• NQF 2079: HIV medical visit frequency
• NQF 2080: Gap in HIV medical visits
• NQF 2082: HIV viral load suppression
• NQF 2083: Prescription of HIV antiretroviral therapy

Three of these measures were based on in+care Campaign measure (Gap Measure, Visit Frequency Measure, and Viral Suppression Measure). HRSA aims to get these 4 NQF endorsed measures included into Centers for Medicare and Medicaid Services programs including Meaningful Use and Physician Quality Reporting system (PQRS). When these measures are integrated, it will mean in+care Campaign participating agencies will have experience in collecting, extracting, synthesizing, and reporting these data.

Some agencies see fewer than 50 patients, but many agencies see far more patients, even thousands! How do agencies that have so many patients identify those who are in need of personalized retention plans?

Your data systems can come to your rescue. For example, you can take the patients who have a gap in care based on your Campaign Performance Data Gap Measure (Measure 1) and compare them with the patients that did not have a gap in care. You can produce a table that describes each group (gap and no gap) demographically, clinically, and perhaps in terms of service utilization. Once you have the comparison table created, you can add measures of significance to determine how important the variations between the two groups are for each demographic, clinical or utilization comparison. For example, do people of certain gender, age, race, or payor source tend to experience gaps disproportionately from others? Do people with certain diagnoses (i.e., depression, substance use of different varieties, or with multiple chronic illnesses) experience gaps in care disproportionately from others? Do people who receive certain services tend to have fewer gaps in care than others?

By gaining an understanding of who experiences gaps or inconsistency in care you will be better able to hypothesize why this is. Building from there, you will be better suited to design efficient interventions that target these groups that are more likely to experience gaps in care than others.

• Provides confidential assistance to assess your individual situation, short-term and long-term needs
• Provides answers to your questions with accurate information
• Assists you in obtaining medical care and other services which will help you effectively manage HIV disease

One of the hallmarks of this program is in the way it approaches each client separately to address his/her own barriers. Before a patient is considered formally linked to care, he or she must have completed the following steps:

• Contact the Early Intervention Services Program
• Schedule an Appointment
• Enter Medical Care (patient attends the scheduled visit)
• Complete Mental Health / Substance Use Screening
• Receive Health Education and Risk Reduction Information
• Receive Nutritional Assessment
• Transfer to Primary Medical Case Management

If your agency has a similar process or checklist in use to consider people linked to care, please share it with Michael Hager at Michael@NationalQualityCenter.org.

How can we increase initiation of and retention in care among persons living with HIV?-Perspectives from patients and professionals.
Vyavaharkar, M., Richter, D., Annang, L., Williams, L., Glover, S.

A research team at the University of South Carolina is conducting a qualitative study, funded by NIH/ National Center on Minority Health and Health Disparities, that is designed to gain a better understanding of factors that may facilitate or impede initiation and continuation of HIV care in a rural county with a predominantly minority population in South Carolina. 

The data were collected between 2011 and 2012 through focus group discussions with persons living with HIV (PLWH) and personal interviews with health care professionals assisting or delivering care to PLWH.  Three focus groups were conducted with an average of six participants who were in regular care (having at least two visits to their HIV care provider in the previous 12 months) and eight personal interviews were conducted with health care professionals from a local Federally Qualified Health Center (FQHC) that provided HIV care. The research team contacted a broad range of health care professions that included not only physicians and nurses who provided actual care, but also case managers and other FQHC staff that assisted clients in navigating the medical care system or coordinating care. Dr. Vyavaharkar and her team are currently in the process of reaching out to those individuals living with HIV who have not visited their providers for HIV care in more than six months in order to get their perspectives.

Focus group and interview transcripts were analyzed using the qualitative software NVivo 9. Several themes emerged during the process.   

• Themes from Persons Living with HIV/AIDS:
• Need for survival
• Self-determination
• Stigma and discrimination
• Fear of disclosure
• Patient-provider interactions
• Organizational culture/environment
• Themes from Providers:
• Similar themes as noted by PLWHA including needs for survival, stigma, and fear of disclosure
• Importance of a professional, trusting, and respectful care environment to facilitate access to care
• Overarching organizational characteristics and culture played a critical role in retaining PLWHA in care including:
• Availability of an infectious disease doctor
• "Caring" health care providers
• Transparency in provider actions and communications
• Dedicated and efficient case managers who often went beyond duty to assist clients
• Supportive and accessible management
• Assistance with ancillary services
• Welcoming and comforting environment without stigma or discrimination
• Ability to request a different case manager
• Presence of a peer on the staff

These findings will help individuals and organizations that offer services to PLWHA to reflect upon their interactions with clients and formulate strategies to improve the care retention rates.