Cross-site Monitoring and Evaluation of the Care and Prevention in the United States Demonstration Project, 2012-2016: Selected Process and Short-term Outcomes

Abstract

Objective: The Care and Prevention in the United States (CAPUS) Demonstration Project was a 4-year (2012-2016) cross-agency demonstration project that aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states (Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, and Virginia). Its goals were to increase the identification of undiagnosed HIV infections and optimize the linkage to, reengagement with, and retention in care and prevention services for people with HIV (PWH). We present descriptive findings to answer selected cross-site process and short-term outcome monitoring and evaluation questions.

Methods: We answered a set of monitoring and evaluation questions by using data submitted by grantees. We used a descriptive qualitative method to identify key themes of activities implemented and summarized quantitative data to describe program outputs and outcomes.

Results: Of 155 343 total HIV tests conducted by all grantees, 558 (0.36%) tests identified people with newly diagnosed HIV infection. Of 4952 PWH who were presumptively not in care, 1811 (36.6%) were confirmed as not in care through Data to Care programs. Navigation and other linkage, retention, and reengagement programs reached 10 382 people and linked to or reengaged with care 5425 of 7017 (77.3%) PWH who were never in care or who had dropped out of care. Programs offered capacity-building trainings to providers to improve cultural competency, developed social marketing and social media campaigns to destigmatize HIV testing and care, and expanded access to support services, such as transitional housing and vocational training.

Conclusions: CAPUS grantees substantially expanded their capacity to deliver HIV-related services and reach racial/ethnic minority groups at risk for or living with HIV infection. Our findings demonstrate the feasibility of implementing novel and integrated programs that address social and structural barriers to HIV care and prevention.

Keywords: CAPUS; Care and Prevention in the United States; HIV prevention and care; demonstration project; project monitoring and evaluation; racial/ethnic minorities.

Figure.

Processes and outcomes of Data to Care programs to link to or reengage in care those people diagnosed with HIV who were presumed to not be in care at 7 Care and Prevention in the United States (CAPUS) Demonstration Project sites, 2012-2016. The 7 sites were Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, and Virginia. By the end of the project, Georgia had implemented a new policy to allow the use of surveillance data for program follow-up, improve the completeness of its surveillance data, and develop a system to generate the presumed not-in-care list. However, it did not fully implement the Data to Care process. Data to Care is a public health strategy that uses surveillance, care, prevention, and other data to identify people with HIV (PWH) who need HIV medical care or other services, to facilitate their linkage to those services, and to eventually improve viral suppression and other health outcomes. This figure presents the Data to Care process that typically begins with using HIV surveillance data to identify PWH who are presumed to be not in care. The not-in-care list is further cross-checked with other data systems (eg, care or prevention program data) to complete missing data and to verify care status. Health departments may also apply inclusion or exclusion criteria to determine a priority not-in-care list, which is subsequently shared with field staff members to locate PWH who are presumed to be not in care, confirm their care status, and provide them with linkage and reengagement services if they are confirmed as not in care. Information for some PWH presumed to be not in care was not forwarded for follow-up because of various reasons, including the person being deceased, out of jurisdiction, not in a CAPUS implementation area within the jurisdiction, or in care after checks in other data systems. PWH presumed to be not in care who received follow-up and were not contacted included primarily those who were deceased, out of jurisdiction, or incarcerated. Linkage to or reengagement with care included confirmed PWH who were previously not in care and had attended their first HIV medical appointment. Linkage or reengagement was also confirmed by documented viral load test or CD4 count. Data to Care program process and outcomes reflect data as of September 29, 2016, which was the final data reporting date for the project.