Increase the percentage of newly diagnosed 24+ year-olds linked to HIV medical care within 1 month of their HIV diagnoses to at least 90%

Pillar: Treat
Goal: Achieve 90% linkage to care, 90% engagement in care, and 90% viral suppression among those newly diagnosed with HIV.
Strategy: Increase the percentage of newly diagnosed 24+ year-olds linked to HIV medical care within 1 month of their HIV diagnoses to at least 90%.
Target: Community-based organizations, Community health workers, ID providers in Ryan White and private providers, Individuals that certify for Ryan White eligibility, Shelby County Health Department, Linkage-to-care programs, Over 24 yrs., Diagnosed within last 30 days, Programs with linkage-to-care grant funding, Testing agencies

Key Activities:

High Priority and Disruptively Innovative

  1. Create a meeting for at least 1 representative for each Ryan White agency to attend with updates according to each funding source (Part A, Part D, Part B, etc.).
  2. Create a new staff position for a Rapid Start coordinator, housed under state/health department to oversee all care facilities.

High Priority

  1. Standardize LTC program using the YOUTH
    LTC model and make the patient’s program participation opt out to assist with retention in care to increase likelihood of viral suppression.
  2. An early intervention specialist follows the client until they are settled and comfortably medically compliant.

Key Partners

ASCC, Case managers with RW certification eligibility, CBOs, CHS, CCHS, CHWs/LTC Programs, FFL entities, SCHD, LCHN, MHC, Other testing agencies, OM, PEAS, Private providers, Privately
& publicly funded clinics who do not receive RW funding, Programs with LTC component as part of their grant funding, Rooming houses, RW providers, Spirit Medical, SSPs, Testing agencies, THD

Potential Funding Sources

  • EHE funds
  • Other private and public funding
  • RWHAP
  • Ryan White
  • Shelby County government

Estimated Funding Allocation

  • $32,000 x 6 FTE CHWs = $192,000
  • $25,000 for community wide CHW training (trainer, supplies, materials, incentives, venue, mileage, etc.)
  • $50,000 (.25 FTE) = $12,500, Sr. Linkage to Care Coordinator trainers/mentor
  • $4000/year, incentives for newly diagnosed youth (trinkets, giveaways, gas reimbursements, etc.)
  • $30000 for new providers
    Total: $263,500

Outcomes

(Reported annually, locally monitored more frequently)

  • LTC, # of newly identified
  • LTC, # of persons identified as not in care
  • # of attendees at train the trainer (sign-in)
  • # of agencies that hire CHWs and require yearly training

Monitoring Data Source

  • RWHAP
  • CDC testing linkage data
  • Consumer surveys
  • Ryan White audit