A team-based approach to reducing HIV viral load in patients experiencing homelessness

This workshop will highlight the experiences and best practices of the Multnomah County HIV Clinic related to serving persons living with homelessness and HIV. The HIV Clinic is an accredited patient center medical home that serves over 1300 patients each year. These patients have other co-morbidities such as severe mental illness, diabetes, Hepatitis C, and hypertension. The clinic has a public health mandate to reduce the spread of HIV by suppressing the HIV viral load of our patients. Viral load suppression is also one of the clinic's quality indicators. Homeless and unstably housed clients are among the most difficult to engage in care and with whom to achieve medication adherence. Service issues are further compounded by the lack of affordable housing. This workshop will address team-based care, service integration, quality improvement, and client engagement strategies. The presentation will include case examples, data, and first-person stories (audio/video) of how a multidisciplinary team works with homeless patients to achieve HIV viral suppression. This workshop will also highlight the roles community social services, housing partners, and behavioral health staff play in enhancing a traditional medical home model to better serve persons experiencing homelessness. The lessons learned from serving an HIV population are transferrable to serving other tri-morbid groups experiencing homelessness. The presenters include a primary care provider/HIV specialty provider, a medical case manager, and a community health worker.