HIV/AIDS: Program Evaluation and Technical Assistance

Current Projects

Data Integration, Systems, and Quality Technical Assistance (DISQ) Project

For the HIV/AIDS Bureau, Health Resources and Services Administration (HRSA HAB), Mission Analytics Group, as a subgrantee to Cicatelli Associates, Inc., provides technical assistance to Ryan White grantees to improve the collection, retrieval, and submission of client-level data for program reporting, evaluation, and quality improvement purposes. Project activities include designing and hosting a webcast series on data issues; analyzing and providing feedback on data quality; identifying solutions for grantees experiencing data collection and submission challenges; and developing tools to facilitate high quality data submission across grantees and providers.  Many of our TA products are featured on the Ryan White Services Report page of the TARGET Center website for the Ryan White community, including the X-ERT tool (Xml Extraction and Reporting Tool) and the RSR Training Video Series. http://www.careacttarget.org/category/topics/ryan-white-services-report-rsr. Prior to July 2020, this project was named “Data and Reporting Technical Assistance (DART).”

TEchnical Assistance Provider - Innovation Network (TAP-IN): National Training and Technical Assistance

Mission, as a subgrantee to Cicatelli Associates, Inc., will help serve as the Technical Assistance Provider (TAP) for the HRSA HAB’s national plan for Ending the HIV Epidemic: A Plan for America (EHE). The TAP Innovation Network (TAP-IN) will provide tailored technical assistance (TA) to EHE priority jurisdictional recipients of HRSA-20-078. Mission is participating in leadership group planning meetings and discussions. Mission’s other tasks may include: review and analyze jurisdictional work plan; participate in the enhancement of jurisdictional work plans to reach EHE goals in a way that is responsive to local need; support the adaptation and/or development of implementation packages based on implementation science; and generally provide TA.

Recipient Compilation of Best Practice Strategies and Interventions

For HRSA HAB, Mission works with John Snow, Inc., to collect data on and analyze best practice strategies and interventions implemented by RWHAP grant recipients and sub-recipients that yield the best health outcomes along the HIV care continuum. By identifying these strategies and interventions, this project could allow HRSA HAB to invest resources more efficiently and disseminate knowledge to HIV service providers.

HAB Benchmarking and Data Dashboards for the Ryan White HIV/AIDS Program

Under subcontract with Mathematica, for HRSA HAB, Mission is working to update the content and structure of the RWHAP Compass Dashboard. The dashboard includes benchmarking that normalizes outcomes, such as viral suppression and retention in care, based on client populations served. The underlying structure of the dashboard will also be modernized to improve load times, based on feedback from the community. To improve the dashboard, Mission will conduct interviews, surveys and user testing to get feedback from users. Mission will also produce any analytic files needed for updating the benchmarking approach.

Completed projects

Alternative Resource Allocation Methodologies for Ryan White HIV/AIDS Programs Part A&C – Phase II

Mission, as a subcontractor to Walter R. McDonald & Associates, Inc. (WRMA), for the HRSA HAB, is building upon both the Part A and the Part C Phase I-funded activities that resulted in customized Excel tools developed for HAB to use in testing different alternatives for funding allocations. In addition, the Part C activities also included development of SAS code to generate the required RSR output for use in the Excel tool. Phase II will build upon these activities to enable HAB to utilize the funding allocation methodologies for future funding. WRMA-Mission will incorporate up to three new factors as well as modify existing factors, including need, geography, and performance, in the Excel tool to further examine the impact that different approaches have on funding allocation. In addition, WRMA-Mission will examine what impact the shift from funded to eligible scope in the Ryan White Services Report (RSR) has on funding allocations for both Part A and Part C.

Determining Factors for Re-imagining Ryan White HIV/AIDS Programs Part D

For HRSA HAB, Mission has partnered with WRMA to serve as the contractor to determine factors that would contribute to the re-imagining of Part D of the RWHAP, addressing how to maximize Part D’s resources by exploring sub-population, regional, and other considerations.

Evaluation Methods of Part C Funds

For the HRSA HAB, Mission, as a subcontractor to WRMA, addressed the lack of historical variation in Objective Review Committee (ORC) scores and subsequent allocations while incorporating a model that addresses the methodological and policy issues. The Division of Community HIV/AIDS Programs (DCHAP) outlined specific goals to be addressed in an allocation model. These goals fell into five key areas: (1) linking funding to current indicators of need, (2) ensuring funding addresses legislative priorities, (3) aligning costs per patient based on geographic and health care financing considerations, (4) promoting programmatic results along the HIV Care Continuum, and (5) addressing individual grant actions.

Evaluation of the AHEAD Dashboard

Mission worked with the Office of Infectious Disease and HIV/AIDS Policy (OIDP) to evaluate the Office of the Assistant Secretary for Health’s America’s HIV Epidemic Analysis Dashboard (AHEAD). Our evaluation included an environmental scan of public HIV-related dashboards, interviews with individual users or groups of users, and guided user testing sessions.

Factors that Impact AIDS Drug Assistance Program (ADAP) Enrollment Management in the Face of ADAP Waiting Lists

For the HRSA HAB, Mission, as a subcontractor to WRMA, studied states’ use of waiting lists and other cost-containment strategies to manage their AIDS Drug Assistance Programs (ADAPs).  This mixed-methods project examined the use of waiting lists and other cost-containment strategies and potential opportunities for ADAPs to more effectively serve clients and avoid reliance on such options.  The quantitative analysis assembled data on ADAP expenditures, demographics, epidemiology, health insurance and economic conditions to determine the factors that drive demand for ADAP and how these differ between states with waitlists and states without waitlists. The qualitative component included site visits with eight states to examine ADAP management practices, budget forecasting, and the use of waitlists and other cost containment practices, to identify best practices and potential strategies to improve efficiency in states turning to waitlists. 

Formula Calculation Methods Assessment

Mission is working with HRSA HAB to conduct an environmental scan of Federal government programs that distribute funding via a formula calculation, catalog the technological and process methods used for those formula calculation processes, and to make recommendations for system(s) that are best suited for determining eligibility and calculating award amounts for the RWHAP Parts A and B programs.

Integration of Oral Health and Primary Care Evaluation/Technical Assistance to Ryan White HIV/AIDS Program (RWHAP) Recipients

Mission is working with the HRSA HAB, to conduct an evaluation to identify barriers, facilitators, promising practices, and examples associated with the integration of oral health and primary care for PLWH across RWHAP Part C and D funded clinics.

Leveraging a Data to Care Approach to Cure Hepatitis C within the Ryan White HIV/AIDS Program (RWHAP) Evaluation Contract

To leverage a data to care approach to cure hepatitis C within the RWHAP, HRSA HAB released cooperative agreement HRSA-20-077, titled, “Leveraging a Data to Care Approach to Cure Hepatitis C within the Ryan White HIV/AIDS Program (RWHAP).” In support of that agreement, Mission worked with HRSA HAB to design, pilot, and conduct the evaluation of this two-year cooperative agreement to demonstrate the achievement and effectiveness of the project’s objectives and activities. Over the course of the contract, Mission disseminated our findings on behalf of HRSA, helping HAB promote successful project interventions for adoption by other jurisdictions.

Providing Primary Care and Preventative Medical Services in Ryan White-Funded Medical Care Setting

For the HRSA HAB, Mission has partnered with WRMA to identify the types of primary and preventative care services provided by Ryan White clinics, models of service provision, gaps in care, and strategies for filling those gaps. The treatment advances in HIV/AIDS care are allowing people living with HIV/AIDS to live longer, fuller lives. As the impact of HIV/AIDS disease is changing, so are the health care needs of PLWHA. HIV/AIDS care needs to improve overall well-being by including strategies to prevent disease, promote healthy lifestyles, and manage other chronic conditions. This shift requires more integration of HIV/AIDS disease management and primary care.  

Public Health and Economic Impact of the Ryan White HIV/AIDS Program

For the HRSA HAB, Mission partnered with Mathematica Policy Research to develop a mathematical model to quantify the long-term clinical/public health impact and cost-effectiveness of the RWHAP, conduct analyses on the model and publish resultant manuscript(s), and provide training to HAB staff on the model. The results of this model helped guide RWHAP planning efforts, identify funding priorities to reach national HIV health outcome goals, and maximize the health outcomes and quality of life for people living with and affected by HIV who are served by the RWHAP.

Ryan White HIV/AIDS Program Outcomes within the Context of Affordable Care Act

For HRSA HAB, Mission served as a subcontractor to Abt Associates Inc. to examine the effect of enrollment in Affordable Care Act-provided health care coverage has on RWHAP clients related to their health outcomes as well as to examine any remaining gaps in health care, and issues related to utilizing health care services.

Ryan White HIV/AIDS Program Outcomes for Clients Who Do Not Receive Outpatient Ambulatory Health Services

For HRSA HAB, Mission served as a subcontractor to Mathematica to assess the utilization of HIV care for RWHAP clients who do not receive outpatient ambulatory health services (OAHS). In 2016, over one-third of people living with HIV and receiving services from RWHAP did not receive RWHAP-funded OAHS. The aim was to identify if and where these clients are receiving HIV care services, as well as the unmet needs among RWHAP clients who did not receive RWHAP-funded OAHS.

Ryan White HIV/AIDS Programs Part A Supplemental Funding- Feasibility Study of Proposed Allocation of Funds Responsive to Need

For HRSA HAB, Mission partnered with WRMA to serve as the contractor. Part A of the Ryan White HIV/AIDS Treatment Extension Act of 2009 provides assistance to EMAs and Transitional Grant Areas (TGAs)—locales that are most severely affected by the HIV/AIDS epidemic. In addition to formula funds, HAB funds grantees with Part A supplemental awards on an annual basis. The method for evaluating need for this supplemental funding involved reviewing and scoring applications submitted by grantees demonstrating the need for additional funding. Historical data related to this process shows that Part A grantees, all of which are established and longstanding recipients of Part A funds, uniformly score within a very limited point range, resulting in proportional funding with little differentiation in regard to absolute need. This project identified for a HRSA/CDC workgroup an empirical, quantifiable framework or formula for awarding supplemental funding to Part A grantees.

To achieve the goals of the project, the Mission team developed an electronic database that included historical funding patterns, alternative measures of unmet need, data quality measures, performance measures, and cost measures. In addition to implementing it as a statistical model, Mission built an Excel tool to allow HRSA HAB to experiment with alternative strategies.  

Special Projects of National Significance, Dissemination Assistance Provider (DAP) for Rapid Antiretroviral Therapy (ART) Start in the Ryan White HIV/AIDS Program (RWHAP)

Mission, as a subgrantee to Cicatelli Associates, Inc., helped serve as the Dissemination Assistance Provider (DAP) for Rapid Antiretroviral Therapy (ART) Start in the RWHAP. As part of a strategic set of Cicatelli’s partners, Mission supported the environment scan through review of RWHAP Parts A, B, C, and D grant applications, RWHAP provider survey, RSR data analysis, cataloguing research findings, and participating in RWHAP on-site and virtual exploratory site visits. Our team also supported dissemination efforts by supporting development of Rapid ART Start compendium of evidence-based and promising practices, creating profiles of successful Rapid ART Start programs, and hosting office hours on Rapid ART Start data evaluation.

Strengthening and Improving the HIV Care Continuum within Ryan White Program Part A Jurisdictions: National Training and Technical Assistance National Training and Technical Assistance

For the HRSA HAB, Mission, as a subcontractor to Abt Associates Inc., provided training, technical assistance, and facilitative support to RWHAP Part A jurisdictions throughout the United States to improve health outcomes of individuals living with HIV and ultimately reduce new HIV infections. Mission assisted Abt in the implementation collaborative learning efforts among Part A grantees. 

Supporting Youth Living with AIDS

For HRSA HAB, Mission served as a subcontractor to DSFederal, Inc. to assess the current state of HIV infected youth aged 13-24 receiving RWHAP funded care and treatment, their unique barriers to care, and RWHAP providers' capacity to engage and retain them in care with optimal health outcomes.

Understanding and Monitoring the Interrelationships between Funding Stream in Ryan White-Funded Clinical Settings

For the HRSA HAB, Mission partnered with WRMA to study how RWHAP-funded Part C and Part D grantees use multiple funding sources to provide comprehensive HIV/AIDS care.  The project included a survey of Part C and D grantees on Ryan White services provided to uninsured and underinsured clients, the dynamics of health care coverage, and the interactions among Medicaid, Medicare, private insurance, and HRSA Ryan White funding. The team also developed a prototype tracking tool to assist grantees in monitoring and assessing changes in funding streams by service category.  The goal of this tool was to help grantees better plan for shifts in coverage, especially now that the Affordable Care Act has extended coverage to more individuals, especially under Medicaid.