Table 2.
Selected evidence-based interventions, their effectiveness and previously-documented scale-up of delivery based on the RE-AIM framework
| Population Coverage† |
|||
|---|---|---|---|
| Effectiveness and target population¶ [Evidence Level*] | Previously-documented Implementation | Ideal Implementation** | |
| Protect: HIV prevention programs | |||
| Syringe service program (SSP) | Clean injection equipment reduces parenteral HIV transmission by 58% among PWID. [2a] | Additional scale-up of 11% | 90% |
| MOUD with buprenorphine | Office-based MOUD for PWID reduces the number of injections by 54%. [2a] | Additional scale-up of 14% | 90% |
| MOUD with methadone | OTP-based MOUD for PWID reduces the number of injections by 54%. [2a] | Additional scale-up of 12% | 90% |
| Targeted PrEP for high-risk MSM | PrEP reduces the risk of HIV infection by 60%⍑ among high-risk MSM and MWID.§ [1b] | Additional scale-up of 68% | 90% |
| Diagnose: HIV Testing | |||
| Opt-out testing in ER | Routine HIV testing increases by 28% among individuals visiting the ER. [1b] | 3%–6% | 10%–26% |
| Opt-out testing in primary care | Routine HIV testing increases by 28% during primary care visits. [1b] | 25%–40% | 53%–85% |
| EMR testing offer reminder | HIV testing increases by 178% among individuals visiting the ER. [2b] | 11%–29% | 10%–26% |
| Nurse-initiated rapid testing | HIV testing increases by 73% during health care visits.^ [2b] | 25%–40% | 53%–85% |
| MOUD integrated rapid testing | On-site HIV testing increases by 352% among PWID receiving MOUD. [1b] | 17% | 49% |
| Treat: ART engagement and re-engagement | |||
| Case management (ARTAS) | ART initiation increases by 41% among PLHIV linked to care. [1b] | 57% | 77% |
| Care coordination | ART retention increases by 10% among PLHIV. [2b] | 10%–20% | 34%–68% |
| Targeted care coordination | ART retention increases by 32% among PLHIV with CD4<200 cells per μL. [2b] | 30%–46% | 41%–63% |
| EMR ART engagement reminder | ART drop-out is reduced by 31% among PLHIV on ART. [1b] | 42%–78% | 54%–82% |
| RAPID ART initiation | Immediate ART initiation increases by 32% among newly diagnosed PLHIV. [3b] | 30%–61% | 41%–84% |
| Enhanced personal contact | ART re-initiation increases by 22% among PLHIV having dropped-out of ART. [1b] | 45% | 62% |
| Re-linkage program | ART re-initiation increases by 70% among PLHIV who are out-of-care. [2b] | 8% | 22% |
PWID: People who inject drugs; MOUD: Medication for opioid use disorder; OTP: Opioid treatment program; PrEP: Pre-exposure prophylaxis; MSM: Men who have sex with men; MWID: MSM PWID; ER: Hospital emergency room; EMR: Electronic medical records; PLHIV: People living with HIV; ART: antiretroviral therapy.
Interventions target the general adult population 15–64 unless noted otherwise.
Where applicable, scale ranges indicate evidence stratified by sex/gender and/or race/ethnicity and/or city/region.
Adapted from the Oxford Centre for Evidence-based Medicine – Levels of Evidence: 1a - Systematic review of RCTs; 1b - Individual high-quality RCT; 2a - Systematic review of cohort studies; 2b - Individual cohort study or quasi-experimental study; 3a - Systematic review of case-control studies; 3b - Individual case-control study; 4 - Case series; 5-Expert opinion.
Ideal implementation defined as 90% adoption.
Effectiveness: efficacy for 4 doses/week [96% (90%, 99%)]19 X protective level adherence [62.5% (≥4 doses/week)]20.
We assumed that 25% of MSM are high-risk and indicated for PrEP in accordance with CDC guidelines21.
With either a physician or health care professional.