By Channing Wickham, executive director of Washington AIDS Partnership and Jennifer Jue, senior program officer at Washington AIDS Partnership
There are over 13,000 people living with HIV in Washington, D.C., and many of them struggle to access and stay in care and reach HIV viral suppression, the primary way we can prevent further transmission of HIV and end the local HIV epidemic. When an individual living with HIV is successfully engaged in care, their HIV virus becomes so low that it is undetectable and they are no longer able to transmit the virus.
In the District, people living with HIV often face multiple barriers to care and traditional medical services may not have worked for them, whether because of stigma, a lack of cultural competency, or inaccessible services. “Daniel,” one such resident, experienced this before participating in one of the Washington AIDS Partnership’s (WAP) most innovative and successful programs to date – the Mobile Outreach Retention and Engagement initiative (MORE):
When “Daniel” enrolled in MORE, he was depressed, had uncontrolled HIV, and was not working. He was living with a family member, who moved out and took all of the home’s furniture, drastically reducing his quality of life. Daniel had always been proud of his independence and as he became overwhelmed with his illness, he lost confidence in himself. With the support of the MORE program, he was able to engage in care, including successfully recovering from surgery at home. His self-esteem increased, and he recently found a job, telling his MORE provider, “I can do it.”
MORE grew out of a joint effort by WAP and the D.C. Department of Health’s HIV/AIDS, Hepatitis, STD, and TB Administration to figure out how to help people living with HIV to access and stay in care when traditional medical services have not worked for them and they are facing multiple barriers to care. To respond to this issue, WAP secured over $1 million in national funding and developed a request for applications (RFA) for organizations providing medical care to HIV-positive individuals. The RFA’s focus was a novel one: tailor medical services to the unique needs of each patient, and meet them where they are. The two overarching goals were: helping people access and stay in care; and improved health outcomes using innovative strategies such as medical visits in the home, evening hours, and providing care at non-traditional sites in the community.
After a competitive application process, Whitman-Walker Health (WWH) was selected and received funding to implement the Mobile Outreach Retention and Engagement (MORE) initiative. The initiative had a team-based approach with both clinical staff (physician assistant and nurse practitioners) and non-clinical staff (two care navigators and a community health educator). The MORE team provided medical care, counseling, and supportive services in the home and at pop-up community sites. Outcomes for the initiative are exciting: thousands of medical and support visits for patients who were out of care or struggling with staying in care, and real improvements in terms of engagement in care and lower HIV viral loads.
For more information about the initiative and its outcomes, click here.