Increase the percentage of persons with diagnosed HIV infection who are virally suppressed 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 persons with diagnosed HIV infection who are virally suppressed to at least 90%.
Target: African American MSMs (15-20 years old), African Americans, All county residents, Consumers, Hispanic communities, HIV positive, PWH, Transpersons

Key Activities:

High Priority and Disruptively Innovative

  1. Create “Fast Track” Viral Load (VL) blood draw program.
  2. PWH will come to their appointments 1-2 days before their adherence appointment. On the day of their appointment, they will receive the results for their viral load. Patients who come to their first appointment will receive a gift card for participation and viral suppression. A running log will be created to show their viral load status and will be used as a motivation log.
  3. Implement peer coordinators to oversee all providers for peer support for RW or privately insured.
  4. Engage Part B at state level for Shelby County, ensuring that Part B at the state level mirrors Part B at the county level.
  5. Incorporate mental health at diagnosis or in linkage-to-care process. (Partner to offset costs.)
  • Provide mental health care to patients at their locations so that they do not have to travel.
  • Use mental health care to address medication noncompliance.
  • Use mental health care to address concerns of transpersons.

6. Promote benefits to taking medication. (Target: patients, medical case
managers, and supportive professionals)
7. Have conversations (training) w/providers to engage them to refrain from making medication a “carrot.”
8. Begin Rapid ART in all areas

9. Virtually implement directly observed therapy (DOT).
10. Create relationships with pharmaceutical companies and provider agencies to obtain antiretroviral (ARV) samples for same-day start.
11. For Transpersons,

  • Host social media LIVE (Facebook, etc.) sessions.
  • Distribute pamphlets.
  • Promote on news stations by buying ads.
  • Promote neutral places to obtain care (e.g., place information on mailboxes and in corner stores/gas stations).
  • Add a category for “Preferred Name” to paperwork in doctors’ offices and hospitals. Some individuals feel uncomfortable having to use their “dead name” when filling out paperwork, especially if their gender marker does not match their appearance.
    20. Provide supports to increase the self-care potential of transpersons. o Financial literacy education
  • o Assistance enrolling in college or trade school
  • o Emergency assistance (e.g., for emergency housing)

12. Increase the number of provider locations that offer services, including private providers.
13. Make sure providers have access to co-pay cards for those who have commercial insurance.
14. Offer flexible clinic hours.
15. Improve providers’ working environments to affect work morale, thus increasing client engagement, rapport, trust, and communication.
16. Develop relationship w/ providers for opt-out.
17. Text message reminders for appointments
18. Meet with medical case managers to determine barriers (e.g., lack of transportation and insurance).
19. Reduce fears of discrimination or lack of professional care for transpersons (e.g., add “Preferred Name to medical paperwork).

Key Partners

  • A Betor Way
  • AHC, CAAPS, Inc.
  • Caremore
  • Casa Luz
  • Cherokee Health
  • CCHS
  • FFL
  • HH
  • Latino Memphis
  • LeBonheur Comm. Outreach
  • MHC
  • Memphis Teen Vision
  • Memphis Area Prevention Coalition
  • colleges/universities
  • OM
  • PEAS
  • Pharmaceutical Representatives
  • Pharmacies (Walgreens, Kroger, AVITA, etc.)
  • Private practitioners
  • Rapid Start/HRSA
  • RW providers and/or HIV providers (medical facilities and community-based organizations)
  • Ryan White- funded agencies
  • Shelby County government
  • SCHD.
  • Shelby County Schools
  • SR
  • Spirit Health
  • TDH
  • University of Memphis

Potential Funding Sources

  • AIDS United, CDC (HIV Prevention)
  • Elton John
  • HRSA
  • Janssen
  • Merck
  • Red Door Foundation
  • Ryan White (A. B, C & D)
  • TheraTech
  • ViiV

Estimated Funding Allocation

  • LTC staff/EIS specialist/ engage with practitioner – $50,000
  • Mental health provider – $75,000 (new position)
  • Transportation Services -$5000
  • Training staff – $5000 Total: $135,000
    Total: $135,000


(Reported annually, locally monitored more frequently)

  • # of PWH Virally Suppressed • # of patients utilizing mobile
    mental health services
  • # of PWH adherent to HIV medications

Monitoring Data Source

  • From other data sources
  • Continuum of Care data
  • Medical reports from physicians
  • # of new patients that reach 90-90-90