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in+care Newsletter | Issue 12


National Campaign to Improve Retention in HIV Care
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In This Issue
Upcoming Events
MedScape News Today
Provider Spotlight
Journal Spotlight

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Data - National Averages*

(as of 12/06/12)


Gap Measure
(n = 162 sites, 111,879 patients)

Visit Frequency Measure
(n = 150 sites, 91,667 patients)

New Patient Measure
(n = 159 sites, 7,115 patients)

Viral Load Suppression
(n = 158 sites, 130,917 patients)

*data not unduplicated
Did you know

The in+care Campaign is interested in hearing your ideas on directions we can take our editorial calendar! Contact Michael Hager with your thoughts and ideas!

Quick Links

Campaign Headquarters

National Quality Center (NQC)

New York State Department of Health AIDS Institute


90 Church Street, 13th floor
New York, NY 10007


Work: 212-417-4730
Fax: 212-417-4684


The Importance of Mental Health for Retention


The in+care Campaign is excited to continue to offer you opportunities to join a national dialogue on retention in HIV care. One of the most frequently noted barriers by our participants is the patient's mental health status. Many Campaign participants have been working to put together improvement strategies that address mental health concerns and/or work with people around their mental health issues. This newsletter contains two pieces that address mental health as far as retention in HIV care is concerned. We look forward to presenting a webinar on this topic in early January (more details below)!

Upcoming Events

+ in+care Campaign Office Hours

Mondays and Wednesdays 4pm-5pm ET

Office Hours allow in+care Campaign participants to directly communicate with NQC staff and consultants. Callers can ask general questions, request technical assistance, or engage in dialogue about the Campaign. Upcoming discussion topics include:

  • Monday, December 10 - Open Space, no set topic
  • Wednesday, December 12 - Interpreting Enhanced Data Reports
  • Monday, December 17 - Open Space; no set topic
  • Wednesday, December 19 - Low-Maintenance Retention Improvement Projects
  • Monday, December 24 - Campaign Offices Closed, no Office Hours
  • Wednesday, December 26 - Campaign Offices Closed, no Office Hours
  • Monday, December 31 - Campaign Offices Closed, no Office Hours
  • Wednesday, January 2 - Building Infrastructure to Personalize Care

Dial-in#: 866.394.2346

Participant Code: 418 257 6142 #



+ Journal Club Webinar | Low-Effort, Clinic-Wide Intervention

Wednesday, December 12, 2012 at 1pm ET

Agenda: The authors will review their research on a simple intervention that made an impact on patient retention in care. The work was published during AIDS 2012 in July in Clinical Infectious Diseases.


30 minutes will be saved for questions from the audience. If you have any specific questions you would like to have addressed, please mail them to Michael@nationalqualitycenter.org in advance!


Dial-in#: 866.394.2346

Participant Code: 397 154 6368 #

URL: http://www.nqcqualityacademy.org/incarecampaign



+ Partners in+care Webinar | Optimal Wellness

Thursday, December 13, 2012 2pm ET

Agenda: As we grow older, our retention in health care becomes all the more important. Our HIV infection is made more complex as we experience additional, natural chronic illnesses seen in the public, like diabetes, hypertension, and so on. Mark Brennan-Ing of ACRIA in New York State will discuss the concept of Optimal Wellness with participants in this program. Specifically, the webinar will address:

  1. Wellness concerns for aging people living with HIV
  2. emerging trends for this population related to wellness and HIV
  3. tools and resources recommended on this topic

If you have any specific questions you'd like to have addressed through this webinar, please contact Michael Hager -Michael@NationalQualityCenter.org


Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #

URL: http://www.nqcqualityacademy.org/incarecampaign



+ in+care Campaign Webinar | Sustainability of Retention Projects in Unsure Funding Envionements

Wednesday, January 9, 2013 at 2pm ET

Agenda: Amy Sitapati of the Owen Clinic at UCSD will present on her agency's progress in sustaining retention projects once the dedicated funding source for them has expired. This is an issue of great importance, because as we know, eventually, almost all funding comes to an end, but our work never does. We will also be reviewing the data that has been submitted through the in+care Campaign to date and introducing our new enhanced data reports - Parts by Measure! If you have any specific questions you'd like to have addressed through this program, please contact Michael at Michael@nationalqualitycenter.org


Dial-in#: 866.394.2346

Participant Code: 397 154 6368 #

URL: http://www.nqcqualityacademy.org/incarecampaign



+ in+care Campaign Webinar | Mental Health and Retention

Thursday, January 10, 2013 2pm ET

Agenda: Kevin Moore of AIDS Care Group in Philadelphia will present on the connection between mental health and retention. He will focus on miscommunication between medical and behavioral providers that leave patients in vulnerable situations. He will also describe opportunities for building mental health into HIV Patient Centered Medical Homes. In addition, Mike Rollison of Virginia Commonwealth University will present his process diagram for linking mental health patients to HIV primary care developed through the SPNS Linkage to Care Project of Virginia as another example of successful QI interventions.


Campaign Staff will also be reviewing the data that has been submitted through the in+care Campaign to date and introducing our new enhanced data reports - Measures by Part! If you have any specific questions you'd like to have addressed through this program, please contact Michael at Michael@nationalqualitycenter.org


Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #

URL: http://www.nqcqualityacademy.org/incarecampaign



+ Next Campaign Performance Data Submission

January 2, 2013



+ Next Improvement Update Form Submission

December 17, 2012



Keep up-to-date with the latest in+care events through our webpage: http://incarecampaign.org/index.cfm/75283

MedScape Today News - Series on Retention

The in+care Campaign is excited to announce that members of its Technical Working Group are authoring articles for a new MedScape Today News Series on retention in HIV care. The Technical Working Group is made up of nationally renowned researchers and providers who have a strong track record in researching or promoting patient retention in HIV care.Links to all the articles are included below. We recommend that you subscribe to HIV/AIDS MedPlus to be informed of new and exciting articles in this series! Registration is free and anyone can subscribe, regardless of training background or job function. The following articles have been posted already:


Provider Spotlight - Virginia Commonwealth University

It is a well-known fact that people with mental health concerns are often not linked and retained in care as easily as other people who do not have these concerns. In general, it is felt that the referral and follow-up process between mental health providers and providers of HIV clinical care was not well documented, which led to patients falling through the cracks. Some experts feel that this is due to misunderstanding between providers of these types in that each feels the other is responsible for tracking patients through referral processes. In attempt to help understand and end this polemic, the Virginia Commonwealth University (VCU) has developed a process map to examine the linkage between mental health programs and medical programs for people with HIV. Mike Rollison, MSW LCSW, of VCU states "we saw value in a model that simplifies the system for review of operational processed and training for our staff."


The VCU linkage map was adapted from a template model in use by another agency. Once VCU revised the template to include their organizational processes for linking HIV-infected patients with mental health concerns in HIV care, the team was able to identify areas for intervention and process improvements. Some examples of the changes made through this mapping project include:

  • Changes in the management of the clinic's call center
  • Changes in the patient relations program
  • Changes in the clinic's patient no-show policies.


Mr. Rollison notes "it's important to keep a living document mentality when working with process maps." Some change strategies take time to make a noticeable difference in outcomes and fixing one problem will sometimes highlight new or additional problems that require action. When working with process maps, Mr. Rollison stressed the NQC mantras 'Do what you can do when you can do it' and 'Don't make perfect the enemy of the good.'


So far, the Virginia State Department of Health has been pleased with the work VCU has accomplished using its process maps. Data collected through the SPNS project show initial promising results that people receiving mental health services are more routinely also engaged in HIV clinical care. As one of the seven SPNS Linkage to Care Project states, Virginia is striving to connect as many of its HIV-infected citizens with ongoing HIV care as possible. VCU's map has been so successful, that the Virginia SPNS Program, overseen by Virginia Department of Health, has asked its other program partners to develop similar linkage process maps; these include, Patient Navigation, Disease Intervention Specialty, and Care Coordination. It will be intriguing to learn what successes are made by the other programs that implement linkage to care process maps.

Journal Spotlight -  HIV System Navigation: An Emerging Model to Improve HIV Care Access. J.Bradford, S.Coleman, W.Cunningham.

Judith B. Bradford, Sharon Coleman, and William Cunningham. HIV System Navigation: an emerging model to improve HIV care access. AIDS Patient Care and STDs. 2007; 21: s49-s58. 



Bradford, Coleman, and Cunningham sought out to learn more about the effectiveness of outreach interventions to engage and retain underserved populations living with HIV in consistent medical care. At the time of the study, the term "patient navigation" was referenced in several peer reviewed publications, but the concept was not tested for rigorous demonstrations of effects or effectiveness. This study provided an opportunity to adapt a patient navigation model first developed for cancer care to assess its effectiveness with HIV-infected populations. Several HRSA grantees funded by HIV/AIDS Bureau's Outreach Initiative developed and successfully implemented navigation-like interventions. While the grantees did not coordinate the design and implementation of their interventions, they shared the following features:

  • Non-clinical staff act as client navigators / client coaches / client cheerleaders
  • Navigators work with clients to develop skills in provider interactions, including modeling through practice conversations
  • Navigators work with clients to address barriers to care, including physically bringing clients to appointments, when necessary
  • Navigators work behind the scenes to develop and maintain service linkages with other agencies
  • Navigators are trained in several frameworks, including the strengths-based perspective from social work practice, motivational interviewing, and stages of change
  • Patient navigation programs target populations that encounter multiple obstacles to receipt of HIV care, including complex personal and psychosocial factors, structural barriers and support service needs, and difficulty negotiating systems.

Bradford, Coleman, and Cunningham evaluated the effectiveness of these grantee programs in addressing barriers to HIV care and ultimately improving health outcomes. A conceptual framework described in the 1993 Institute of Medicine report Access to Health Care in America provided a valuable roadmap for guiding this study's analysis, including the selection of measures used in the study.

The results of the study included a reduction in barriers and improved health outcomes over the 12-month intervention periods. In this study, the structural barriers to HIV care and provider engagement were significantly associated with health outcomes. Based on the results of their study, Bradford, Coleman and Cunningham propose that an adapted navigation approach "HIV System Navigation" has potential for improving access to HIV care and merits further study. There is a critical need to develop more effective methods to engage and retain HIV-infected patients in HIV care. The study shows that patient navigation approaches may assist in filling gaps in the continuum of care. Recently released 
International Association of Physicians in AIDS Care (IAPAC)  Guidelines for Improving Entry Into and Retention in Care for Persons with HIV agreed with the authors of this study in that use of peer or paraprofessional patient navigators may be considered to positively impact patient retention in HIV care on a patient by patient basis, though not routinely (guideline 5). The IAPAC Guidelines note that there are critical limitations to the current literature in terms of quality of the evidence around patient navigation.

Connect. With patients.
Collaborate. With a community of learners.
Change. The course of HIV. 

incareCampaign.org  |  212-417-4730