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Keuroghlian AS, Marc L, Goldhammer H, Massaquoi M, Downes A, Stango J, Bryant H, Cahill S, Yen J, Perez AC, Head JM, Mayer KH, Myers J, Rebchook GM, Bourdeau B, Psihopaidas D, Chavis NS, Cohen SM. Correction: A Peer-to-Peer Collaborative Learning Approach for the Implementation of Evidence-Informed Interventions to Improve HIV-Related Health Outcomes. AIDS Behav 2024:10.1007/s10461-024-04296-0. [PMID: 38436808 DOI: 10.1007/s10461-024-04296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Linda Marc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Biostatistics, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hilary Goldhammer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Massah Massaquoi
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Health Sciences, Bouvé College of Health, Northeastern University, Boston, MA, USA
- Kansas City Free Health Clinic, Kansas City, MO, USA
| | - Jessica Yen
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Antonia C Perez
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Jennifer M Head
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Synergy Scientifics LLC, Port Orford, OR, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janet Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Demetrios Psihopaidas
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Keuroghlian AS, Marc L, Goldhammer H, Massaquoi M, Downes A, Stango J, Bryant H, Cahill S, Yen J, Perez AC, Head JM, Mayer KH, Myers J, Rebchook GM, Bourdeau B, Psihopaidas D, Chavis NS, Cohen SM. A Peer-to-Peer Collaborative Learning Approach for the Implementation of Evidence-Informed Interventions to Improve HIV-Related Health Outcomes. AIDS Behav 2024:10.1007/s10461-023-04260-4. [PMID: 38340221 DOI: 10.1007/s10461-023-04260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/12/2024]
Abstract
The nationwide scale-up of evidence-based and evidence-informed interventions has been widely recognized as a crucial step in ending the HIV epidemic. Although the successful delivery of interventions may involve intensive expert training, technical assistance (TA), and dedicated funding, most organizations attempt to replicate interventions without access to focused expert guidance. Thus, there is a grave need for initiatives that meaningfully address HIV health disparities while addressing these inherent limitations. Here, the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) initiative Using Evidence-Informed Interventions to Improve HIV Health Outcomes among People Living with HIV (E2i) piloted an alternative approach to implementation that de-emphasized expert training to naturalistically simulate the experience of future HIV service organizations with limited access to TA. The E2i approach combined the HAB-adapted Institute for Healthcare Improvement's Breakthrough Series Collaborative Learning Model with HRSA HAB's Implementation Science Framework, to create an innovative multi-tiered system of peer-to-peer learning that was piloted across 11 evidence-informed interventions at 25 Ryan White HIV/AIDS Program sites. Four key types of peer-to-peer learning exchanges (i.e., intervention, site, staff role, and organization specific) took place at biannual peer learning sessions, while quarterly intervention cohort calls and E2i monthly calls with site staff occurred during the action periods between learning sessions. Peer-to-peer learning fostered both experiential learning and community building and allowed site staff to formulate robust site-specific action plans for rapid cycle testing between learning sessions. Strategies that increase the effectiveness of interventions while decreasing TA could provide a blueprint for the rapid uptake and integration of HIV interventions nationwide.
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Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Linda Marc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Biostatistics, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hilary Goldhammer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Massah Massaquoi
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Kansas City Free Health Clinic, Kansas City, MO, USA
| | - Jessica Yen
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Antonia C Perez
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Jennifer M Head
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Synergy Scientifics LLC, Port Orford, OR, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janet Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Demetrios Psihopaidas
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Bryant H, Bourdeau B, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for Integrating Behavioral Health Services into HIV Clinical Care: A Narrative Review. Open Forum Infect Dis 2022; 9:ofac365. [PMID: 35967264 PMCID: PMC9364372 DOI: 10.1093/ofid/ofac365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Boston University School of Public Health , Boston, MA , USA
- Bouve College of Health Sciences, Northeastern University , Boston, MA , USA
| | | | - Beth Bourdeau
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco , San Francisco, CA , USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Nortrup E, Dawson Rose C, Meyers J, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for addressing trauma among people with HIV: a narrative review. AIDS Care 2021; 34:505-514. [PMID: 34612097 DOI: 10.1080/09540121.2021.1984382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Traumatic experiences are disproportionately prevalent among people with HIV and adversely affect HIV-related health outcomes. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature for interventions designed to address trauma among people with HIV in the U.S. Our search yielded 22 articles on 14 studies that fell into five intervention categories: expressive writing, prolonged exposure therapy, coping skills, cognitive-behavioral approaches integrated with other methods, and trauma-informed care. Thematic elements among the interventions included adaptating existing interventions for subpopulations with a high burden of trauma and HIV, such as transgender women and racial/ethnic minorities; addressing comorbid substance use disorders; and implementing organization-wide trauma-informed care approaches. Few studies measured the effect of the interventions on HIV-related health outcomes. To address the intersecting epidemics of HIV and trauma, it is critical to continue developing, piloting, and evaluating trauma interventions for people with HIV, with the goal of wide-scale replication of effective interventions in HIV settings.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Carol Dawson Rose
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Janet Meyers
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Chavis NS, Klein PW, Cohen SM, Dempsey A, Hauck H, Cheever LW. The Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program's Response to the Opioid Epidemic. J Infect Dis 2021; 222:S477-S485. [PMID: 32877537 DOI: 10.1093/infdis/jiaa230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The United States is in the midst of an unprecedented opioid crisis with increasing injection drug use (IDU)-related human immunodeficiency virus (HIV) outbreaks, particularly in rural areas. The Health Resources and Services Administration (HRSA)'s Ryan White HIV/AIDS Program (RWHAP) is well positioned to integrate treatment for IDU-associated HIV infections with treatment for drug use disorders. These activities will be crucial for the "Ending the HIV Epidemic: A Plan for America" (EHE) initiative, in which 7 southern states were identified with rural HIV epidemics. METHODS The RWHAP Services Report data were used to assess the IDU population and substance use services utilization among RWHAP clients in 2017, nationally and in the 7 EHE-identified states. THe HRSA held a 1-day Technical Expert Panel (TEP) to explore how RWHAP can best respond to the growing opioid crisis. RESULTS During the TEP, 8 key themes emerged and 11 best practices were identified to address opioid use disorder (OUD) among people with HIV. In 2017, among RWHAP clients with reported age and transmission category, 6.7% (31 683) had HIV attributed to IDU; among IDU clients, 6.3% (1988) accessed substance use services. CONCLUSIONS The TEP results and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care. These activities are critical to ending the HIV epidemic.
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Affiliation(s)
- Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Pamela W Klein
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Antigone Dempsey
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Heather Hauck
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Office of the Associate Administrator, Rockville, Maryland, USA
| | - Laura W Cheever
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Office of the Associate Administrator, Rockville, Maryland, USA
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Klein PW, Geiger T, Chavis NS, Cohen SM, Ofori AB, Umali KT, Hauck H. The Health Resources and Services Administration's Ryan White HIV/AIDS Program in rural areas of the United States: Geographic distribution, provider characteristics, and clinical outcomes. PLoS One 2020; 15:e0230121. [PMID: 32203556 PMCID: PMC7089565 DOI: 10.1371/journal.pone.0230121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background People living with HIV (PLWH) residing in rural areas experience substantial barriers to HIV care, which may contribute to poor HIV health outcomes, including retention in HIV care and viral suppression. The Health Resources and Services Administration’s Ryan White HIV/AIDS Program (HRSA RWHAP) is an important source of HIV medical care and support services in rural areas. The purpose of this analysis was to (1) assess the reach of the RWHAP in rural areas of the United States, (2) compare the characteristics and funded services of RWHAP provider organizations in rural and non-rural areas, and (3) compare the characteristics and clinical outcomes of RWHAP clients accessing medical care and support services in rural and non-rural areas. Methods and findings Data for this analysis were abstracted from the 2017 RWHAP Services Report (RSR), the primary source of annual, client-level RWHAP data. Organizations funded to deliver RWHAP any service (“RWHAP providers”) were categorized as rural or non-rural according to the HRSA FORHP’s definition of modified Rural-Urban Commuting Area (RUCA) codes. RWHAP clients were categorized based on their patterns of RWHAP service use as “visited only rural providers,” “visited only non-rural providers,” or “visited rural and non-rural providers.” In 2017, among the 2,113 providers funded by the RWHAP, 6.2% (n = 132) were located in HRSA-designated rural areas. Rural providers were funded to deliver a greater number of service categories per site than non-rural providers (44.7% funded for ≥5 services vs. 34.1% funded for ≥5 services, respectively). Providers in rural areas served fewer clients than providers in non-rural areas; 47.3% of RWHAP providers in rural areas served 1–99 clients, while 29.6% of non-rural providers served 1–99 clients. Retention in care and viral suppression outcomes did not differ on the basis of whether a client accessed services from rural or non-rural providers. Conclusions RWHAP providers are a crucial component of HIV care delivery in the rural United States despite evidence of significant barriers to engagement in care for rural PLWH, RWHAP clients who visited rural providers were just as likely to be retained in care and reach viral suppression as their counterparts who visited non-rural providers. The RWHAP, especially in partnership with Rural Health Clinics and federally funded Health Centers, has the infrastructure and expertise necessary to address the HIV epidemic in rural America.
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Affiliation(s)
- Pamela W. Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
- * E-mail:
| | - Tanya Geiger
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Alexa B. Ofori
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Kathryn T. Umali
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Heather Hauck
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
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