Staged training for engaging providers (STEP): The HIV community care continuum (CCC) model

HIV care delivery in the United States is changing with the implementation of the Patient Protection and Affordable Act and the National HIV Strategy. Newly insured individuals, including those with HIV, will seek care in primary care settings and community health centers (CHCs). Developed by a national nonprofit, the STEP model responds to the lack of effective models for integrating HIV services into primary care. The STEP model provides a progressive staging framework to determine the training and capacity building needs of CHCs, while providing a stepwise approach to implementation, integration, and measurement. CHCs are level-set into clinical stage using organizational assessments focused on clinical capacity. A tailored training plan is developed based on this level setting. Monitoring and outcome evaluation are conducted to determine the extent to which participating CHCs are achieving program goals. Lessons learned and outcomes from this capacity building engagement include increased rates of HIV testing, newly identified HIV-positive patients, and facilitated linkages to care and treatment. This model allowed providers to increase their capacity to deliver integrated HIV care and treatment in primary care settings. The STEP model provides a scalable framework to meet sustainable needs of CHC's to integrate HIV care. The STEP model combines clinical and performance improvement staging for primary care integration. This model is an essential tool for HIV-related implementation and integration in CHCs around the country. It should be used to integrate quality HIV care and serve as a platform for sustaining capacity building around management of other chronic diseases.