Part B - States/Territories

Part B of HRSA's Ryan White HIV/AIDS Program (RWHAP) funds States and Territories to deliver HIV/AIDS care, including HIV/AIDS medications under the AIDS Drug Assistance Program (ADAP). Part B addresses care needs across many cities and rural regions. Recommendations about service priorities are typically made by statewide planning groups or regional and local consortia. States then advertise and award contracts to agencies to deliver services. HRSA project officers and technical assistance/training services help Part B programs conduct planning; deliver care (with attention to quality, clinician training, and data reporting); and manage their grant funds. Learn more about Part B—formula and supplementary grants, ADAP, eligible services, and more. 

Questions? Email the HRSA HAB Division of State HIV/AIDS Programs (DSHAP).

Resources 50

Best Practices

  • NASTAD

    Ideas for RWHAP Part B/ADAPs to support access to medications and tailor related services for Black/African American men living with HIV.

  • Best Practices Compilation
    Ten organizations across the U.S. integrated Community Health Workers (CHWs) into their multidisciplinary care teams. Enrolled clients had statistically significant improvements in viral suppression, antiretroviral therapy prescription, and appointment attendance after six months in the program.
  • Best Practices Compilation
    The Oregon Health Authority awarded contracts to local public health authorities across the state to work with community partners to integrate early intervention services and outreach services, link people to HIV care, and provide support to help clients reach viral suppression. Quick linkage to care resulted in a median of 57 days to viral suppression for Early Intervention Services and Outreach clients in 2019.
  • Best Practices Compilation
    The Enhanced Patient Navigation for Women of Color with HIV intervention uses patient navigators, who are non-medical staff in clinical settings, to reduce barriers to health care and optimize care. The intervention was effective in improving linkage to and retention in care, as well as viral suppression.
  • Best Practices Compilation
    Extramural dental clinics implemented the medical home model, with integrated trauma-informed care, to expand oral health care services for people with HIV, and saw increases in referrals from partner organizations and the number of new clients.
  • Best Practices Compilation
    The HIV Clinical Pharmacist Services intervention shortens the time between referral to and engagement in care by allowing newly referred clients to see pharmacists in addition to other clinical providers for their initial appointment. This intervention is supported by findings from a retrospective cohort study that took place from 2013 to 2017 at a RWHAP-funded clinic. In addition to significantly decreasing the time between referral and initial visit, clients who saw a pharmacist also experienced shortened time to antiretroviral therapy initiation and viral suppression compared to those who only saw non-pharmacist providers.
  • Best Practices Compilation

    Caracole, an AIDS Service Organization, uses three interconnected approaches to improve retention in HIV care: housing first, harm reduction, and motivational interviewing. Clients in permanent supportive housing had high rates of viral suppression, exceeding Caracole's goal of 75%.

  • Best Practices Compilation
    The Huntridge Family Clinic launched the Rapid Start Initiative to provide same-day ART treatment and comprehensive case management to clients with a new diagnosis of HIV. Over 90% of clients received ART on the same day as diagnosis, and 78% of clients were retained in care within the first year of starting treatment.
  • Best Practices Compilation
    The AIDS Institute is committed to promoting, monitoring, and supporting the quality of clinical services for people with HIV in New York State. The Adolescent Quality Learning Network (AQLN) is a collaborative of 16 HIV Adolescent/Young Adult Specialized Care Center (SCC) programs. In collaboration with the AIDS Institute, SCC providers selected a quality improvement project aimed to raise viral suppression rates by improving access to mental health services.
  • Best Practices Compilation
    The Adolescent Quality Learning Network (AQLN) identified barriers to sexual health care in four areas: sexual health assessment; receipt of sexual health counseling; three-site STI testing; and receipt of STI treatment. The AQLN then tested approaches to address the identified barriers including opt-out testing, self-rectal swabs, and creating a sex positive environment in the clinic. After one year, the AQLN found improvements in the percentage of clients assessed for sexual health risks, as well as improvements in testing and treatment of STIs.
  • Best Practices Compilation
    Kern County Rapid ART links people with a new diagnosis of HIV to ART. The Kern County Health Officer’s Clinic identifies people with a new diagnosis of HIV through onsite testing, surveillance data, and referrals from local hospital emergency departments. Kern County Rapid ART provides support services and refers clients to other community clinics for ongoing care. A study of clients with a new diagnosis of HIV in 2021 found that on average, Kern County Rapid ART clients were linked to care and provided ART within two days of diagnosis.
  • Best Practices Compilation
    LA Links is a combined data-to-care and client navigation approach that cross-references routinely collected HIV surveillance data with other secondary data sources to identify and locate people with HIV who are not in care, as well as those who are in care, but with high viral loads. Originally implemented in 2013 as part of the Care and Prevention in the United States Demonstration Project, LA Links improved linkage to care, reengagement in care, and viral suppression. Louisiana expanded the program statewide in 2016.
  • Best Practices Compilation
    Link-Up Rx is a pharmacy-data-based Data to Care program implemented by the Detroit Health Department in partnership with the Michigan Department of Health and Human Services and a specialty pharmacy. Using pharmacy data to identify clients in need of follow-up greatly reduced the amount of time for clients to appear on “not in care” lists compared to traditional D2C approaches. Protocols for a three-tiered outreach and reengagement approach were developed to connect clients back to antiretroviral therapy and HIV care following a missed pharmacy pick-up. Nearly half of identified clients were linked back to their pharmacy or other HIV medical services.
  • Best Practices Compilation
    This data-to-care (D2C) initiative, implemented by the San Francisco Department of Public Health and its affiliated clinics from 2015–2017, used three sources of data to identify people not in care: HIV surveillance data, healthcare provider referrals, and electronic health record (EHR) data. LINCS navigators then used disease intervention searching tools and EHR data to locate clients and connect them to an HIV care provider. LINCS navigators followed up with clients for 90 days to support engagement in care. LINCS participants were more likely to be retained in care and virally suppressed after the intervention than before.
  • Best Practices Compilation
    The Louisiana Public Health Information Exchange is a bidirectional exchange that connects hospital system electronic health records with state surveillance data. Providers use the exchange to identify and relink people with HIV who are out of care to clinical and supportive services. Since LaPHIE was implemented in 2009, thousands of people with HIV who were out of care have been identified, with a significant number being successfully linked to care.
  • Best Practices Compilation
    The Utah Department of Health and Human Services collaborated with RWHAP Part B-funded medical case managers to improve care and outcomes for clients following Franklin Covey’s 4 Disciplines of Execution: 1) focus on the wildly important goal; 2) act on the lead measures; 3) keep a compelling scoreboard; and 4) create a cadence of accountability. Through intensive case management, regular monitoring, and feedback sessions, the state's RWHAP Part B program's overall viral suppression rate increased from 88.9% in 2020 to 90.4% by December 2021.
  • Best Practices Compilation
    MORE focuses on people who are not virally suppressed and/or who have not attended an HIV medical appointment in six months. Participants can choose from one of three MORE programs, depending on the intensity of services they want. Based on initial evaluation findings, participants who received more intensive MORE services were more likely to be virally suppressed and less likely to be lost to follow-up than those who received less intensive services.
  • Best Practices Compilation
    The Navigator Case Management intervention helps people with HIV who are incarcerated and are leaving to return to the community. The intervention uses harm reduction, case management, and motivational interviewing techniques to promote healthy behaviors. Enhanced case management including peer support and connection to other needed services both immediately before and after release supports increased linkage to and retention in HIV care for people transitioning to the community from jail.
  • Best Practices Compilation
    The University of Pittsburgh Medical Center, Center for Care of Infectious Diseases, Pittsburgh Area Center for Treatment (PACT) began implementing the Food Assistance Program in August 2017 to serve as a supplemental resource for people with HIV receiving care who experience food insecurity. The program helps bridge gaps in Supplemental Nutrition Assistance Program (SNAP) benefits and monthly food costs while promoting access to healthy foods and retention in HIV care.
  • Best Practices Compilation
    Positive Care Center implemented the Rapid Access program in 2018, providing clients with ART on the same day as HIV diagnosis. Pharmacists, embedded within Positive Care Center’s care team, help clients with their treatment plans and adherence strategies. Over 90% of clients served through Rapid Access in 2021 received ART on the same day as diagnosis, and 82% of clients were retained in care at six months.
  • Best Practices Compilation
    PositiveLinks is a mobile platform deployed by clinics or community-based organizations to connect people with HIV to a digital support community. The client-facing app helps people with a new diagnosis of HIV become engaged in care and helps people at risk of being lost to care overcome barriers related to geographic or social isolation. From the app, people can access Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant patient dashboards, secure messaging, and patient lab records. People who used PositiveLinks had increased rates of retention in care and viral suppression.
  • Best Practices Compilation
    Project ACCEPT is designed to improve engagement and retention in medical care for youth ages 16 to 24 years with newly diagnosed HIV. The educational and skill-building intervention was deployed at four demonstration sites and increased rates of medication use and appointment adherence in comparison to a control group. Although originally developed for cisgender youth, Project ACCEPT may be adapted for gender-diverse people.
  • Best Practices Compilation
    San Joaquin County Public Health Services Department partnered with the California Department of Public Health, Office of AIDS to help clients get to medical appointments via ridesharing. Representing the first partnership between a jurisdiction and a ridesharing company, this program addresses transportation barriers, promotes engagement in medical care, and leads to cost savings.
  • Best Practices Compilation
    TAVIE Red is a mobile application that aims to improve retention in HIV care and address social determinants of health. It helps case managers connect with clients and uses gamification, a technique with elements of gameplay such as earning points and completing quests, to increase engagement with HIV care and psychological self-care management tools. TAVIE Red participants overwhelmingly reported that the technology helped them manage their HIV diagnosis.
  • Best Practices Compilation
    The Test and Treat initiative, implemented by Oklahoma State University, connects people to antiretroviral therapy (ART) within 14 days of HIV diagnosis through streamlined intake and initial clinic visit protocols and 30-day medication starter packs. Participants in Test and Treat are linked to care and reach viral suppression sooner, and are more likely to be retained in care, as compared with people in standard care.
  • Best Practices Compilation
    The Max Clinic, located within the University of Washington’s Harborview Medical Center complex in Seattle, offers walk-in services and incentives to clients reengaging in HIV care, especially those who have not been well served by the traditional health care model—including clients who are experiencing homelessness, or who have mental health and substance use issues. The Max Clinic offers rapid antiretroviral therapy, incentives, a flexible clinical model, and access to comprehensive support services. Max Clinic clients were significantly more likely to reach viral suppression after 12 months than a comparable control group.
  • Best Practices Compilation
    Virginia Rapid Start launched with HIV care providers across the state with goals to initiate ART for clients within 14 days of HIV diagnosis and to improve access to, and retention in, high-quality HIV care and support services. Through Virginia Rapid Start, providers initiated ART medications within an average of four days of HIV diagnosis, as compared with the statewide average of 28 days. Virginia Rapid Start clients had higher rates of viral suppression compared to both the RWHAP Part B overall and Virginia overall. The success of Virginia Rapid Start led VDH to expand the program to the entire Virginia RWHAP Part B.

Resources

Webinars

Conference Presentations

HRSA HIV/AIDS Bureau, Division of State HIV/AIDS Programs
Presenters:
2022 National Ryan White Conference on HIV Care & Treatment
NASTAD
Presenters:
Chloe' Bernard, MSCP
2022 National Ryan White Conference on HIV Care & Treatment
HRSA HAB DSHAP
Presenters:
Kenya Young, MPH
2022 National Ryan White Conference on HIV Care & Treatment
HRSA DSHAP
Presenters:
Susan Robilotto, D.O., and others
2022 National Ryan White Conference on HIV Care & Treatment
Massachusetts Department of Public Health
Presenters:
Dennis Canty, Randie Kutzen, Alyssa Harrington
2020 National Ryan White Conference on HIV Care & Treatment

Technical Assistance

  • HRSA recipients first point-of-contact for managing federal grants and accessing training and technical assistance.

  • TAP-in supports the 47 EHE jurisdictions funded by HRSA to strengthen their EHE work plans, promote cross-jurisdictional learning, and ensure jurisdictions have access to the resources they need. Project period: 2020-2025.

  • TA and training on administration of Ryan White ADAPs and Part B planning and management. Project period: 2022-2027.

  • Help with the RSR, ADR, CDR, EHE, HIVQM, and AETC data systems. Project period: 2020-2025.

  • The SCP delivers TA aimed at strengthening healthcare system engagement in local EHE efforts by supporting the coordination of planning activities, alignment of funding sources, and program implementation. Project period: 2020-2025.
  • Help with HRSA Electronic Handbooks (EHB) - 877-464-4772 - 8am-8pm ET, M-F - Contact HRSA About the EHB

  • Support for Part A and B recipients and their planning bodies around integrated HIV/AIDS planning efforts. Project period: 2016-2023.

  • Interactive data tool to visualize the reach, impact, and outcomes of the RWHAP. HRSA offers office hours and webinars to help use the tool.
  • RSR, ADR, HIVQM, PTR, AETC, DSR, GCMS, EHE - 888-640-9356 - 10am-6:30pm ET, M-F [email protected] Project period: 2022-2026.

  • Initiative documenting best practice strategies and interventions that have been shown to improve HIV outcomes in a "real world" setting and can be replicated by other programs. Project period: 2021-2024.

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