Innovative, Replicatable Public Health Interventions to Improve Engagement and Retention in HIV Care

Issues: The CDC estimates that 1.2 million Americans are HIV-positive (HIV+), with a 66% not linked to care and only 37% subsequently retained in care. Interventions to improve HIV linkage and retention are commonly inadequately designed and evaluated. Local health departments in Atlanta, Houston, and Philadelphia are undertaking a three-year foundation-funded initiative to increase the rate of HIV+ adults linked and engaged in care. The HIV Care Collaborative (HCC) for Underserved Populations in the U.S. funds adoption of replicable, innovative strategies in public health settings to improve outcomes and prevent further HIV infections.

Description: We identify key lessons learned from earlier HIV initiatives in designing an effective, replicable intervention with measurable process and clinical outcomes. We describe the role of paraprofessionals in linking, engaging, and re-engaging HIV+ individuals in care. We summarize four HCC innovations applicable to HIV+ and other chronic care populations. First, HCC workers are integrated in care teams and undertake a defined intervention. Second, workers are supported to enhance their skills, improve quality of their services, and retain them in employment. Third, quality improvement (QI) strategies apply health record data to improve quality. Fourth, the HCC evaluation maximizes existing surveillance, clinical, and Ryan White Program reporting systems to reduce evaluation burden.  

Lessons Learned: HIV linkage and engagement initiatives deploying paraprofessions benefit from carefully planned interventions, input from workers, and ongoing QI.

Recommendations: HCC intervention, worker support, quality improvement, and evaluation strategies can be adopted by HIV and other chronic care initiatives to improve linkage and reengagement rates and improve clinical outcomes.