1. Integrating Program Innovation to Improve Prevention and Care Services USCA 2016 – September 17, 2016 April Stubbs-Smith, MPH Director, Division of Domestic HIV Programs Office of Training and Capacity Development HIV/AIDS Bureau Health Resources & Services Administration

2. Improving Access To Care: Using Community Health Workers to Improve Linkage and Retention in HIV Care

3. Goal of the Cooperative Agreement The goal is to increase the utilization of community health workers (CHW): To improve access to and retention in health care; and to improve health outcomes for people living with HIV (PLWH) by strengthening the health care workforce building healthier communities achieving health equity among racial and ethnic minority populations

4. CHWs and the HIV Care Continuum The project will focus on assisting HIV medical care provider sites, particularly those funded by the Ryan White HIV/AIDS Program (RWHAP), with the support needed to integrate CHWs into an HIV multidisciplinary team model through training, direct technical assistance, and collaborative learning sessions. The use of CHWs supports the goals of the recently updated National HIV/AIDS Strategy (NHAS 2020)

5. Technical Assistance and Evaluation Center (TAEC) and CHW This three-year cooperative agreement, was awarded to Boston University’s Center for Advancing Health Policy One major activity is to support a Technical Assistance and Evaluation Center (TAEC) increase the utilization and integration of community health workers (CHW) into primary HIV models of care to improve access to health care and health outcomes for racial and ethnic minority people living with HIV (PLWH).

6. TAEC Activities Will pilot CHW programs at 10 community-based Ryan White- funded medical sites across the county and provide them with direct technical assistance. In addition, the TAEC will develop and conduct web-based training, open to any HIV provider, on CHW integration into HIV multidisciplinary treatment teams. A third component is the development of a multi-session learning collaborative to develop provider capacity are around the use and sustainability of CHW models.

7. CHW Implementation Guide Some of the deliverables from this effort will be a CHW Implementation Guide, which will include: Available CHW resources Lessons learned and best practices from learning collaboratives and direct technical assistance sessions Information on the various components required for the development and integration of an effective CHW program into an HIV primary care model Evaluation tool to assess CHW programs in HIV care and treatment settings

8. Housing Data Integration Initiative

9. Importance of Collaborative Approach to Housing-Health Studies consistently find homelessness and housing instability are directly linked to higher viral loads and failure to achieve or sustain viral suppression, even after controlling other factors known to impact treatment effectiveness such as substance use and mental health needs. Aidala,A.A, et al. (2012).Housing status and the health of people living with HIV/ AIDS: A systematic review. Presented at the XIX International AIDS Conference, Washington, D.C., July 2012; Leaver C.A. et al. (2007).The effects of housing status on health-related outcomes in people living with HIV:A systematic review of the literature. AIDS and Behavior, 11(6)/Supp 2: S85-S100.

10. Ryan White HIV/AIDS Program Data on Unstably Housed PLWH Over 16% of RWHAP clients have temporary or unstable housing situations Populations identified as high priority in National HIV/AIDS Strategy (NHAS) experience highest rates of unstable housing (youth, injection drug users, men having sex with men (MSM) injecting drugs, transgender persons) Unstably housed clients had lowest level of medical retention in all sub- analysis Clients with unstable housing also have among the lowest rates of viral load suppression of any sub-group Ryan White HIV/AIDS Program Annual Client-Level Data Report Ryan White HIV/AIDS Program Services Report (RSR)

11. HIV, Homelessness, & Suppression 2014 Ryan White Services Report Data Viral Suppression by Housing Status Viral suppression: had at least one OAMC visit, at least one viral load count, and last viral load test <200

12. Housing and the National HIV/AIDS Strategy Housing Measure Indicator 7 Reduce percentage of persons in HIV medical care who are homeless to < 5 percent from a baseline 7.4 percent Progress The rate of homelessness increased to 8.3% in 2012 Federal Action Plan Addressing HIV Care and Housing Coordination through Data Integration to Improve Health Outcomes along the HIV Care Continuum (HRSA) Improving the ability of HUD-funded "Continuums of Care" to identify homeless persons living with HIV and link them to housing assistance, medical care, and other services (HUD) Addressing the intersection of HIV and IPV, identify models of improved service integration among HIV housing providers and providers of services for persons experiencing sexual assault, domestic violence, dating violence, and stalking (HUD)

13. SMAIF Housing Data Integration Initiative Addressing HIV Care and Housing Coordination through Data Integration to Improve Health Outcomes along the HIV Care Continuum Collaboration with HRSA HIV/AIDS Bureau, HUD’s Office of HIV/AIDS Housing 3 Year SPNS Initiative with RAND Funds integration of housing and HIV care data systems to improve and bring efficiencies in the coordination of housing and HIV care services Supports a Coordination and Technical Assistance Center (CTAC) that provides technical assistance and capacity building to five (5) performance sites

14. SMAIF Housing Data Integration Initiative Addressing HIV Care and Housing Coordination through Data Integration to Improve Health Outcomes along the HIV Care Continuum 5 Performance Sites Selected Cascade AIDS Project (Portland, OR) Kansas City Health Department (Kansas City, MO) Hartford Department of Health and Human Services (Hartford, CT)* Palm Beach County Dept of Community Services, (Palm Beach, FL)* Gregory House (Honolulu, HI)* Sites are Submitting Integrated Data System Plans & Enhanced Coordinated Delivery Strategies Next Steps Implementation, Evaluation, Dissemination

15. THANK YOU! April Stubbs-Smith, MPH Director, Division of Domestic HIV Programs HRSA/HAB/Office of Training and Capacity Development 301-443-7813 Astubbs-smith@hrsa.gov