Note: The HIV care innovations implemented by RWHAP clinics and providers discussed during Thursday’s plenary session represent the types of advancements that are vital to our work to end the HIV epidemic in the U.S. by 2030. I was particularly struck by the idea of “designing for the margins” rather than the middle as a thought-provoking frame for ensuring that our HIV prevention, care, and treatment efforts focus on reaching the most marginalized populations thus working to address disparities in health outcomes. With this approach, we acknowledge one size does not fit all and we engage with the community to develop innovative solutions. –Harold J. Phillips, COO, EHE
Yesterday, for the third consecutive day, thousands of HIV care and treatment leaders, Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) recipients and providers, stakeholders, and people with HIV reconvened virtually for the 2020 National Ryan White Conference on HIV Care & Treatment. The theme for Day 3 was “Innovating Care,” spotlighting the RWHAP’s commitment to innovation and to addressing social determinants of health.
Day 3 Plenary: Innovating Care
The Day 3 plenary session highlighted innovative models of care from RWHAP recipients focusing on specific geographic areas and populations experiencing health disparities, including rural southern communities, unstably housed individuals, youth and young adults, and transgender individuals. HRSA HIV/AIDS Bureau Division of Community HIV/AIDS Program Director Captain Mahyar Mofidi moderated the session, which featured RWHAP recipients from Alabama, Massachusetts, North Carolina, and New Orleans and their varied work to design and implement innovative HIV services essential to ending the HIV epidemic.
Rural Telehealth in the South
Montgomery AIDS Outreach (MAO) was established in 1987 and is the largest HIV service agency in southern Alabama. MAO CEO Michael Ray Murphree shared disparity data for Alabama and outlined his agency’s many partnerships, including the University of Alabama and the regional AIDS Education and Training Center (AETC), in providing medical care and outreach services in the region. He highlighted the addition of telehealth to their service delivery model, which is used to address clinical, preventive, behavioral, social, trainings, and planning services. As a result, Murphree said there were fewer no-shows, particularly during the COVID-19 pandemic, and better adherence compared to clinic visits.
Comprehensive Care for Unstably Housed
Boston Health Care for the Homeless was founded in 1985 and has evolved its model over time under the principle of “design for the margins,” which means reaching the most vulnerable and, in doing so, you reach the middle, like a tent. Director of HIV Services Jennifer K. Brody, MD, MPH, AAHIVS, described how a broader array of services had an impact on the health of a high need client: a transgender African American woman with multiple accessibility and other challenges. The agency’s innovations include: intensive outreach, low barrier addiction treatment, harm reduction, and co-locating of housing and clinic. Most agency clients are on antiretroviral therapy and viral suppression rates are high; from 81% to 83%, depending on the stability of their housing conditions.
Youth and Transitions to Adult Care
Charlotte, North Carolina’s Regional AIDS Interfaith Network (RAIN) Vice President of Operations Chelsea Gulden shared the organization’s youth-focused work which long ago evolved past its support group design to embrace partnerships with pediatric and adult clinics. More recently, patient navigation was added to their array of services. They also accommodate considerations for youth, including communication preferences, health literacy, mental health, and attention to sub-cultures. RAIN’s Empowering Positive Youth Peer Navigator Laurenzo Surrell-Page highlighted the organization’s peer navigation, which is peer-designed and includes mentoring by staff and varied services, like job training, financial counseling and education. As for the transition to adult care, the navigator plays a “soft hand-off” role in advocating for the client as they adjust to expectations and protocols in an adult clinic.
Primary Care, Family, and Transgender Health Clinician Jennifer Suski, FNP-BC, AAHIVS, of CrescentCare in New Orleans highlighted how the RWHAP recipient developed a transgender health and a gender clinic with guidance by a Transgender Advisory Committee in 2017. The gender clinic operates four days a week and has 549 patients. The clinic features cultural-humility trainings for staff and local providers and has developed a five-point plan to improve the care experience for this population. As with all of CrescentCare’s work, wraparound services are a feature, from navigation and behavioral health to legal. The clinic collaborates with various agencies, such as the University speech team to provide vocal coaching. As for lessons learned, Suski shared needs including continuously collecting community feedback, better data, and more consensus on provider protocols. CrescentCare’s COVID-19 adjustments have included expanded telehealth and an updated intake process.
Stay Connected to #RyanWhite2020
Want to stay connected to the Virtual 2020 National Ryan White Conference on HIV Care & Treatment? Follow HRSA on Twitter: @HRSAgov. You can also share which sessions you are enjoying – just use the hashtags #RyanWhite2020 and #30YearsofCARE.