Connection between social determinants and viral suppression
Abstract Format : For people living with HIV/AIDS in the United States, lack of stable or sufficient housing is a significant barrier to HIV medical care, including access to ART and the resulting clinical outcomes of lowered viral load and decreased transmission rates (Aidala, 2016). Recognizing this interconnection, HIV medical and housing service providers in Portland, OR have created a shared data platform called CAREWare, in an attempt to better coordinate services.
Methods : The shared CAREWare platform is utilized by Ryan White Providers across the Portland Transitional Grant Area (TGA). Cascade AIDS Project (CAP), a member of the Portland TGA that provides housing services, undertook a data integration project in 2015 to optimize and evaluate the use of CAREWare. With the assistance of RAND Research Corporation, CAP launched a pre-project survey to better design how housing and medical data were shared. Changes made included a shared data tab of housing information searchable to medical providers, as well as the incorporation of viral load data into the acuity scales of clients housed by CAP. Additional survey results from Medical Case Managers mid-project assisted in directing system optimization. Finally, audit data from CAREWare provided CAP with quantitative measures on frequency of platform use over time.
Results : Study results recognize the variable length of time it may take providers to adapt to both technological and service level changes. It proved important to recognize the need for providers to feel included in data sharing decisions, as well as the changes in service provision that result from data sharing; this ensured buy in from key players in the system. Additionally, providing insight into how data could be used to simplify work is essential. Survey results before data integration showed that nearly half of Medical Case Managers never or rarely used CAREWare for housing information, and that educating providers on how to integrate this information into their services resulted in increased use of the system.
Conclusions : As the project comes to a close, CAP will be collecting more survey responses from providers, as well as using focus group results to continue to design data sharing and collaboration in a targeted manner.