Case Studies in ART and Retention in Care (Web)

A. Training front desk staff around cultural humility and destigmatization of healthcareB. Encourage patient to arrange transportation with friends or familyC. Coordination with case managers with access to Ryan White services including transportation assistanceD. Appointment Reminders

Congratulations. The best choice is C. A team approach to address logistical, structural and financial barriers is essential for smooth immediate access to medication. Case management and patient navigation generally improve retention and can provide access to transportation through dedicated programing like Ryan White. Transportation assistance has been shown to improve retention and viral suppression. Asking family and friends may be difficult for patients due to stigma or other barriers. Appointment reminders and developing a welcoming culture are excellent approaches to retention, however they do not directly address the underlying problem of transportation.

Reference: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Available at
https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv. Accessed 9/5/24.Higa, Darrel HIGA, et al Strategies to improve HIV care outcomes for people with HIV who are out of care. AIDS. 2022;36(6):853-862.

Sorry, the correct answer is C. A team approach to address logistical, structural and financial barriers is essential for smooth immediate access to medication. Case management and patient navigation generally improve retention and can provide access to transportation through dedicated programing like Ryan White. Transportation assistance has been shown to improve retention and viral suppression. Asking family and friends may be difficult for patients due to stigma or other barriers. Appointment reminders and developing a welcoming culture are excellent approaches to retention, however they do not directly address the underlying problem of transportation.

A. Stabilize psychosocial factors through referral to case management and/or behavioral health services prior to starting ARVsB. Start ARVs immediately with DTG/3TCC. Have patient attend an initial intake visit including biopsychosocial assessment and get labs including a genotype, then have patient return once genotype is resulted to start ARV.D. Start ARVs immediately with BIC/TAF/FTC

Congratulations. The best answer is D. Although involvement of a care team potentially including case management and behavioral health have been shown to improve viral suppression, they do not need to delay access to ARV medications. Rather they serve as a support as a patient embarks on treatment. Although DTG/3TC is considered a first line regimen per DHHS guidelines, it should not be started if a patient’s viral load is >500,000 copies/mL and therefore would not be appropriate for an immediate start prior to labs. However, there are other regimens, such as BIC/TAF/FTC or DTG + TXF/XTC that may be started prior having labs like viral load or genotype. Therefore there is no need to delay starting ART while awaiting lab results.

Sorry, the best answer is D. Although involvement of a care team potentially including case management and behavioral health have been shown to improve viral suppression, they do not need to delay access to ARV medications. Rather they serve as a support as a patient embarks on treatment. Although DTG/3TC is considered a first line regimen per DHHS guidelines, it should not be started if a patient’s viral load is >500,000 copies/mL and therefore would not be appropriate for an immediate start prior to labs. However, there are other regimens, such as BIC/TAF/FTC or DTG + TXF/XTC that may be started prior having labs like viral load or genotype. Therefore there is no need to delay starting ART while awaiting lab results.

A. Given their long half-lives, long-acting injectable doses can be given at any time and there are no risks associated with missed or late doses.B. Patients have a window of 5 days to receive their dose of long-acting cabotegravir/rilpivirine.C. When starting long-acting injectables, patients should be counseled on the importance of receiving medication doses on time.D. Patients can self-administer long-acting cabotegravir/rilpivirine to improve adherence.

Congratulations. The best answer is C. When counseling patients on long acting cabotegravir/rilpivirine emphasis should be placed on the importance of receiving medication doses on time to avoid the development of resistance. Answer A is not the correct answer as receiving medication doses outside of the dosing window may result in the development of resistance. Amswer B is not correct because patients have a dosing window of 14 days (7 days prior to and 7 days following the target dose) to receive a dose of long acting cabotegravir/rilpivirine. Answer D is not correct because cabotegravir/rilpivirine must be administered by a healthcare provider.

Reference: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Optimizing Antiretroviral Therapy in the Setting of Viral Suppression. Available at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/optimizing-antiretroviral-therapy. Accessed: 9/3/24.

Sorry, the best answer is C. When counseling patients on long acting cabotegravir/rilpivirine emphasis should be placed on the importance of receiving medication doses on time to avoid the development of resistance. Answer A is not the correct answer as receiving medication doses outside of the dosing window may result in the development of resistance. Amswer B is not correct because patients have a dosing window of 14 days (7 days prior to and 7 days following the target dose) to receive a dose of long acting cabotegravir/rilpivirine. Answer D is not correct because cabotegravir/rilpivirine must be administered by a healthcare provider.

Reference: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Optimizing Antiretroviral Therapy in the Setting of Viral Suppression. Available at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/optimizing-antiretroviral-therapy. Accessed: 9/3/24.

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The content covered was useful and relevant to my current or future scope of practice.
The activity was fair, balanced, and free of bias.
The activity improved my knowledge of this clinical issue.
The learning objectives for this activity were achieved.
I am better able to: Communicate/collaborate with other members of the care team on this issue.
I am better able to: Improve access to care and treatment for underrepresented patient groups or geographies because of what I learned.
The information learned during this activity will help improve my skills or judgment within the next six months.
The content was presented clearly.
The educational activity was well planned and presented.

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I intend to: Modify/change my practice or the practice of my team based on this educational activity.
I intend to: Work with my team to create/revise protocols, policies, and/or procedures with my care team.
I intended to: Share what I learned with other members of my care team.
I intend to: Make changes in how I communicate with/educate my patients.
I intend to: Seek additional information on topics discussed during the activity.
On average, I utilized the patient treatment strategies described in this educational activity prior to my participation.

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My office and practice systems can accommodate the above changes.
My patients can accommodate the above changes.
Patient access to the treatments provided will be a barrier to implementing the above changes.

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Case Studies in ART and Retention in Care (Web)

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