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. 2018 Apr;32(4):149-156.
doi: 10.1089/apc.2017.0313.

The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington

Julia C Dombrowski  1   2   3 , Meena Ramchandani  1   3 , Shireesha Dhanireddy  1 , Robert D Harrington  1 , Allison Moore  3 , Matthew R Golden  1   2   3
Affiliations

The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington

Julia C Dombrowski et al. AIDS Patient Care STDS. 2018 Apr.

Abstract

The Max Clinic in Seattle, Washington is designed to engage patients who have extensive barriers to HIV care. In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that includes walk-in access to primary care in a Sexually Transmitted Disease Clinic. Patients who have failed to engage in care and achieve viral suppression with lower intensity support are referred by clinicians, case managers, and the health department Data to Care program. The clinic offers food vouchers, cash incentives, no-cost bus passes, and cell phones, as well as intensive case management with cross-agency coordinated care. The primary evaluation outcome was the percentage of patients who achieved viral suppression (HIV RNA <200 copies/mL) at least once after enrollment. Secondary outcomes were continuous viral suppression (≥2 suppressed results in a row ≥60 days apart) and engagement in care (≥2 completed medical visits ≥60 days apart). During January 2015-December 2016, 263 patients were referred; 170 (65%) were eligible, and 95 (56% of eligible) were enrolled. Most patients used illicit drugs or hazardous levels of alcohol (86%) and had diagnosed psychiatric illness (72%) and unstable housing (65%). During the year after enrollment, 90 (95%) patients engaged in care. As of the end of 2016, 76 (80%) had achieved viral suppression, and 54% had continuous viral suppression. The Max Clinic successfully treated HIV in high-need patients and, to date, has been sustainable through a combination of federal, state, and local funding.

Keywords: HIV care continuum; Public Health Department; care delivery; high-need patients; retention in care; substance use.

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Conflict of interest statement

J.C.D. has conducted research unrelated to this work supported by grants to the U.W. from the following companies: Hologic, Genentech, Curatek Pharmaceuticals, ELITech and the Quidel Corporation. J.C.D. received an honorarium for speaking at a continuing medical education event on retention in HIV care sponsored by Gilead and attended a meeting on retention in HIV care sponsored by Gilead. All other authors have no competing financial interests exist.

Figures

<b>FIG. 1.</b>
FIG. 1.
Flowchart of Max Clinic referrals, January 2015–December 2016.
<b>FIG. 2.</b>
FIG. 2.
Timing of viral suppression after Max Clinic enrollment among patients enrolled January 2015–December 2016 (N = 95).
<b>FIG. 3.</b>
FIG. 3.
Care engagement and viral suppression outcomes as of January 31, 2016 among patients enrolled January 2015–December 2016 (N = 95).
See this image and copyright information in PMC

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