The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington
The Max Clinic in Seattle, Washington is designed to engage patients who have extensive barriers to HIV care. In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that i...
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| Veröffentlicht in: | AIDS patient care and STDs 2018-04, Vol.32 (4), p.149-156 |
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| creator | Dombrowski, Julia C Ramchandani, Meena Dhanireddy, Shireesha Harrington, Robert D Moore, Allison Golden, Matthew R |
| description | The Max Clinic in Seattle, Washington is designed to engage patients who have extensive barriers to HIV care. In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that includes walk-in access to primary care in a Sexually Transmitted Disease Clinic. Patients who have failed to engage in care and achieve viral suppression with lower intensity support are referred by clinicians, case managers, and the health department Data to Care program. The clinic offers food vouchers, cash incentives, no-cost bus passes, and cell phones, as well as intensive case management with cross-agency coordinated care. The primary evaluation outcome was the percentage of patients who achieved viral suppression (HIV RNA |
| doi_str_mv | 10.1089/apc.2017.0313 |
| format | Article |
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In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that includes walk-in access to primary care in a Sexually Transmitted Disease Clinic. Patients who have failed to engage in care and achieve viral suppression with lower intensity support are referred by clinicians, case managers, and the health department Data to Care program. The clinic offers food vouchers, cash incentives, no-cost bus passes, and cell phones, as well as intensive case management with cross-agency coordinated care. The primary evaluation outcome was the percentage of patients who achieved viral suppression (HIV RNA <200 copies/mL) at least once after enrollment. Secondary outcomes were continuous viral suppression (≥2 suppressed results in a row ≥60 days apart) and engagement in care (≥2 completed medical visits ≥60 days apart). During January 2015-December 2016, 263 patients were referred; 170 (65%) were eligible, and 95 (56% of eligible) were enrolled. Most patients used illicit drugs or hazardous levels of alcohol (86%) and had diagnosed psychiatric illness (72%) and unstable housing (65%). During the year after enrollment, 90 (95%) patients engaged in care. As of the end of 2016, 76 (80%) had achieved viral suppression, and 54% had continuous viral suppression. The Max Clinic successfully treated HIV in high-need patients and, to date, has been sustainable through a combination of federal, state, and local funding.</description><identifier>ISSN: 1087-2914</identifier><identifier>EISSN: 1557-7449</identifier><identifier>DOI: 10.1089/apc.2017.0313</identifier><identifier>PMID: 29630852</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>AIDS/HIV ; Alcohols ; Cellular telephones ; Clinical and Epidemiologic Research ; Clinics ; Health care ; Health care access ; Health services ; HIV ; Housing ; Human immunodeficiency virus ; Incentives ; Patients ; Quality of care ; Ribonucleic acid ; RNA ; Sexually transmitted diseases ; STD ; Vouchers</subject><ispartof>AIDS patient care and STDs, 2018-04, Vol.32 (4), p.149-156</ispartof><rights>Copyright Mary Ann Liebert, Inc. Apr 2018</rights><rights>Copyright 2018, Mary Ann Liebert, Inc. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-fe7e43a45d1abae7cf72b6eaaea7c4312ef60236969cf1096a91fec25f442b333</citedby><cites>FETCH-LOGICAL-c415t-fe7e43a45d1abae7cf72b6eaaea7c4312ef60236969cf1096a91fec25f442b333</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29630852$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dombrowski, Julia C</creatorcontrib><creatorcontrib>Ramchandani, Meena</creatorcontrib><creatorcontrib>Dhanireddy, Shireesha</creatorcontrib><creatorcontrib>Harrington, Robert D</creatorcontrib><creatorcontrib>Moore, Allison</creatorcontrib><creatorcontrib>Golden, Matthew R</creatorcontrib><title>The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington</title><title>AIDS patient care and STDs</title><addtitle>AIDS Patient Care STDS</addtitle><description>The Max Clinic in Seattle, Washington is designed to engage patients who have extensive barriers to HIV care. In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that includes walk-in access to primary care in a Sexually Transmitted Disease Clinic. Patients who have failed to engage in care and achieve viral suppression with lower intensity support are referred by clinicians, case managers, and the health department Data to Care program. The clinic offers food vouchers, cash incentives, no-cost bus passes, and cell phones, as well as intensive case management with cross-agency coordinated care. The primary evaluation outcome was the percentage of patients who achieved viral suppression (HIV RNA <200 copies/mL) at least once after enrollment. Secondary outcomes were continuous viral suppression (≥2 suppressed results in a row ≥60 days apart) and engagement in care (≥2 completed medical visits ≥60 days apart). During January 2015-December 2016, 263 patients were referred; 170 (65%) were eligible, and 95 (56% of eligible) were enrolled. Most patients used illicit drugs or hazardous levels of alcohol (86%) and had diagnosed psychiatric illness (72%) and unstable housing (65%). During the year after enrollment, 90 (95%) patients engaged in care. As of the end of 2016, 76 (80%) had achieved viral suppression, and 54% had continuous viral suppression. The Max Clinic successfully treated HIV in high-need patients and, to date, has been sustainable through a combination of federal, state, and local funding.</description><subject>AIDS/HIV</subject><subject>Alcohols</subject><subject>Cellular telephones</subject><subject>Clinical and Epidemiologic Research</subject><subject>Clinics</subject><subject>Health care</subject><subject>Health care access</subject><subject>Health services</subject><subject>HIV</subject><subject>Housing</subject><subject>Human immunodeficiency virus</subject><subject>Incentives</subject><subject>Patients</subject><subject>Quality of care</subject><subject>Ribonucleic acid</subject><subject>RNA</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>Vouchers</subject><issn>1087-2914</issn><issn>1557-7449</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNpdkctv1DAQhyMEog84ckWWuHAgi595cEBCobAVW4GgwNGadSaJq6y9xE5Lz_zjOGqpgJNtzaefZ-bLsieMrhit6pewNytOWbmigol72SFTqsxLKev76U6rMuc1kwfZUQgXlNKKK_owO-B1IWil-GH263xAcgY_STNaZ80rcoatNTCSBiYkbzHY3mFLoicnroceSUz8GqYWQ8yjzz8jmIF8wil4F8jGXlrXkysbB7I-_UasI18QYhyRgGvJh6XY-NnF6xfkO4QhvaN3j7IHHYwBH9-ex9nXdyfnzTrffHx_2rzZ5EYyFfMOS5QCpGoZbAFL05V8WyAAQmmkYBy7gnJR1EVtOkbrAmrWoeGqk5JvhRDH2eub3P283WFr0MUJRr2f7A6ma-3B6n8rzg6695da1VRVqkoBz28DJv9jThvQOxsMjiM49HPQPH1fCiUlS-iz_9ALP08ujaf5okVUsqKJym8oM_kQJuzummFUL3p10qsXvXrRm_inf09wR__xKX4DZc-hFw</recordid><startdate>201804</startdate><enddate>201804</enddate><creator>Dombrowski, Julia C</creator><creator>Ramchandani, Meena</creator><creator>Dhanireddy, Shireesha</creator><creator>Harrington, Robert D</creator><creator>Moore, Allison</creator><creator>Golden, Matthew R</creator><general>Mary Ann Liebert, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T5</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201804</creationdate><title>The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington</title><author>Dombrowski, Julia C ; Ramchandani, Meena ; Dhanireddy, Shireesha ; Harrington, Robert D ; Moore, Allison ; Golden, Matthew R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-fe7e43a45d1abae7cf72b6eaaea7c4312ef60236969cf1096a91fec25f442b333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>AIDS/HIV</topic><topic>Alcohols</topic><topic>Cellular telephones</topic><topic>Clinical and Epidemiologic Research</topic><topic>Clinics</topic><topic>Health care</topic><topic>Health care access</topic><topic>Health services</topic><topic>HIV</topic><topic>Housing</topic><topic>Human immunodeficiency virus</topic><topic>Incentives</topic><topic>Patients</topic><topic>Quality of care</topic><topic>Ribonucleic acid</topic><topic>RNA</topic><topic>Sexually transmitted diseases</topic><topic>STD</topic><topic>Vouchers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dombrowski, Julia C</creatorcontrib><creatorcontrib>Ramchandani, Meena</creatorcontrib><creatorcontrib>Dhanireddy, Shireesha</creatorcontrib><creatorcontrib>Harrington, Robert D</creatorcontrib><creatorcontrib>Moore, Allison</creatorcontrib><creatorcontrib>Golden, Matthew R</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>AIDS patient care and STDs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dombrowski, Julia C</au><au>Ramchandani, Meena</au><au>Dhanireddy, Shireesha</au><au>Harrington, Robert D</au><au>Moore, Allison</au><au>Golden, Matthew R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington</atitle><jtitle>AIDS patient care and STDs</jtitle><addtitle>AIDS Patient Care STDS</addtitle><date>2018-04</date><risdate>2018</risdate><volume>32</volume><issue>4</issue><spage>149</spage><epage>156</epage><pages>149-156</pages><issn>1087-2914</issn><eissn>1557-7449</eissn><abstract>The Max Clinic in Seattle, Washington is designed to engage patients who have extensive barriers to HIV care. In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that includes walk-in access to primary care in a Sexually Transmitted Disease Clinic. Patients who have failed to engage in care and achieve viral suppression with lower intensity support are referred by clinicians, case managers, and the health department Data to Care program. The clinic offers food vouchers, cash incentives, no-cost bus passes, and cell phones, as well as intensive case management with cross-agency coordinated care. The primary evaluation outcome was the percentage of patients who achieved viral suppression (HIV RNA <200 copies/mL) at least once after enrollment. Secondary outcomes were continuous viral suppression (≥2 suppressed results in a row ≥60 days apart) and engagement in care (≥2 completed medical visits ≥60 days apart). During January 2015-December 2016, 263 patients were referred; 170 (65%) were eligible, and 95 (56% of eligible) were enrolled. Most patients used illicit drugs or hazardous levels of alcohol (86%) and had diagnosed psychiatric illness (72%) and unstable housing (65%). During the year after enrollment, 90 (95%) patients engaged in care. As of the end of 2016, 76 (80%) had achieved viral suppression, and 54% had continuous viral suppression. The Max Clinic successfully treated HIV in high-need patients and, to date, has been sustainable through a combination of federal, state, and local funding.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>29630852</pmid><doi>10.1089/apc.2017.0313</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | AIDS patient care and STDs, 2018-04, Vol.32 (4), p.149-156 |
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| subjects | AIDS/HIV Alcohols Cellular telephones Clinical and Epidemiologic Research Clinics Health care Health care access Health services HIV Housing Human immunodeficiency virus Incentives Patients Quality of care Ribonucleic acid RNA Sexually transmitted diseases STD Vouchers |
| title | The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington |
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