Palm Beach HIV Program: Mixed Results on Viral Load Suppression

Jupiter, FL – A year-long quality improvement project aimed at increasing viral load suppression among individuals with HIV in Palm Beach County concluded with mixed results. The initiative, called Improving Viral Load Suppression through Active Linkage & Referral to Tele-adherence Counseling (PL Cares®), ran from April 1, 2022, to June 7, 2023.

The collaboration between the Ryan White Part A/MAI program and the Ending the HIV Epidemic initiative in Palm Beach County sought to improve viral load suppression rates by actively connecting clients not meeting suppression targets with the PL Cares® smartphone app and tele-adherence counseling.

During the project's baseline period, June 1, 2021, to March 10, 2022, 210 individuals with HIV had elevated viral load results (greater than 200 copies/mL) identified within the Ryan White HIV/AIDS Programs in Palm Beach County. The PL Cares® program previously relied on passive referrals.

This project shifted to an active referral model. A team coordinator identified non-virally suppressed clients from the Provide Enterprise database. Program contacts and supervisors at each agency reviewed these client lists and initiated referrals. Case managers discussed PL Cares® benefits with clients, encouraged referrals, submitted them in Provide Enterprise to a Tele-adherence Counselor (TAC), and informed clients about the TAC's upcoming contact. The TAC communicated any client contact issues back to the case manager.

The project phases yielded varying success. From April to October 2022, 56 of 210 clients (27%) received TAC referrals. Of those referred, 25 enrolled, 17 were in the process of enrolling, and 14 declined.

Phase I, incorporating March 11, 2022, to May 31, 2022, data and worked on from June to October 2022, involved 209 clients. Of the 172 eligible clients, 36 (21%) were referred to a TAC. Of those referred, 22 enrolled, and 13 achieved viral load suppression within four months.

Phase II, covering March 1, 2022, to October 31, 2022, identified 227 non-virally suppressed individuals. Sub-recipients referred only 22 (9.7%) to PL Cares®. The project noted that some sub-recipients did not update their lists, and many clients were not reached.

Identified barriers included case managers' competing priorities and clients' own competing priorities, which sometimes led to overwhelm and refusal during enrollment. The project emphasized that PL Cares® supplements, rather than replaces, existing case management efforts.