Table 2.
Description of the implementation, reach, adoption, and scale of delivery of HIV prevention programs and HIV testing and care interventions.
| Intervention | Implementation | Reach* (Setting-specific) | Reach | Adoption (Setting-specific) | Adoption | Scale of Delivery** (95% CI) |
|---|---|---|---|---|---|---|
| HIV prevention programs | Expanded access | |||||
| Syringe service program (SSP) | Expanded access to clean injection equipment for the prevention of parenteral HIV transmission for people who inject drugs (PWID). | - - | - - | - - | - - | 11% (7%, 15%) |
| Medication for opioid use disorder (MOUD) with buprenorphine | Expanded access to office-based medication for opioid use disorder with buprenorphine for PWID. | - - | - - | - - | - - | 14% (10%, 17%) |
| Medication for opioid use disorder (MOUD) with methadone | Expanded access to opioid treatment program-based medication for opioid use disorder with methadone for PWID. | - - | - - | - - | - - | 12% (2%, 17%) |
| Targeted PrEP for high-risk MSM and MWID | Expanded access to pre-exposure prophylaxis (PrEP) targeted to high-risk men who have sex with men (MSM) and high-risk MSM who inject drugs (MWID)§. | - - | - - | - - | - - | 68% (55%, 80%) |
| HIV Testing | Reach X Adoption | |||||
| Opt-out HIV testing in ER | Individuals visiting an hospital emergency room (ER) receive a routine HIV test unless they decline. | % with ER visit L12M^^ | 11%−29% | % visits with testing | 19%−26% | 3%−6%⍑ (2%, 7%) |
| Opt-out HIV testing in primary care | Individuals visiting a primary care provider receive a routine HIV test unless they decline. | % seeing Dr. L12M^ | 59%−94% | % visits with testing | 32%−54% | 25%−40%⍑ (19%, 51%) |
| EMR testing offer reminder | Individuals visiting an hospital emergency room with a certified EMR are routinely offered an HIV test. | % with ER visit L12M^^ | 11%−29% | % with certified EMR | 97%−100% | 11%−29%⍑ (9%, 36%) |
| Nurse-initiated rapid testing | Individuals visiting a physician or health care professional are routinely offered an HIV test. | % seeing Dr. L12M^ | 10%−16% | % visits with testing | 32%−54% | 4%−7%⍑ (3%, 9%) |
| MOUD integrated rapid testing | PWID receiving medication for opioid use disorder are offered on-site rapid HIV testing from their prescriber. | % accepting intervention | 54% | % prescribers implementing | 14%−40% | 17% (8%, 22%) |
| ART engagement | ||||||
| Individual case management for ART initiation | HIV clinics offer the intervention to ART-naive people living with HIV (PLHIV) to increase the probability of ART initiation. | % accepting intervention | 86% | % clinics implementing | 60%−71% | 57% (52%, 62%) |
| Individual care coordination for ART retention | HIV clinics offer the intervention to eligible PLHIV currently receiving ART to reduce the probability of ART drop-out. | % PLHIV eligible for RWHAP | 38%−75% | % RWHAP clinics offering intervention | 20%−33% | 10%−20%⍑ (8%, 25%) |
| Individual care coordination for ART retention, targeted | HIV clinics offer the intervention to PLHIV with CD4<200 cells per^L currently receiving ART to reduce the probability of ART drop-out. | % initiating ART with CD4<200⍑ | 46%−70% | % clinics implementing | 60%−71% | 30%−46%⍑ (27%, 50%) |
| EMR alert of suboptimal ART engagement | PLHIV receiving ART are reminded of care engagement information to reduce the probability of ART drop-out when visiting their physician. | % receiving HIV care L12M | 60%−91% | % with certified EMR† | 69%−86% | 42%−78%⍑ (29%, 84%) |
| RAPID ART initiation | HIV clinics offer the intervention for same-day ART initiation to newly diagnosed individuals to increase the probability of immediate ART initiation. | % PLHIV linked to care | 46%−93% | % clinics implementing | 60%−71% | 30%−61%⍑ (27%, 66%) |
| ART re-engagement | ||||||
| Enhanced personal contact | HIV clinics offer the intervention to individuals who have imperfect ART engagement to increase the probability of ART re-initiation. | % successfully enrolled | 69% | % clinics implementing | 60%−71% | 45% (41%, 49%) |
| Re-linkage program | HIV clinics implement the program and successfully contact a proportion who have dropped-out of ART to increase the probability of ART re-initiation. | % successfully contacted | 24% | % RWHAP funded clinics | 29%−40% | 8% (7%, 10%) |
*
ART: antiretroviral therapy; EMR: Electronic medical records; MOUD: Medication for opioid use disorder. Reach also includes proportion of patients accepting, when applicable.
**
Scale of delivery is defined as Reach X Adoption, with the exception of HIV prevention programs where it is defined as the annual rate of expanded access.
^
Any visits to a medical doctor or health professional stratified by gender, race/ethnicity, and region.
^^
Any visit to a hospital emergency room stratified by gender, race/ethnicity, and region.
†
State-specific.
⍑
Stratified by gender, race/ethnicity, and region.
§
We assume that 25% of MSM are indicated for PrEP in accordance with CDC guidelines.