Journal
AIDS PATIENT CARE AND STDS
Volume 32, Issue 4, Pages 149-156Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/apc.2017.0313
Keywords
HIV care continuum; retention in care; Public Health Department; care delivery; substance use; high-need patients
Funding
- National Institute on Drug Abuse [R03 DA 042668]
- University of Washington Center for AIDS Research (CFAR)
- NIH - NIH Institutes and Centers (NIAID) [P30AI027757]
- NIH - NIH Institutes and Centers (NCI) [P30AI027757]
- NIH - NIH Institutes and Centers (NIMH) [P30AI027757]
- NIH - NIH Institutes and Centers (NIDA) [P30AI027757]
- NIH - NIH Institutes and Centers (NICHD) [P30AI027757]
- NIH - NIH Institutes and Centers (NHLBI) [P30AI027757]
- NIH - NIH Institutes and Centers (NIA) [P30AI027757]
- NIH - NIH Institutes and Centers (NIGMS) [P30AI027757]
- NIH - NIH Institutes and Centers (NIDDK) [P30AI027757]
- CFAR supplemental grant [P30 AI 027757-28S1]
- Health Resources & Services Administration
- Washington State Department of Health
- Centers for Disease Control and Prevention
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The Max Clinic in Seattle, Washington is designed to engage patients who have extensive barriers to HIV care. In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that includes walk-in access to primary care in a Sexually Transmitted Disease Clinic. Patients who have failed to engage in care and achieve viral suppression with lower intensity support are referred by clinicians, case managers, and the health department Data to Care program. The clinic offers food vouchers, cash incentives, no-cost bus passes, and cell phones, as well as intensive case management with cross-agency coordinated care. The primary evaluation outcome was the percentage of patients who achieved viral suppression (HIV RNA <200 copies/mL) at least once after enrollment. Secondary outcomes were continuous viral suppression (2 suppressed results in a row 60 days apart) and engagement in care (2 completed medical visits 60 days apart). During January 2015-December 2016, 263 patients were referred; 170 (65%) were eligible, and 95 (56% of eligible) were enrolled. Most patients used illicit drugs or hazardous levels of alcohol (86%) and had diagnosed psychiatric illness (72%) and unstable housing (65%). During the year after enrollment, 90 (95%) patients engaged in care. As of the end of 2016, 76 (80%) had achieved viral suppression, and 54% had continuous viral suppression. The Max Clinic successfully treated HIV in high-need patients and, to date, has been sustainable through a combination of federal, state, and local funding.
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