Table 3 Essential elements of RAPID, operationalized by site
Innovator site | Testing site | FQHC | |
|---|---|---|---|
Comfort and competence prescribing ART | MDs/NPs prescribing HIV primary care team w expertise in HIV care Select cadre of RAPID providers from broader pool of primary care providers | NPs prescribing (recent addition for other prescribing services at site) All providers available to participate in RAPID as any other sexual health service | MDs/NPs/DOs/PAs/APNs prescribing HIV primary care team w expertise in HIV care All providers available to participate in RAPID as any other sexual health service |
Expedited access to ART | Starter packs + Rx for ongoing ART to be filled by patient | Starter packs + Rx Proximity to pharmacy for immediate prescription fulfillment (same-day Rx fulfillment so successful, starter packs rendered unnecessary) | Prescription that could be filled immediately or next-day at the on-site pharmacy Proximity to pharmacy for immediate prescription fulfillment Medication sample packs |
Benefits, linkage, and care navigation | Access to patient drug assistance programs (same day ADAP) Clinic receives warm hand-offs from referrals; on-site HIV primary care, occasional external linkage necessary Social worker as part of RAPID team to assess and connect pt to wraparound services Navigation of pt through RAPID process (“red carpet” treatment) | Access to patient drug assistance programs (ADAP) Ability to assess eligibility and enroll patients in benefits programs same-day Assess for additional needs (housing, mental health, etc.), psychosocial support on site Off-site linkage to external HIV PC provider (includes assessments of benefits and needs to find appropriate match, coordinating transition) | Access to patient drug assistance programs (ADAP) Insurance and patient assistance program knowledge for patients to access free meds Clinic receives referrals as warm hand-offs and self-referrals; on-site HIV primary care, no external linkage necessary Assess for additional needs (housing, mental health, etc.), psychosocial support on site Navigation of pt through RAPID process, ensuring warm hand-off to internal HIV PC provider |
Flexibility and adaptive capacity | Appointment & Drop-in Interdisciplinary Team Prescribing clinicians flexible in accommodating RAPIDs in the schedule Iterative program development and improvement | Appointment & Drop-in Interdisciplinary Team Iterative program development and improvement (i.e., cross-training benefits navigators and health navigators; expanding physical space for RAPID; opening access to mental health services at RAPID visit when needed) | Appointment & Drop-in Interdisciplinary Team Iterative program development and improvement (i.e., adding Uber account, adding on-site linkage coordinator to clinic) |
Patient-centered approach | Services for patients experiencing homelessness, substance use RAPID as a red-carpet event to provide patient support Warm hand offs between RAPID team members | LGBTQ + community focus, including transgender and gender nonbinary services Community outreach and site-specific access (for patients experiencing homelessness), mobile testing units Meet with as few people as possible during encounter Attitude of doing whatever it takes to meet the patient’s need | LGBTQ + community focus, including transgender and gender nonbinary services Services for patients experiencing homelessness, mental health needs, substance use Community outreach and testing Meet with as few people as possible during encounter, stays in same exam room throughout process, (when possible/desirable) has prescription brought to them Attitude of doing whatever it takes to meet the patient’s need Accessing all needs for patients (i.e., clothing, food, transportation vouchers) In-house linkage to minimize time patient spends alone |
Communication methods and culture | Interdisciplinary team, team members present and together for some parts of the RAPID encounter Central pager system | Small team communicates informally throughout daily activities | Centralized “linkage to care phone” Repeated check-ins among RAPID team throughout RAPID process, and continued in-person and EMR-based communication throughout full linkage to care process (first 6–12 months of patient’s care) RAPID team members use EMR to read patient notes during RAPID encounter |