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Review
. 2023 Jul 26;77(2):252-257.
doi: 10.1093/cid/ciad202.

Implementation of Low-Barrier Human Immunodeficiency Virus Care: Lessons Learned From the Max Clinic in Seattle

Julia C Dombrowski  1   2   3 , Meena S Ramchandani  1   2   3 , Matthew R Golden  1   2   3   4
Affiliations
Review

Implementation of Low-Barrier Human Immunodeficiency Virus Care: Lessons Learned From the Max Clinic in Seattle

Julia C Dombrowski et al. Clin Infect Dis. .

Abstract

Low-barrier care (LBC) for people with human immunodeficiency virus (HIV) is a differentiated service delivery strategy to engage people in HIV treatment who are not well-engaged in conventionally organized HIV medical care. The LBC approach is flexible, but experience suggests that the intervention has distinct core components. This review summarizes our experience implementing one model of LBC, the Max Clinic in Seattle; describes the core components of the intervention; and presents a framework for implementing low-barrier HIV care with the goal of providing a practical guide for clinical and public health leaders seeking to implement a new LBC program. A systematic approach to addressing key factors during LBC implementation can support practitioners to design an LBC approach that fits the local context while maintaining essential elements of the intervention.

Keywords: HIV; complex care; delivery of healthcare; differentiated service delivery; low-barrier care.

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Conflict of interest statement

Potential conflicts of interest. J. C. D. has conducted research with supplies donated by Hologic, Cepheid, and Mayne Pharmaceuticals; reports consulting fees from the National Alliance of State and Territorial AIDS Directors (NASTAD), Northwest University, Fenway Community Health Center, and Simon Fraser University (paid to author); has received honoraria for speaking engagements from the Oregon AIDS Education and Training Center, the University of California, San Diego, and the Planned Parenthood Federation of America; and reports board membership at the American Sexually Transmitted Disease Association and the National Medical Committee of Planned Parenthood Federation of America. M. R. G. has conducted research with supplies from Hologic and Speedx; has received grants or contract from the NIH, Centers for Disease Control and Prevention (CDC), and Gate Ventures (paid to institution); and received consulting fees from NASTAD (paid to author). M. S. R. reports grants or contracts from Nabriva and CDC; payment or honoraria from McGraw-Hill; travel support from IDWeek; and previous stock ownership in Gilead and Merck. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Framework for low-barrier care implementation.
See this image and copyright information in PMC

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