ryan White HIV/AIDS Program’s Work towards Ending the HIV Epidemic in the United States (HRSA)
  Implementation science is an essential field for HIV treatment and prevention, providing crucial insights for clinical effectiveness and efficacy trials, bench-to-bedside translation of clinical trial evidence into real-world intervention strategies, and routine program monitoring and evaluation. (HRSA, 2020)
• Status Neutral HIV Care and Service Delivery Eliminating Stigma and Reducing Health Disparities
  HIV prevention and treatment tools can keep people healthy and help end the HIV epidemic. Combining these tools in a status neutral approach can help people maintain their best health possible, while also improving outcomes in HIV prevention, diagnosis, care, and treatment. (CDC, 2022)