Building Capacity to Implement Rapid Start to Improve Care Engagement in RWHAP Settings

Rapid Start accelerates the initiation of antiretroviral therapy (ART) and entry into HIV medical care for people with HIV who are newly diagnosed, new to care, or out of care. The initiative funds 15 implementation sites that have the capacity and infrastructure to support rapid start, have initiated pilot programs, or are ready to expand rapid start services, with the goal of replicating and expanding successful rapid start models. Implementation sites include Ryan White HIV/AIDS Program (RWHAP)- funded clinics, FQHCs, academic medical centers, and community-based organizations.

This HRSA HIV/AIDS Bureau SPNS initiative funds organizations across the United States in the implementation and evaluation of “Rapid Start” interventions. The project is supported through funding from the Department of Health and Human Services (HHS) Minority HIV/AIDS Fund (MHAF).

Sites | Key Components | Goals | Learning Collaborative

Implementation Sites

Site  Location 
University of Illinois  Chicago, IL
Abounding Prosperity  Dallas, TX 
Valley AIDS Council  Harlingen, TX 
AIDS Foundation Houston, TX 
AltaMed  Los Angeles, CA 
St. John's Well Child and Family Center  Los Angeles, CA 
Compass Cares  Macon, GA 
Golden Valley Health Centers  Merced, CA 
Empower U  Miami, FL 
La Casa de Salud  New York City, NY
University of Miami  Miami, FL 
SUNY Downstate  New York City, NY
Desert AIDS Project  Palm Springs, CA 
Multnomah County Health Dept  Portland, OR
Washington University  St. Louis, MO

Key Components

  • Accelerated access to medical visit with an HIV provider

  • On-site testing or strong partnerships between testing programs and Rapid Start implementation sites

  • Warm hand-offs and accessible linkage coordinators

  • Accelerated insurance/payor approval & clinic enrollment

  • Accessible education on beginning ART

  • Early & sustained access to ART - Pre-approved ART regimens & starter pack of medications

  • Observed administration of the first dose

  • Follow-up with continued education, patient navigation efforts, and contact with retention teams

Project Goals

The University of California San Francisco (UCSF) has been funded by HRSA to act as the Evaluation and Technical Assistance Provider (ETAP). UCSF offers technical assistance to the implementation sites, evaluates the implementation of Rapid Start interventions and their outcomes on the HIV care continuum, and produces resources for future replication and scale-up in other RWHAP provider organizations.

Learning Collaborative

All sites participate in the initiative-wide Learning Collaborative1 which provides the structure for the provision of technical assistance to implementation sites and provides a common set of implementation strategies for adoption, uptake, and integration of their rapid start interventions. Sites participate in regular initiative-wide learning sessions and receive individualized coaching to support local quality improvement projects to benefit implementation outcomes. The Learning Collaborative: 

  • Facilitates capacity building by providing trainings, offering TA, and facilitating peer-to-peer learning to share best practices and lessons learned
  • Provides opportunities for engagement with subject matter experts to guide the development and implementation of Rapid Start
  • Increases system-level capacity for adoption of Rapid Start to improve HIV care continuum outcomes

Multi-site Evaluation Focusing on Implementation, Effectiveness and Cost

Based in the Proctor Implementation Science Framework2 and Dynamic Capabilities Model,3 UCSF is using an Effectiveness-Implementation Hybrid Type 24 Design to assess the key implementation strategies for uptake of a rapid start intervention and assess HIV Care Continuum outcomes for the patients served by these 15 implementation sites. Using a mix of qualitative and quantitative data approaches (Embedded Experimental Model Design5), the ETAP multisite evaluation work includes:

  • Conduct a process evaluation to characterize adaptation, implementation and barriers and facilitators to factors associated with Rapid Start intervention implementation
  • Evaluate multi-site patient outcome data, including early entry into care, initiation of ART, rates of engagement, and retention in care after rapid ART initiation
  • Assess the impact of adaptation and implementation of Rapid Start interventions on increased viral suppression (VS), shorter time to VS and/or durable and sustained VS
  • Collect cost data to determine the labor, programmatic and structural costs associated with adapting and implementing the Rapid Start models and interventions at the implementation sites

Dissemination and Replication

Implementation tools will be developed through the course of the initiative, building to the capstone Replication and Implementation Manual (The Rapid Playbook). Other products could include:

  • Toolkits that focus on overcoming specific challenges (e.g., preventing provider and staff burnout)
  • Training curricula that can be used by the AETCs and other trainers
  • Webinars and conference presentations about Rapid Start implementation
  • Briefs for policy stakeholders that fund and support Rapid Start programs
  • Journal articles describing findings

References

  1. Wells, S., Tamir, O., Gray, J., et al. (2018). Are quality improvement collaboratives effective? A systematic review. BMJ Quality & Safety, 27, 226-240.
  2. Proctor, E.K., Powell, B.J. & McMillen, J.C. (2013). Implementation strategies: recommendations for specifying and reporting. Implementation Science, 8, 139.
  3. Helfat C.E. et al.(2007). Dynamic Capabilities: Understanding Strategic Change in Organizations. Malden, MA: Blackwell.
  4. Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50, 217–226.
  5. Creswell, J.W. and Plano Clark, V.L. (2011). Designing and Conducting Mixed Methods Research. 2nd Edition, Sage Publications, Los Angeles.

Contact Information

Project Contacts:

Beth Bourdeau, PhD
Project Director
University of California, San Francisco
Janet Myers, PhD, MPH
Principal Investigator
University of California, San Francisco

HRSA Contacts:

PO Name
Son Phan, MPH, MD
PO Title
Health Scientist
PO Phone
301-443-7112

Funding:

Funding Mechanism: Cooperative Agreement

Recipient Organization: University of California, San Francisco

Grant number: U90HA39730

Project Period: 09-01-2020 - 08-31-2023