The Dissemination of Evidence-Informed Interventions initiative will run from 2015-2020 and disseminate four adapted linkage and retention interventions from prior Special Projects of National Significance (SPNS) and the Secretary’s Minority AIDS Initiative Fund (SMAIF) initiatives to improve health outcomes along the HIV Care Continuum.
The end goal of the initiative is to produce four evidence-informed Care And Treatment Interventions (CATIs) that are replicable; cost-effective; capable of producing optimal HIV Care Continuum outcomes; and easily adaptable to the changing health care environment.
The multisite evaluation of this initiative will take a rigorous Implementation Science (IS) approach, which places greater emphasis on evaluation of the implementation process and cost analyses of the interventions, while seeking to improve the HIV Care Continuum outcomes of linkage, retention, re-engagement, and viral suppression among client participants.
Interventions and Grantees:
Collaborations between public health agencies, community-based organizations, and jail health services have implications for public health and safety efforts and have been proven to facilitate linkage to care after incarceration. Medical screenings that happen for all inmates through the jail intake process offer an opportunity to implement such interventions, as do booking processes and intervention intake. Jordan et al., introduce the concept of "Warm Transitions" as an integral part of implementing the HIV Continuum of Care Model by "applying social work tenets to public health activities for those with chronic health conditions, including HIV-infection." Absent "a caring and supportive warm transition approach," pre-existing barriers to care and other stressors that come with the experience of incarceration and cycling in and out of correctional facilities will continue or be exacerbated after incarceration. Without transition assistance, people living with HIV who are released from jails are at risk of unstable housing; lack of access to health insurance and medication; overdose due to period of detoxification; exacerbation of mental health conditions due to increased stress; and lack of social supports, when exposed to the same high risk communities from which they were incarcerated. The Transitional Care Coordination intervention is designed to strengthen connections between community and jail health care systems to improve continuity of care for HIV-positive individuals recently released from jails.
Transitional Care Coordination Grantees
- The Cooper Health System Early Intervention Program– Camden, NJ
- The University of North Carolina at Chapel Hill, School of Medicine, Division of Infectious Diseases– Chapel Hill, NC
- Southern Nevada Health District – Las Vegas, NV
For people living with HIV, office‐based buprenorphine treatment delivered in HIV clinics is associated with decreased opioid use, increased ART use, higher quality of HIV care, and improved quality of life. “Integrating Buprenorphine Treatment for Opioid Use Disorder in HIV Primary Care” is intended to be implemented in HIV primary care settings that do not already provide on-site buprenorphine treatment services. The intervention is designed to increase the number of patients retained in buprenorphine treatment and HIV primary care, as well as integrate buprenorphine treatment into the standard of care in the clinic setting.
Integrating Buprenorphine Treatment for Opiod Use Disorder in HIV Primary Care Grantees
- Centro Ararat, Inc., FAITH Clinic– Ponce, PR
- The MetroHealth System – Cleveland, OH
- University of Kentucky Research Foundation, Bluegrass Care Clinic and Center for Health Services Research – Lexington, KY
The Peer Linkage and Re-Engagement of HIV-Positive Women of Color intervention is designed to best serve Women of Color (WoC) who are newly diagnosed with HIV or who have fallen out of HIV primary care. Trained HIV-positive WoC known as "peers" will link and re-engage patients in HIV primary care. Patients will be considered linked or re-engaged once they have attended 2 medical appointments, attended 1 case management appointment, and have completed HIV lab work (all within a 4-month period). Peers offer a unique personal perspective and can provide coaching and emotional support to patients who may need assistance in managing medical and case management appointments. In addition, peers who work closely with case managers and the clinical team can better provide individualized patient-centered services over a short time period to address immediate patient needs and build trust between the patient and the clinic team.
Peer Linkage and Re-Engagement of HIV-Positive Women of Color Grantees
- AIDS Care Group – Chester, PA
- Howard Brown Health– Chicago, IL
- Meharry Medical College– Nashville, TN
The Enhanced Patient Navigation for HIV-Positive Women of Color intervention is designed to retain HIV-positive Women of Color (WoC) in HIV primary care after receiving support, education, and coaching from a patient navigator. Patient navigators are critical members of the health care team focused on reducing barriers to care for the patient at the individual, agency, and system levels. While engaging with patients, patient navigators lend emotional, practical, and social support; provide education on topics related to living with HIV and navigating the health care system; and support both patients and the health care team in coordinating services. In this intervention, patient navigators will work with HIV-positive WoC who are experiencing at least one of the following challenges: have fallen out of care for 6 months or more, have missed 2 or more appointments in the prior 6 months, are loosely engaged in care (have cancelled or missed appointments), are not virally suppressed, and/or have multiple co-morbidities.
Enhanced Patient Navigation for HIV-Positive Women of Color Grantees
- Grady Health System, Infectious Disease Program– Atlanta, GA
- Keck School of Medicine at University of Southern California – Los Angeles, CA
- Newark Beth Israel Medical Center, a part of the RWJBarnabas Health System– Newark, NJ