Optimizing delivery of an intensive case management intervention for people living with HIV who experience challenges with adherence to care (Opti-HEAT Study)

About This Grant

PROJECT SUMMARY Significance: Despite availability of modern antiretroviral therapy regimens in the United States, many people living with HIV (PWH) experience barriers to care, and targets to End the HIV Epidemic (EHE) have still not been achieved. Case management is an evidence-based intervention which can improve HIV outcomes; however, these programs require extensive human resources to deliver services to PWH who are hardest to reach, which can limit feasibility. To realize EHE targets, implementation innovations are needed to optimize delivery of these programs to facilitate viral suppression and retention in care. Setting: The HIV Enhanced Access to Treatment (HEAT) program at Massachusetts General Hospital is a Ryan-White supported intensive case management program for PWH who experience significant barriers to care, often due to mental health comorbidities, substance use, homelessness/unstable housing, and/or language/cultural barriers. Innovation: We propose to develop a novel multi-level case management implementation toolkit in conjunction with community partners, with components for both patients and care team members, that is designed specifically to optimize care for PWH with the greatest barriers to care who are often unreached. Investigators: Our multidisciplinary team of investigators with expertise in clinical epidemiology (Suzanne McCluskey), HIV program leadership (Jacqueline Chu), qualitative research (Christina Psaros), and implementation science (Ingrid Bassett) is well-suited to address these public health challenges through the following Specific Aims: Aim 1) We will conduct a mixed-methods study to assess the determinants of viral suppression achieved through participation in the HEAT program. We will analyze historical data from the HEAT program, followed by semi-structured in-depth interviews with HEAT program participants, HEAT program staff, and representatives of community-based organizations, guided by the Consolidated Framework for Implementation Research. Aim 2) We will employ a Delphi process to develop a toolkit to optimize the delivery of Ryan White-supported intensive case management programs. We will invite participation from multiple levels of stakeholders including HEAT program participants, HEAT program staff and leadership, representatives from partnering community- based organizations, Ryan White program administrators, and leaders of external Ryan White-supported programs. Aim 3) We will evaluate the pilot implementation of the toolkit within the HEAT program using the Proctor outcomes framework, assessing implementation outcomes of feasibility, acceptability, and appropriateness, as well as preliminary recipient-level outcomes of viral suppression and retention in care at six months. Impact: This study proposal responds directly to the NIH EHE priorities through development of an innovative strategy to expand engagement in HIV care with a focus on populations that are largely unreached. Results of this work will inform development of a future cluster randomized trial to evaluate deployment of the toolkit across Ryan White programs in priority areas where EHE targets have not been met.