METHODS: The intervention involves a multidisciplinary acuity assessment of adherence barriers. The patient partners with a team consisting of a peer navigator, social worker, case manager, nurse, and medical doctor. Working with the patient and team, the nurse uses a stepwise clinical framework. Interventions range from daily medication dispensing on the street or in a drop in center, to weekly mobile and clinic based nursing visits, up to monthly medication dispensing. A nurse visits consists of HIV primary care, adherence counseling, and general medical care (i.e. wound care).
Nursing visits, medical visits, and viral load are tracked through the city's electronic medical record system. Case management, social work visits, and peer navigator encounters are tracked through the Ryan White Database/HRSA research portal. These data are currently being collected. The multi-site study enrollment ends February 2016, at which point the final data analysis will be conducted using a correlation coefficient. This analysis will also investigate if there is a differential impact on viral load based on mobile outreach vs. drop-in vs. clinic visits covariates. In a separate analysis, housing, viral load suppression, and treatment adherence will be correlated with overall visits from the team.
EVALUATION PLANS/DISCUSSION: Final analysis will include all data from the 3 year intervention. Preliminary findings to date show that viral load suppression is correlated to team nursing care. Interventions that address multiple barriers to care--unstable housing, serious mental health issues, and substance use--enhance health outcomes, improve engagement, and retain clients in HIV care.