ALERT - Active Linkage, Engagement and Retention to Reduce HIV

PI: Richard Haubrich
University of California, San Diego

Epidemic Interventions Demonstration Research Project
Awarded: 2012

Background: Scientific evidence supports a new role of antiretroviral (ARV) medications in the prevention of HIV infection by suppressing viral load in HIV-infected people and reducing the risk of acquisition for exposed individuals. The use of ARVs to suppress HIV among a population of HIV-infected individuals can benefit both the health of the individual and the community. However, to achieve the greatest benefit, all HIV-infected individuals need to be engaged in medical care. Structural changes are needed in the current HIV care system to seamlessly transition individuals from the diagnosis of HIV to durable ARV treatment that sustains suppression of viral load.

Results from recent prevention studies give credence to the clinical paradigm of using ARVs not only as a treatment for the HIV-infected, but also for pre-exposure prophylaxis (PrEP) option for high-risk, HIV-negative individuals. Methods to implement PrEP have not been fully developed. Similar to treating those with HIV infection, the individuals who might benefit from PrEP will need to be identified and engaged in medical care; provision of comprehensive prevention services with ARV medication, monitoring for safety and reinforcement of medication adherence are all critical.

Study Design and Aims: Our demonstration project will be a collaboration of three HIV testing sites (San Diego HIV, STD, and Hepatitis Branch, The City of Long Beach Department of Health and Human Services and LAC-USC Emergency Department) with three CCTG primary care clinics (UCSD Owen Clinic, Harbor-UCLA Medical Center and LAC-USC Rand Schrader Clinic). We have the following Aims: 1) Aim 1 (Test and Link) will focus on linking individuals with a new HIV diagnoses and those at highest risk of acquiring HIV into medical care. The project will hire an Active Linkage, Engagement, and Retention (ALERT) specialist and measure the success of the specialist at linking individuals from the testing site to a healthcare provider. 2) Aim 2 (Engagement in Care for HIV-Infected) will study how effective the ALERT specialist is at retaining HIV-infected people in care compared to current Standard of Care (SOC). 3) Aim 3 (PrEP) will study how the ALERT specialist, using a texting adherence application, helps people maintain adherence to PrEP medication compared to comprehensive preventive care alone.

For Aim 1, we will utilize the ALERT worker to collaborate with the testing sites to assist people who tested for HIV (either positive or negative test results) to be linked to HIV care or PrEP as appropriate. A total of 300 HIV-infected individuals, new to or who fell out of HIV care, will be enrolled into the Engagement in Care Project, will receive either the usual clinical care or the ALERT intervention. The Intervention arm will include enhanced retention efforts by an ALERT specialist. HIV-uninfected people with continued high risk for HIV infection and who are willing to take PrEP will receive free medication given with comprehensive preventive care either alone or combined with the ALERT/ text-message intervention. Participants will be carefully followed for at least 12 months in AIMS 2 and 3. Participants of the studies in Aims 2 and 3 will also be offered the opportunity to refer their social contacts for HIV testing and counseling if they think their contacts might benefit from HIV testing.