Capacity Building for Innovative Program Replication

Background

In August 2019, the Health Resources and Services Administration funded the Capacity Building in the Ryan White HIV/AIDS Program (RWHAP) to Support Innovative Program Model Replication initiative through its Special Projects of National Significance (SPNS) program. The initiative’s purpose was to enhance the capacity of RWHAP recipients and subrecipients to replicate evidence-informed interventions (EIIs) using program implementation tools, manuals, and other resources previously developed by HRSA. Dissemination and implementation of recent innovative tools, interventions, and manuals aim to reduce the impact of the HIV epidemic within metropolitan areas and states identified as disproportionately affected.

The University of California, San Francisco, was selected to provide capacity building assistance (CBA) and technical assistance (TA) to four jurisdictions: Las Vegas, New Orleans, Atlanta, and the State of Mississippi. The jurisdictions selected their EIIs to meet the needs of local populations with HIV and experiencing health disparities.  

Approach

HRSA requested the formation of Learning Collaboratives (LCs) in each jurisdiction to serve as the vehicle for CBA provision. Although in-person learning sessions (LSs) were planned, the COVID-19 pandemic necessitated a change to all virtual meetings for all learning collaborative meetings and LSs until the last year of the initiative, when two of the four jurisdictions were able to conduct hybrid (both in-person and virtual) LSs.  

Because of the change to virtual meetings, UCSF employed a unique, three-tiered structure to implement the learning collaboratives:

  • UCSF Faculty served as faculty for the LCs, guiding the development and collection of performance measures for the Plan-Do-Study-Act (PDSA) cycles of local organizations participating in the LCs. They also assisted UCSF Evaluation staff in their assessment of the CBA delivery itself.
  • UCSF staff and contractors served as Coaches for the LCs, working to support the LC Planning Bodies, identifying training and TA resources and coordinating their provision, and supervising the delivery of TA to participating organizations. Coaches also assisted UCSF Evaluation staff in assessing CBA delivery.
  • UCSF also funded Project Coordinators in each jurisdiction to work with the Coaches and Planning Bodies in planning LSs, training and TA provision, and the collection and evaluation of PDSA performance data.  

Dissemination products (training resources, manuals, and other tools) are listed separately for ease of access by interested recipients. This content is introductory. 

Demonstration Sites and Intervention Descriptions

Las Vegas: Rapid ART

Las Vegas 

Las Vegas Rapid Start Implementation Manual

Service gap addressed: Immediate access to care post-HIV diagnosis

Intervention: Rapid ART

Description:
The Southern Nevada Rapid stART (SNRS) was established to improve access to prompt HIV treatment initiation in the region. Led by the Office of HIV under Clark County Social Service, the initiative received support from the Pacific AIDS Education Training Center (AETC) to implement a comprehensive Rapid stART approach. Multiple stakeholders were involved in the Learning Collaborative, including the University Medical Center (UMC), the largest public hospital in Southern Nevada, the Southern Nevada Health District (SNHD) Community Health Center, Huntridge Family Clinic, and eight agencies funded by the Ryan White HIV/AIDS Program (RWHAP). Additionally, a non-RWHAP-funded agency also participated in the SPNS Learning Collaborative.

The Learning Collaborative achieved significant outcomes, such as expanding the number of Rapid stART testing facilities from three to 21. Moreover, a Rapid stART Rideshare program was established to address transportation barriers. Recognizing the importance of sustainability, the SNRS Learning Collaborative developed a comprehensive Rapid stART Manual. Further, they established the Rapid stART Response Team, which was responsible for facilitating coordinated action to ensure immediate access to care post-HIV diagnosis.

To maintain consistency and quality in the delivery of Rapid stART testing within the Rapid stART Care Continuum, the Learning Collaborative developed a dedicated Rapid stART Module. This module worked in conjunction with Rapid stART Performance Measures tools to monitor and assess the effectiveness of the program. The collaborative efforts of all stakeholders involved in the SNRS Learning Collaborative aimed to improve access to rapid HIV treatment initiation and enhance the overall care continuum for individuals diagnosed with HIV in Southern Nevada.

New Orleans: Community Health Workers

New Orleans

Service gap addressed: Engagement, re-engagement, and retention in care for people lost-to-follow-up and/or who have fallen out of care

Intervention: Community Health Worker

Description:
The City of New Orleans Mission: Undetectable CBA Learning Collaborative applied Quality Improvement (QI) methods and peer engagement to improve HIV care continuum outcomes. Mission Undetectable implemented community health worker intervention to improve engagement and retention in care of people with HIV in their EMA. Their Planning Team included staff from the city health department, state health department, SE AETC and nine RWHAP-funded clinics and community-based organizations. Mission: Undetectable also focused on emergency preparedness planning and relinking clients lost to care in the wake of Hurricane Ida.

Atlanta: Patient-Centered Medical Neighborhood

Atlanta

Service gaps addressed: Retention in care and viral load suppression among African American/Black MSM and people of transgender experience.

Interventions: Project Connect and Retention through Enhanced Contacts; Collaborative Care Model; Peer Re-engagement program, TransLife Care, and In It Together.

Description:
The Atlanta CBA Learning Collaborative used the Patient Centered Medical Neighborhood concept to frame its intervention selection.  This concept acknowledges that when a single medical home cannot serve all patient needs, a broader support system becomes necessary.  Ideally the Patient Centered Medical Neighborhood includes all the caregivers and services interacting with each patient.  Atlanta’s participating sites then exercised agency-level autonomy in EII selection as long as the selected EII focused on the jurisdiction’s service gaps and populations of focus. Therefore, Atlanta implemented multiple EIIs compared to the other three jurisdictions which implemented an EII of singular focus. 

Mississippi: Community Health Workers

Mississippi

Service gap addressed: Access and engagement in care for people with HIV living in mostly rural locations.

Intervention: Community Health Worker

Description:
The statewide Mississippi CBA Learning Collaborative included staff from the state health department, the AETC (the University of Mississippi Medical Center), and eight RWHAP-funded clinics across the state. Leadership was provided by the Community Health Center Association of Mississippi (CHCAMS), the state's HRSA-funded primary care association. Their intervention was the Community Health Worker (CHW) model. Learning Collaborative activities included five learning sessions and a Harvest Meeting; CHW training conducted by the Aaron E. Henry Community Health Services Center; and the formation of the Mississippi Community Health Worker Association (MSCHWA), which has the registry for CHWs in the state. MSCHWA advocates for CHWs in the state and will sustain the CHW intervention model after the learning collaborative ends.

Webinars

Four Part Continuous Quality Management Training

A complete series on CQM, its methods and tools, and how to incorporate CQM into the routine operations of an HIV clinic, by Jamie Shank for the Atlanta CBA Learning Collaborative. These webinars are:

A Beautiful Day in the Neighborhood (the Patient-Centered Medical Neighborhood)

Michael Hager presents the Patient-Centered Medical Neighborhood concept, used by the Atlanta CBA Learning Collaborative to help frame its discussion in selecting evidence-informed interventions.

Trans Life Care Training

An Innovative Care Engagement Intervention for Transgender Women of Color. By Josie Lynne Paul, Director of the TLC Program for Chicago House, Chicago IL, for the Atlanta CBA Learning Collaborative. Josie describes the implementation of this comprehensive Evidence-Informed Intervention for transwomen to improve the engagement in HIV care of transgender women of color, which she helped develop during the SPNS Transgender Women of Color initiative (2012-2017). 

Peer Engagement/Re-engagement Training

By Tom Pietrogallo, CEO of the Poverello Center in Wilton Manor, FL for the Atlanta CBA Learning Collaborative. Tom presents on the critical, multifaceted work of peers in linking, re-engaging and support clients with HIV. 
 

Evaluation Technical Assistance for Community Health Workers in Mississippi

UCSF CBA ETAP staff provided capacity building assistance to the four jurisdictions during this SPNS initiative. These two presentations were made to the Mississippi CBA Learning Collaborative during their Fourth Learning Session, November 2021. 

Contact Information

Project Contacts:

Greg Rebchook, PhD
Principal Investigator
UCSF Center for AIDS Prevention Studies

HRSA Contacts:

PO Name
Joanne Hsu, MPH
PO Title
Project Officer, Special Projects of National Significance (SPNS)

Funding:

Funding Mechanism
Cooperative Agreement

Recipient Organization: University of California, San Francisco

Grant number: U90HA33189 (HRSA-19-040)

Project Period: 2019-2022