“Unapologetically enabling” is the mantra of the Baltimore City Health Department’s Getting to Zero + Initiative, which employs novel approaches to support clients with engagement and re-engagement in HIV care. Dr. Victoria A. Cargill, Assistant Commissioner of the Baltimore City Health Department, discussed the program at the 2020 Ryan White HIV/AIDS Program Clinical Conference. Her August 12 presentation was part of a panel about the Ending the HIV Epidemic (EHE) initiative which includes a focus on engaging people with HIV in care who have yet to be engaged and re-engaging those who are lost to care. Baltimore City is one of the 57 Phase I EHE jurisdictions.
The goal of Baltimore’s city-wide initiative, adapted from a program developed by the REACH Initiative of the Johns Hopkins University School of Nursing and implemented in the John G. Bartlett Specialty Clinic in the Johns Hopkins Division of Infectious Disease, is to increase viral suppression rates. It utilizes a patient navigator model that aims to remove any potential barriers to linkage, access, engagement, retention in care, and antiretroviral adherence. Navigators link and engage individuals into HIV care, including a fast response to newly diagnosed cases, and continue to provide navigation to support retention in care and viral suppression. The initiative focuses on people who are undiagnosed, unengaged in care, and/or not virally suppressed, especially youth, young men who have sex with men, racial and ethnic minority women, formerly incarcerated people, and the marginally housed. “We used the term ‘unapologetically enabling’ with great intent,” noted Dr. Jason Farley, REACH’s Director. “Our Ryan White Clinics are already excellent examples of patient-centered medical homes. Those who continue to have undetectable viral loads are a unique sub-set of patients, where clinic-based resources are simply not sufficient.”
Patient navigation going beyond the walls and hours of the clinic, meeting people where they are at in the community, is a key to the initiative’s success, explained Dr. Cargill. Navigators use a standardized barrier assessment and address immediate health and psychosocial needs. To help meet these needs, they coordinate with community partners for services, such as STAR TRACK, a unique program with a long track record that focuses on youth and sexual and gender minority populations; New Vision House of Hope, a housing program that is state-certified to manage mental health and substance use disorders; and syringe services programs. The Getting to Zero + patient navigator works with collaborating clinics and the initiative provides the clinics technical assistance and training, data management support, and data-informed provider support. Evaluation of the program is pending, but REACH’s evaluation of the Bartlett Clinic program on which the city-wide program is modeled revealed that after nearly one year 90% (126) of eligible patients with a detectable viral load were served by the patient navigator. Among patients with >1 repeat viral load test during that time, 70% (n=79) achieved viral suppression and 20% consistently sustained viral suppression at <200 copies/mL for more than 6 months.
Key lessons from the program include the importance of using consumer feedback and creativity for the program to better meet people’s needs, making the program nimble for mobile and street settings, and enhancing collaborations with clinics and many other service providers in the city.
A number of other innovative approaches to engaging and re-engaging people in HIV care were presented during the 2020 National Ryan White Conference on HIV Care and Treatment, which followed the Clinical Conference. Many also used a community health worker or patient navigator model for specific populations and also connected individuals to robust services for housing and employment, for example. Tips for implementing such programs were shared from NIH supported EHE implementation science research projects.
“I am so pleased that Baltimore and other jurisdictions are sharing their creative approaches to reaching, engaging, and supporting individuals newly diagnosed with HIV and those returning to HIV care. To be successful in ending the HIV epidemic, we must find new and different ways to reach people who have yet to be reached effectively and support them in care,” said Harold Phillips, MRP, Senior HIV Advisor and Chief Operating Officer of Ending the HIV Epidemic: A Plan for America in the HHS Office of Infectious Disease and HIV/AIDS Policy. “Communities can learn much from each other and, in consultation with their own community members, apply, and adapt what they learn, given local needs and resources.”
See the Getting to Zero + presentation by Dr. Cargill. Get more information about other presentations at the 2020 Ryan White HIV/AIDS Program Clinical Conference