How One Organization Uses Rapid Initiation to Link People from HIV Testing to Care

Medical advances are one of the major developments that allow us to envision and work towards ending the HIV epidemic nationally and in Texas.  New testing technologies and better medications make it possible to achieve our goal.  One of these new strategies is “rapid start” treatment processes.  Sometimes called “test and treat” these processes can connect newly diagnosed individuals to treatment and provide medication in one day.

Achieving Together interviewed Jacobi Hunter-Wright, Senior Programs Manager at Abounding Prosperity, about their experience in implementing rapid start for their community. Abounding Prosperity, Inc. was founded in 2005 with the express purpose of responding to social and health disparities that continue to have a devastating impact on Black men, women, transgender women, and their families in Dallas County.

Please tell us about how Abounding Prosperity links people from HIV testing to care.

We use a lot of different strategies, including SMS (text), social media, and unconventional outreach hours. Also, our staff is representative of different demographics of the focus population. A good example would be with field testing. If we’re using our mobile unit and we do receive a positive test result, we have processes in place to do post-test counseling and collect a confirmatory specimen, whether it’s 2pm or 2am. We have partnerships with other organizations like Prism Health. Hope Health and Wellness Center acts as our clinical arm and they have a case manager on call 24hrs a day. We can schedule medical appointments right then and there, no matter what time of the day it is. Through our partnership with Hope Health and Wellness Center, we can provide rapid initiation, or bridge care treatment, so we can utilize the preliminary positive test to get someone started on treatment, usually within 24-48 hours.

Can you tell us a little more about rapid initiation of antiretroviral therapy (ART)?

I refer to rapid initiation of ART as bridge care. Basically, it’s getting people started on low-resistance medications right away. People could be on these medications for 30-90 days until they are linked to long-term care. The agency has the ability to get clients started on medications with low resistance until they receive long term care and genotype test without complications. With our population, if we can’t get them into care or on medication within two weeks, we run a high risk of losing them. The bridge care treatment philosophy is that we connect them to all things HIV-treatment-related while also getting them linked in to long term care.

What sort of improvement have you seen since starting rapid initiation/bridge care?

Before, our agency-wide linkage rate was around 92%. Now we’re up to around a 95-96% linkage to care rate.

Since starting rapid initiation, we’ve seen an improvement in getting recently diagnosed people back into care. We’ve built up a lot of trust in our community. This helps. People come to us to not only get help with their HIV medical needs, but also because we try to address the barriers that kept people from getting into care before.

How do youth fit into the linkage process?

We are able to provide services to youth starting at age 14. This has forced us to form new partnerships with other groups, such as pediatricians who specialize in infectious disease. When there’s a positive test result for someone under 17, we’ve learned that there are certain services that you can’t provide without a parent’s permission. Even at that young age, a lot of our population isn’t living at home. They’re in survival mode. We had to do a lot of research into policies to find out what we could and couldn’t do. Initially it took a little longer to get them into care, but it’s gotten easier. We have an awesome peer health navigator. I’ve never seen a case manager like him. He’ll talk to people in the middle of the night—he really tries to build relationships.

Where does testing happen?

We have three testing locations: a mobile testing unit, a community center, and an administrative center. Almost 75% of testing is done in the mobile testing unit. The majority of the rest are done at the community center. The mobile testing unit goes everywhere. We also do concierge testing. If someone wants to be tested, we’ll find a way to test them.

How did your partnerships and processes come about?

We started noticing that the barriers facing MSM and transgender women in Dallas were becoming increasingly challenging. For example, they were becoming more transient and their contact information kept changing. Because of barriers to access and the challenges we were seeing, we knew we needed to find a way to get clients into care faster. We recognized we needed to come up with something new and innovative. Hope Health Center allows us to link people to care within 24-48 hours. For us, having a clinical arm helps navigate the process of linkage to care, medication adherence, and also PrEP access.

What factors within your organization help with your success overall?

Our staff is amazing. Everyone plays an integral role in helping everything go smoothly. Our organization’s leadership intentionally hired staff who represent the different facets of the community. That’s how we’ve been able to reach groups that normally wouldn’t feel comfortable going to health care providers. That serves us well in terms of outreach and engagement. For example, we have a transgender program called Transparency that has an amazing transgender program manager. She also does a lot of advocacy work.

Aside from our formal partnerships, we have excellent community partnerships. We also have an incredibly hardworking leader. He instills in all of us how important it is for us to help each other. More than anything else, the willingness and openness of our staff helps us be successful. We’re using proven strategies that are supported by data, but it’s our relationships with communities that are often hesitant to trust that sets us apart. If we need to, we’ll link someone to care at 3am. We’ll help someone who calls from out of state. People respect our candor and hard work. If someone comes in and doesn’t want to test, but they’re hungry—we’ll feed them. People know they’re not a number. It’s a safe place. 

One of the six focus areas of Achieving Together is to promote the continuum of HIV prevention, care, and treatment to increase health outcomes and viral suppression among people living with HIV in Texas.  This includes adopting rapid start “test and treat” as a standard of care for people newly diagnosed with HIV.

What connections exist in your community?

What opportunities do you see for new connections?

Jacobi Hunter-Wright, B.S., M.A., is an advocate, activist and leader within the LGBTQ community. A native of Dallas, TX, he obtained his Bachelors in Criminal Justice minoring in English at Prairie View A&M University and his Masters of English from Clark Atlanta University. He is currently attending Texas A&M University at Commerce pursuing his Doctorate in English. With a focused commitment on the health disparities of young Black gay men and Transgender women in Texas and Black gay men within the House/Ball community, Jacobi has continuously worked with these populations and their sub-populations since 2013, ensuring they have access into HIV education, prevention, and treatment. Jacobi currently serves as the Senior Programs Manager at Abounding Prosperity Inc. in Dallas, TX, where he has worked for the past 4 years.

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