H4C Collaborative

National HIV/AIDS Strategy (NHAS), released in 2010, identified the need for an increase in the number of HIV?infected individuals with viral suppression to ultimately reduce HIV transmission, serving as a foundation for the national response to the epidemic and a primary goal for Ryan White HIV/AIDS Program (RWHAP) recipients.[1] On July 15, 2013, the U.S. President signed an Executive Order[2] to accelerate improvements in HIV prevention and care in the United States through the application of the HIV Care Continuum. This model “outlines the sequential steps or stages of HIV medical care that people living with HIV (PLWH) go through from initial diagnosis to achieving the goal of viral suppression and shows the proportion of individuals living with HIV who are engaged at each stage.”[3] The continuum begins with HIV testing, followed by early linkage to care for newly diagnosed, retention in care, adherence to ART and finally, viral suppression.

In 2013, the National Quality Center (NQC) in partnership with Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) undertook a large-scale quality improvement (QI) collaborative, HIV Cross-Part Care Continuum Collaborative (H4C), to affect measurable improvements in broad geographic regions utilizing the HIV Care Continuum. The NHAS priorities of increasing access to HIV care and viral suppression were the focus of the H4C, a peer learning opportunity of regional HIV providers across RWHAP funding streams in select jurisdictions to increase their potential to build capacity and improve the overall quality of HIV care.

The goals of H4C were to:

  • Build regional capacity to close gaps across the HIV Care Continuum to ultimately increase viral suppression rates for people living with HIV (PLWH) within H4C jurisdictions;

  • Align clinical quality management (CQM) goals across all RWHAP Parts and with jurisdictional or state goals to jointly meet the legislative CQM mandates; and

  • Implement joint quality improvement activities to advance the quality of care for PLWH within a state and to coordinate HIV services seamlessly across RWHAP Parts.

HAB and NQC invited five regional state teams – Arkansas (AR), Missouri (MO), Mississippi (MS), New Jersey (NJ), and Ohio (OH) – to participate in H4C based on the potential for measurable improvements in retention and viral suppression in these states. NQC and HAB reviewed potential participants and the final decision was made by HAB. The five states were selected based on convenience sampling, lower rates of viral suppression, and readiness for technical assistance. The teams were comprised of RWHAP-funded recipients across all RWHAP Parts. Additionally the teams were asked to consider including state Medicaid, Epidemiology/Surveillance, existing HIV networks, consumers, and local and regional public health leaders. The Collaborative ran from January 2014 through January 2016 (24 months).

[1]   “National HIV/AIDS Strategy,” (July 2010): p. ix. <http://www.whitehouse.gov/administration/eop/onap/nhas> 

[2]  <http://www.whitehouse.gov/the-press-office/2013/07/15/executive-order-hiv-care-continuum-initiative> 

[3] AIDS.gov. https://www.aids.gov/federal-resources/policies/care-continuum/

Michael Hager, MPH
National Quality Center

New York State Department of Health, AIDS Institute
90 Church St, 13th floor
New York, NY 10007
work: 212-417-4730