Leveraging Ancillary Service Staff to Support HIV Care and Treatment Adherence


Sarah Braunstein, PhD, MPH

Susie Hoffman, DrPH

Graham Harriman, MA

Mary Irvine, DrPH, MPH

Funding Agency:

National Institute of Mental Health (NIMH)

Collaborating Institution: 

The New York City Department of Health and Mental Hygiene

Study Location:

New York City, NY


Description: The goal of this study is to develop feasible and acceptable interventions that leverage ancillary service providers to promote HIV care and treatment adherence among PLWH who only access Ryan White Part A (RWPA) ancillary services (food and nutrition, legal, housing, harm reduction) that are designed to meet basic needs, but do not receive RWPA services that offer HIV care and treatment adherence support, including e.g., medical case management (MCM), mental health services, and supportive counseling. Guided by the Behavioral Model of Health Services Use, we will use a concurrent mixed methods design that analyzes existing large datasets and new qualitative data on (a) clients [the NYC HIV Surveillance Registry (viral loads), the Electronic System For HIV/AIDS Reporting and Evaluation (RWPA client data), the Salient Information Miner (Medicaid enrollment and services information), and qualitative interviews]; (b) providers (qualitative interviews); and (c) agencies (RWPA program administrator questionnaires). The specific aims are:

 Aim 1: To better characterize PLWH who only receive RWPA ancillary services overall and those with unsuppressed viral load, we will analyze ancillary service utilization and viral load suppression (VLS), specifically by: (a) identifying groups with similar ancillary service utilization patterns; (b) identifying client and health care environment characteristics (e.g., agency and provider factors) associated with ancillary service utilization patterns; and (c) examining how VLS is associated with client and health care environment characteristics and ancillary service utilization patterns.

 Aim 2: To identify, through qualitative interviews with clients and ancillary service providers and questionnaires with RWPA program administrators: (a) client-perceived barriers to and facilitators of HIV care and treatment adherence and participation in MCM, and attitudes towards receiving HIV care support from ancillary service providers; (b) ancillary service providers’ awareness of virally unsuppressed clients, current efforts to support their HIV care and treatment adherence, and willingness to participate in efforts to address these behaviors; and (c) health care environment characteristics that would facilitate or inhibit the implementation of HIV care and treatment adherence support interventions delivered by ancillary service providers.