Table 1.

Results from Qualitative Interviews

Emergent theme	Impact on patient care
Clinic factors
Patient intake	First point of contact is with Medical Social Worker.
	Barriers to care addressed on first point of contact to improve patient access.
	Patient centeredness and harm reduction inform first point of contact.
Patient transition and retention	Empanelment—patients assigned to specific clinical provider teams so that they see the same providers each time.
	Providers prioritize team-based care and within-team communication via early morning huddles and electronic messaging.
Medication adherence strategies	Individualized adherence plans are developed in collaboration with each patient.
	Creative adherence strategies are used.
System factors
Ancillary services	On-site case management, mental health therapy, and pharmacy services improve patient access to care.
Billing/340B covered entity	Funds derived from 340B provide expanded set of services to patients, as these provide a financial buffer for non-billable no-shows and missed appointments.
	340B funds also enable the provision of material supports to resolve practice barriers to care.
Provider factors
Philosophical approaches: harm reduction and valuing the patient	Providers strive to help patients move to the next lowest acceptable level of risk.
	“Universal harm reduction” messages are shared with all patients regardless of patient disclosure of harmful health behaviors.
	Patients are valued as “whole people” with a range of experiences that impact health behaviors.
	Patients are not judged based on harmful health behaviors.
Individualized care	Care is structured based on each patient's strengths and needs.
Health literacy	Efforts to improve patients' levels of health literacy begin at intake and are carried through all clinic interactions.
	Health literacy emphasizes knowledge of medications, how they work, and the meaning of viral load as well as how it is affected by medication adherence or non-adherence.
	A goal of health literacy is to involve patients in treatment decision making.