Collaborative Learning to Improve the HIV Care Continuum in Metro Areas

Collaborative Learning to Improve the HIV Care Continuum in Metro Areas

November 13, 2017
TARGET Center
Logo of CCLC

When the Ryan White CARE Act was enacted in 1990, communities and states across the U.S. lost no time in creating HIV care systems. Periodically, they experience the need to step back and reassess their approach in order to integrate advances in care and new payer systems and--more recently--develop plans to end HIV altogether. A recent initiative by HRSA is building upon this history of innovation by facilitating peer learning among metropolitan areas hit hardest by the HIV epidemic: Part A jurisdictions funded by the Ryan White HIV/AIDS Program (RWHAP).

Approximately 72% of PLWH in the U.S. reside in RWHAP Part A jurisdictions.

The project, called the Care Continuum Learning Collaborative or CCLC, started in 2016 and has already identified and amplified numerous approaches that participating Part As are employing to enhance care engagement and health outcomes across the HIV Care Continuum. Examples include Part A driven data to care initiatives, better use of the RWHAP’s client level data system in planning/care delivery and expansion of HIV care networks with providers not previously focused on HIV care management.

CCLC’s peer learning network builds upon the quarter-plus century of work by HRSA and RWHAP and others to develop comprehensive systems of HIV care, which has achieved remarkable health outcomes, as documented by client level data in the Ryan White Services Report (RSR).

CCLC: Generating Peer-to-Peer Solutions

CCLC is using peer-to-peer collaboration to identify, accelerate and amplify efforts by RWHAP Part A grant recipients to improve the HIV Care Continuum. The peer work happens in groups that are formed around similar approaches and goals (called “domains). Efforts are being coordinated through a HRSA HIV/AIDS Bureau cooperative agreement with Abt Associates and its team members from NASTAD and Mission Analytics Group. The HRSA/HAB Division of Metropolitan HIV/AIDS Programs, which administers Part A, is directing the project.

CCLC’s collaborative learning model involves expertise from HRSA, the Abt Associates team and expert consultants. Learning happens through distance-based technology: an online platform (the ACTION portal), emails, “cyber teams” and regular conference calls. Communication is regular, open and transparent with each topic group. (See sidebar for CCLC’s learning framework.)

Below are highlights of CCLC’s work to date and what to expect in the next few years of CCLC as RWHAP metropolitan areas and other HIV/AIDS programs look for best practices to improve care engagement and health outcomes for people living with HIV (PLWH).

CCLC’s Early Focus

CCLC involves “a lot of peer-to-peer sharing and walking through of initiatives were actually conducted in each jurisdiction - and how it can be replicated,” [MC5] said Michael Costa of the Abt team. In 2016-2017, 25 Part A jurisdictions participated in CCLC (see map below). 

US Map

In 2016-2017, 25 Part A Recipients participated in CCLC.

Activities carried out under CCLC in 2016-2017 fell within five domains:

  • Data Access and Coordination
  • Using Data to Inform the Need for, and Selection of Evidenced-based/informed Approaches
  • Identifying and Implementing Targeted Evidenced-based/informed Interventions
  • Linkage to Care
  • Changing Healthcare Landscape

Insights to Date

The CCLC teams delivered a considerable amount of tailored TA and training for the wide range of interest areas of Part A sites. CCLC will create an online compendium of each site’s activities and accomplishments in the coming project year. Below are highlights:

  • Care Engagement - Multiple sites shared ideas on care engagement improvements, like improving adherence and retention in care or development of interventions to advance PrEP uptake by leveraging use of RWHAP funds, per HRSA policy.
  • Data - Improved use of RWHAP client level data was a common peer topic. One site explored use of data to more effectively understand the care continuum in the jurisdiction. Another pursued merger of data systems at the state and jurisdictional levels as well as with networks of providers in order to enhance monitoring of client outcomes and facilitate referrals. Yet another site sought insights on development of more streamlined data systems. Another Part A is working on implementation of a Part A driven data-to-care program.

CCLC will be developing briefs highlighting exemplar jurisdictional achievements on topics that may be of interest across Part A jurisdictions.

  • Planning - Several Part A sites focused on needs assessment and planning, like identifying gaps and service needs across populations getting care by other payers (Medicaid or Marketplace plans). Another site explored undertaking more sophisticated analyses of needs for specific populations in order to facilitate their engagement in the care continuum. One peer experience resulted in creation and implementation of a barriers assessment tool.
  • Quality of Care - Quality management was also the topic of several peer sessions. One involved development of quality measurement plans and data collection at the population of interest level. Another disaggregated quality measures in order to get to the heart of why outcomes were lagging for specific populations.
  • HIV Clinician Training - Several sites are working to engage new providers into the RWHAP HIV care network in order to build their HIV clinical care knowledge and understanding of the HIV network available to their clients. This need emerged as more clients secured Affordable Care Act insurance coverage delivered by non-RWHAP providers.

CCLC Ahead: More Standardized Topics

In the project year 2017-2018, CCLC is modifying its learning collaborative approach in order to more narrowly focus the goals of each of the collaboratives. Assignments will involve development of curricula, goals and measures under shorter 9-month time frames. However, the work will still be carried out in a virtual environment of online collaboration. Focus areas include:

  • Part A Driven Data to Care – Exploring ways for Part As to lead Data to Care Initiatives to best meet jurisdictional needs.
  • Integrated Networks to Support Better HIV Care Treatment from Non-RWHAP Providers – Developing approaches to coordinate care across providers who are not part of RWHAP funded sites.
  • Retention in Care (Youth, Transgender and Interpersonal Violence) – Determining best practices for disproportionality affected populations.
  • Pay for Performance Models – Creating approaches to incentivize quality improvement among Part A Subrecipients.