Study: NCT05887557

Intervention type: OTHER
Group type: OTHER
Intervention: Drop-In Multidisciplinary HIV Care
Description: Each site will independently implement a drop-in multidisciplinary site-based HIV care model. Core intervention features include drop-in care (no appointments), panel management to review clinical progress for all referred patients, and case management. Each site may include adaptations to the care model determined during Aim 1 formative work.

Intervention type: OTHER
Group type: OTHER
Intervention: Mobile HIV Care
Description: Each site will independently implement a mobile care model using site-specific resources. At a minimum, the mobile care team will include a clinical nurse with telemedicine (video visit) consultation with a clinician (MD/NP/PA). Mobile teams will also administer medications (including long-acting ART when available) and collect laboratory specimens (e.g. HIV viral loads)

Intervention type: OTHER
Group type: OTHER
Intervention: Staged Care
Description: Clinical decision rules to escalate/de-escalate care intensity will be finalized developed during Aim 1 formative work, though will be based on a combination of clinical assessment and patient preference.

Intervention type: OTHER
Group type: OTHER
Intervention: Identify and prepare champions at referral sites
Description: Identify implementation champions at each referral site. Champions will receive marketing materials to promote uptake of clinical referrals to a drop-in/mobile care site by referral site providers/staff. This strategy is aimed at improving referring provider confidence in the value of referral to the care model, reduce perceived referral complexity/improve provider capability to refer, and provide positive peer pressure to promote referrals.

Intervention type: OTHER
Group type: OTHER
Intervention: Audit and feedback at referral sites
Description: Investigators will provide monthly reports to implementation champions at each referral site on aggregate number of referrals and the success of referrals (proportion linking to care). This strategy is aimed at improving perceived value of the intervention and increasing provider motivation to refer.

Intervention type: OTHER
Group type: OTHER
Intervention: Build a coalition among referral and clinical sites
Description: Investigators will facilitate formation of a coalition of referral and clinic sites to improve cross-site collaboration and promote positive peer pressure to improve intra-site communication and increase referrals.

Intervention type: OTHER
Group type: OTHER
Intervention: Assess for readiness and identify barriers
Description: Investigators will conduct patient in-depth interviews and clinical team focus group discussions to assess barriers to implementation of the clinical intervention. Findings from interviews and focus group discussions will inform site-specific implementation plans and adaptation of the intervention.

Intervention type: OTHER
Group type: OTHER
Intervention: Promote adaptability
Description: During a co-design workshop among drop-in/mobile care site teams and site-specific meetings, the study team will collectively finalize core clinical intervention components and outline site-specific adaptations (i.e. adaptable periphery of clinical intervention).

Intervention type: OTHER
Group type: OTHER
Intervention: Develop a formal implementation blueprint
Description: With each drop-in/mobile care team, develop site-specific implementation plan that includes defining care team and leadership structure, clinic workflow, implementation timeline, and progress measures. This process, and the resulting blueprint, will incorporate site-specific barriers and facilitators to implementation.

Intervention type: OTHER
Group type: OTHER
Intervention: Develop educational materials; conduct ongoing training
Description: Compile a manual that includes detailed description of core intervention features, planned local adaptations, and implementation guidance. We will conduct site-specific meetings to provide training on this manual. We will also conduct regular (at least monthly) meetings between the study team and the clinic site to provide technical assistance and coaching.

Intervention type: OTHER
Group type: OTHER
Intervention: Create a learning collaborative
Description: Create a cross-site learning collaborative with periodic meetings and workshops throughout the study period to facilitate cross-site communication, sharing of best practices and encourage positive peer pressure to support implementation.