In my role as HRSA’s Associate Administrator for the HIV/AIDS Bureau, I have seen firsthand how important it is to tailor programs to meet the unique needs of underserved communities. The “Improving Care and Treatment Coordination: Focusing on Black Women with HIV” initiative, now known as the Black Women First Initiative, supports 12 demonstration sites to design, implement, and evaluate the use of bundled interventions to improve HIV care and treatment coordination for cis- and transgender Black women. The initiative is jointly funded by the HHS Office of the Assistant Secretary for Health’s Minority HIV/AIDS Fund and HRSA’s Ryan White HIV/AIDS Program (RWHAP) Part F: Special Projects of National Significance (SPNS) Program.
The Black Women First Initiative has an important aim: improving health outcomes for Black women with HIV in a culturally sensitive and responsive manner through the delivery of bundled interventions. Bundled interventions are a package of evidence-informed practices when implemented together produce better health outcomes than when delivered separately.
The 12 demonstration sites are receiving funding to participate in this three-year project. Nearly all of the demonstration sites – which span the entire United States – are in jurisdictions prioritized in the Ending the HIV Epidemic in the U.S. (EHE) initiative.
The interventions being used by these demonstration sites include:
- Enhanced patient navigation, case management, or peer engagement
- Red carpet care experience, which provides support and addresses barriers to accessing HIV care including such services as transportation, food/nutrition, housing, employment, mental health, or social support, among others
- Stigma reduction interventions
- Use of trauma-informed care interventions
- Self-efficacy, health literacy and resiliency interventions
- Interventions to address intimate partner violence (IPV), sexual violence, or behavioral health needs
Sites will tailor and implement one to five interventions adapted to meet the specific needs of particular and vulnerable sub-populations of women who are newly diagnosed, at risk of falling out of care, or out of care; cis- and transgender; leaving incarceration; living with multiple co-morbidities; and younger and older women.
Some examples include:
- AIDS Foundation Chicago’s Women Evolving (WE), a multi-sector collaboration to streamline access to care, promote retention and adherence to HIV care and treatment, and improve viral suppression for 85 Black cis- and transgender women who were formerly incarcerated.
- New Orleans’ Institute of Women & Ethnic Studies (IWES), in collaboration with Priority Health Care, will implement Care and Treatment Services (CATS). The demonstration will adapt and evaluate two evidence-informed patient and peer navigation interventions, the Guide to Healing and the Alexis Project, for160 Black cisgender and transgender women who have never entered care, fallen out of care, or are newly diagnosed.
- Atlanta’s Grady Health System, which is using two evidence informed interventions in its Black Women Organized for Wellness (B.WOW!) project: 1) Enhanced peer/patient navigation and 2) Positive Links, a smartphone mobile application to promote retention in care and treatment and healthy behaviors. B.WOW will focus on 150 young Black women aged 18-44 years. Using the smartphone application and support through peers and patient navigators, the intervention aims to provide trauma-informed care and support and enhance social and community networks among women to achieve their care goals.
Importantly, this initiative focuses on a population that was also designated as a priority population in the recently released HIV National Strategic Plan. The HIV Plan discusses the disparate impact of HIV among Black women, noting that Black women accounted for the largest share and highest rate of new HIV infections among women in 2018. The Black Women First initiative supports the HIV Plan’s call to develop new and scale up effective, evidence-based or evidence-informed interventions to improve health outcomes among priority populations.
The evidence-informed interventions developed during this initiative will be disseminated to HIV care team providers throughout the country to better inform their approach to HIV care and treatment to meet the needs of Black women with HIV.