I Don't Want the Tray to Tip: Experiences of Peer Evaluators in a Multisite HIV Retention in Care Study.

Numerous studies demonstrate the efficacy of peer-delivered interventions to improve HIV prevention and care outcomes, yet few explore the role of peers in evaluation and data collection. We conducted qualitative interviews with providers in a multisite HIV Retention in Care initiative to explore peers' evaluation roles, challenges, and strategies for success. We found peers' responsibilities included data collection, client assessments, and data entry. Their rapport with clients was considered an evaluation asset. However, peers struggled with balancing rigorous evaluation and data collection demands with the needs and comfort of clients. Recommendations for peer-based evaluation include ensuring self-care, streamlining workflow, and involving peers in evaluation development and reporting processes. Additional research is needed to explore the extent to which peers participate in evaluation activities and to ensure rigor in peer-based evaluation. Given that peers are well-positioned to collect client-level data, best practices, standards, and trainings for peer-based evaluation should be developed.

Cost-Utility of Access to Care, a National HIV Linkage, Re-engagement and Retention in Care Program.

Linkage to HIV medical care and on-going engagement in HIV medical care are vital for ending the HIV epidemic. However, little is known about the cost-utility of HIV linkage, re-engagement and retention (LRC) in care programs. This paper presents the cost-utility analysis of Access to Care, a national HIV LRC program. Using standard methods from the US Panel on Cost-Effectiveness in Health and Medicine, we calculated the cost-utility ratio. Seven Access to Care programs were cost-effective and two were cost-saving. This study adds to a small but growing body of evidence to support the cost-effectiveness of LRC programs.

Barriers and Facilitators to the Implementation of a National HIV Linkage, Re-Engagement, and Retention in Care Program.

The 2020 National HIV AIDS Strategy (NHAS) sets a target of 90% of diagnosed people living with HIV (PLWH) retained in HIV care. Access to Care (A2C) was a national HIV linkage, re-engagement, and retention in care program funded by AIDS United with support from the Corporation for National and Community Service that aimed to link and retain the most vulnerable PLWH into high-quality HIV care. This study explores the barriers and facilitators of implementing the A2C program from the perspective of program staff. Ninety-eight qualitative interviews were conducted with staff at implementing organizations over the 5 years of the project. Barriers included challenges with recruiting and retaining participants, staffing and administration, harmonizing partnerships, and addressing the basic and psychosocial needs of participants. Facilitators included strong relationships with partner organizations, flexible program models, and the passion and dedication of staff. Findings will inform the development of future programs and policy.