Improving Care and Treatment Coordination for Black Women with HIV in Atlanta Metro Area
6-month preliminary data
BACKGROUND
Grady Health System’s Ponce De Leon Center (Grady) provides care for approximately 6,000 clients of all ages, of whom 85% are Black, 27% are women, and 83% are at or below 200% of the federal poverty level.¹ Grady Ponce De Leon Center integrates primary internal, pediatric, and infectious disease care at their clinics in one location and houses partner organizations that provide legal services, housing support, and a food program.
Grady participated in an AIDS United-funded Enhanced Patient Navigation for Women of Color Dissemination of Evidence-Informed Intervention initiative from 2016 - 2019. In 2020, Grady responded to the Health and Resource Services Administration (HRSA) Notice of Funding opportunity for a 2020 Special Projects of National Significance (SPNS) grant for Improving Care and Treatment Coordination: Focusing on Black Women with HIV Demonstration Project.
CHALLENGE
In 2020, approximately 36% of Atlanta’s population was Black. However, 69% of people with HIV in Atlanta were Black. The Grady Ponce De Leon Center was serving approximately 1,319 Black women. For Black women aged 18-24 in the Center’s care, the retention in care rate at 12 months was 82%, dropping to 77% at 36 months. Similarly, the viral suppression rate fell from 64% at 12 months to 52% at 36 months. Many of the Grady clients face multiple barriers to accessing care, such as being unaware of their sexual partner’s HIV risks, prioritizing the needs of the family and community above their own, poverty, lack of transportation and/or housing, low health literacy, etc.
““Having an HIV diagnosis is tough but at least I can take a medication that will allow me to continue living a healthy life; with a cancer diagnosis you don’t know if the treatment is going to work.”
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SOLUTION
For the SPNS grant, Grady created the B.WOW (Black Women Organized for Wellness) program, an Enhanced Patient Navigation intervention bundling two evidence-based interventions simultaneously: Enhanced Patient Navigation (EPN) for Women of Color and PL Cares®. EPN provides participants with educational sessions, plus additional support (such as transportation, appointment scheduling referrals, etc.) and coaching from a Grady patient navigator. The six educational sessions cover topics such as HIV and the Viral Life Cycle, Communicating with Health Care Providers about Adherence and Managing Side Effects, Understanding basic lab tests, Stigma and Disclosure, HIV and Substance Use, and HIV and Mental Health. PL Cares® is a mobile platform including an app and an administrative portal that supports the development of self-efficacy and connection of participants with staff and each other.
B.WOW recruited Black women who had fallen out of care for more than six months, had missed two or more medical appointments in the prior six months, were loosely engaged in care, were not virally suppressed, and/or had multiple comorbidities. Participants who did not have their own phones were also given phones and data plans to provide the stability of a consistent phone number.
““B.WOW has given these women a reason to keep going. There is information shared that may save a life, stop a wrong decision, as well as give an honest opinion. These relationships provide a different perspective than what one would see within themselves. These women need this program. I fear if this program is not continued, we will lose connections and lose lives that could have been saved.”
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The Grady B.WOW team
OUTCOMES
Over a period of 12 months, the Grady team enrolled 101 Black women to the B.WOW program. In addition to monitoring lab results, follow-up interviews were held at 6 months and 12 months post-enrollment.
6-month results: (Note: All quoted data is preliminary)
Retention in care (2 visits at least 90 days apart post-enrollment or at least one visit with HIV PC): 91.6%
Viral suppression in any post-enrollment period (up to 6 months): 79%.
ART Prescribes post-enrollment period: 98%
The intervention is still collecting data for 12 months.
The Grady team incorporated the use of a Community Advisory Board comprised of ten participants, who call themselves the Dope Chicks. The Dope Chicks were recruited from the intervention to advise the team on various aspects of the program, such as ideas of topics to post on the community board, workshops they think the team should host, and overall ways to better the intervention and improve access to care for more Black women.
As the project was launched during the COVID pandemic, the PL Cares app provided a safe way for the women to stay engaged in their care and communicate with the Grady team. It allowed Grady to provide resources for women and reduce social determinants of health barriers to their care. The PL Cares® application helps to incorporate the second part of the bundled intervention (Self-efficacy) through the use of the app’s features, including the team’s favorite feature: Community Posts. The team uses the community board to engage the women and encourage peer support through motivational posts, discussion topics, quizzes, and providing expanded access to education sessions by sharing them through the Resource section in PL Cares.
PL Cares provides participants with peer support that includes sharing recipes, positive quotes to get each other through the day, and a space to vent when their day is going tough.
Participants have found a space where their HIV care and everyday life are prioritized. PL Cares offers a reminder to take their medications and connect with their peers.
References:
1. Grady Ponce De Leon Center CY 2019 Ryan White RSR Report
