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HIV Healthcare Systems Approaches to Improve Viral Suppression (HH-SAIVS)

NAMHC Concept Clearance

Presenter:

Dianne Rausch Ph.D.
Division of AIDS Research

Goal:

The purpose of this initiative is to identify, develop, and test healthcare system interventions, or healthcare delivery changes, that could improve human immunodeficiency virus (HIV) viral suppression.

Rationale:

The goal of HIV treatment is sustained viral suppression through antiretroviral therapy (ART). Viral suppression improves HIV clinical outcomes and reduces HIV transmission. The number of people living with HIV (PLWH) who achieve viral suppression is limited by gaps in the HIV care continuum. These gaps include undiagnosed HIV infections, delayed care linkage, limited care retention, and suboptimal patient ART initiation, adherence, and persistence.

Research has identified individual-level behavioral and psychosocial factors associated with gaps in the HIV care continuum and failure to achieve viral suppression. Interventions delivered at the individual-level have demonstrated positive impact on HIV care continuum behaviors and outcomes.

A comprehensive approach to improve viral suppression would complement individual-level behavioral interventions with structural interventions in healthcare systems or healthcare delivery. Structural interventions seek to improve the health of populations or groups, rather than individuals. They may be directed at healthcare practice, providers, systems, or policy.

This initiative would target a gap in scientific knowledge on HIV healthcare delivery factors that may improve viral suppression. Research related to this initiative may include:

  • Research testing the impact of prescription-based strategies such as synchronization of medication refill dates, extended refill intervals, and co-packaging of individual medicines on HIV viral suppression;
  • Research testing whether reduced medication co-pays or value-based insurance designs can improve rates of ART medication refills and viral suppression;
  • Research testing clinic-level interventions that target clinic or provider practice to promote ART adherence and viral suppression, including electronic medical record practices;
  • Research on “test and start” HIV care models designed to expedite ART treatment initiation and achievement of viral suppression;
  • Research to test the impact of specialized HIV care clinics or differentiated HIV care models designed to meet the needs of underserved patient populations;
  • Research to enhance and optimize comprehensive HIV care team composition to improve rates of viral suppression;
  • Research testing electronic health informatic “dashboards” and quality improvement approaches to strengthen the HIV care continuum at the clinic, municipal, or state level.