Case Management Training Program
Supporting Ryan White Part A-Funded Case Management Agencies Across the Boston EMA.
Welcome to the Case Management Training Program! The purpose of this website is to provide HIV Case Managers with a comprehensive resource dedicated to providing information and support for individuals living with HIV.
What We Do
What We DoThe Case Management Training Program (CMTP) is funded to provide training, technical assistance, and capacity-building assistance services to Boston EMA subrecipients. Subrecipients funded for Medical Case Management and/or Non-Medical Case management services will be mandated to participate in a series of core competency curricula.
The Case Management Training Program strives to empower case managers to work as a community to provide consistent, comprehensive care to people living with HIV. We do this by partnering with local organizations to provide trainings and resources for case managers so they can ensure people living with HIV can reach and maintain viral suppression by accessing the full continuum of HIV services.
- Collaborate to build and share resources.
- Educate case managers, clients, and communities.
- Advocate for the health and well-being of people living with HIV/AIDS.
Medical Case Management
Non-Medical Case Management
Merrimack Valley Assistance Program (NH)
Non-Medical Case Management - MAI
Understanding HIV/AIDS
HIV AND AIDS
Explore the basics of HIV infection, transmission routes, and the impact of HIV on the immune system.
GETTING TESTED
Learn about the importance of HIV testing, the different testing methods available, and where to get tested.
PrEP (PRE-EXPOSURE PROPHYLAXIS)
This fact sheet answers frequently asked questions about PrEP (Pre-Exposure Prophylaxis).
PEP (POST-EXPOSURE PROPHYLAXIS)
This fact sheet answers frequently asked questions about HIV PEP (Post-exposure prophylaxis).
STAYING HEALTHY TIPS
As part of overall health and wellness, it is important to learn the best practices for addressing sexual health.
RYAN WHITE SERVICES DIVISION
The Ryan White Part A program provides supportive services for people living with HIV across 10 counties in Massachusetts and New Hampshire.
HIV TREATMENT AND CARE
HIV TREATMENT AND CAREHIV CASE MANAGEMENT SERVICES
HIV CASE MANAGEMENT SERVICESMedical Case Management
Medical Case Management is the provision of a range of client-centered activities focused on improving health outcomes in support of the HIV care continuum. Activities provided under this service category may be provided by an interdisciplinary team that includes other specialty care providers. Medical Case Management includes a variety of encounters including face-to-face, phone contact, or via another form of telehealth, etc.
Key activities include:
- Initial assessment of service needs
- Development of a comprehensive, individualized care plan
- Timely and coordinated access to medically appropriate levels of health and support services and continuity of care
- Continuous client monitoring to assess the efficacy of the care plan
- Re-evaluation of the care plan at least every 6 months with adaptations as necessary
- Ongoing assessment of the client’s and other key family members’ needs and personal support systems
- Treatment adherence counseling to ensure readiness for and adherence to complex HIV treatments
- Client-specific advocacy and/or review of utilization of services
In addition to providing the medically oriented activities above, Medical Case Management may also provide benefits counseling by assisting eligible clients in obtaining access to other public and private programs for which they may be eligible (e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, other state or local health care and supportive services, and insurance plans through the health insurance Marketplaces/Exchanges).
Program Guidance:
- Activities provided under the Medical Case Management service category have as their objective improving health care outcomes whereas those provided under the Non-Medical Case Management service category have as their objective providing guidance and assistance in improving access to needed services.
- Visits to ensure readiness for, and adherence to, complex HIV treatments shall be considered Medical Case Management or Outpatient/Ambulatory Health Services. Treatment Adherence services provided during a Medical Case Management visit should be reported in the Medical Case Management service category whereas Treatment Adherence services provided during an Outpatient/Ambulatory Health Service visit should be reported under the Outpatient/Ambulatory Health Services category.
Goal: Engage clients who face significant challenges to enter and maintain treatment for their HIV.
Objective: Assess client needs and develop a Comprehensive Treatment Plan (CTP) that provides guidance and assistance in improving health care outcomes for people living with HIV.
Non-Medical Case Management
Non-Medical Case Management Services (NMCM) is the provision of a range of client-centered activities focused on improving access to and retention in needed core medical and support services. NMCM provides coordination, guidance, and assistance with accessing medical, social, community, legal, financial, employment, vocational, and/or other needed services. NMCM Services may also include assisting eligible clients to obtain access to other public and private programs for which they may be eligible, such as Medicaid, Children’s Health Insurance Program, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, Department of Labor or Education- funded services, other state or local health care and supportive services, or private health care coverage plans. NMCM Services includes a variety of types of encounters including (but not limited to) face-to-face, telehealth, phone contact, etc.
Key activities include:
- Initial assessment of service needs
- Development of a comprehensive, individualized care plan
- Timely and coordinated access to medically appropriate levels of health and support services and continuity of care
- Client-specific advocacy and/or review of utilization of services
- Continuous client monitoring to assess the efficacy of the care plan
- Re-evaluation of the care plan at least every 6 months with adaptations as necessary
- Ongoing assessment of the client’s and other key family members’ needs and personal support systems
Program Guidance:
NMCM Services have as their objective providing coordination, guidance and assistance in improving access to and retention in needed medical and support services to mitigate and eliminate barriers to HIV care services, whereas Medical Case Management Services have as their objective improving health care outcomes.
Goal: Enhance access to and retention in essential medical and social support service for people living with HIV. This is a human service approach that supports engagement and retention into medical care.
Objective: Assess client needs and develop an Individual Service Plan (ISP) that provides guidance and assistance in improving access to needed services. [1]
[1] Health Resources and Services Administration. (2018, October 22). Ryan White HIV/AIDS Program services: eligible individuals & allowable uses of funds. https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/service-category-pcn-16-02-final.pdf
Linkage to care is a crucial early step in successful HIV treatment and is typically defined as the completion of a first medical clinic visit after HIV diagnosis. Linkage to care plays a key role in the HIV care continuum—it is a necessary precursor to antiretroviral therapy initiation and viral suppression.
Evidence clearly demonstrates that antiretroviral treatment significantly reduces the risk of developing HIV-related complications. In addition, antiretroviral therapy dramatically reduces HIV transmission to others. Without timely entry into care, individuals with HIV miss an opportunity to benefit from HIV treatment at the earliest stage feasible; rapid initiation of antiretroviral therapy after HIV diagnosis is a key pillar of the national initiative, Ending the HIV Epidemic: A Plan for America.
In addition, delayed linkage to care is a major barrier to “treatment as prevention” to reduce HIV transmission rates in the United States. Thus, identifying persons with HIV and successfully linking them to care plays a key role in the overall HIV epidemic, both from a treatment and a prevention standpoint.
The federal benchmark for successful linkage to care is completion of a visit with an HIV medical provider within 1 month (30 days) of HIV diagnosis and the federal years 2025 goal is to have successful linkage to care in at least 95% of persons newly diagnosed with HIV.
Key Points:
- For the year 2020, the CDC estimates that approximately 82% of persons were linked to care within 1 month of HIV diagnosis.
- Key factors for delayed linkage include substance use, lack of medical insurance, lack of access to primary care prior to HIV diagnosis, and residence in a high poverty area.
- Linkage to care rates are lower among persons who are Black/African American or American Indian/Alaska Native compared to other racial/ethnic groups.
- Ensuring linkage to care is a crucial part of any HIV testing program and active assistance with linkage to care is more effective than a passive approach.
- The Antiretroviral Treatment Access Study (ARTAS) intervention, which includes multiple sessions of strengths-based counseling, is an evidence-based linkage to care model.
- Assisting persons with linkage to HIV care is a primary goal of public health HIV partner services.
- HIV clinical programs can increase rates of linkage to care by shortening their wait times for new clinic visits, conducting outreach to persons who no-show to their first scheduled visit, and conducting case management intake for new clients prior to the HIV medical provider visit.[2]
[2] Budak, J. (2017, April 17). Linkage to HIV care. The National HIV Curriculum. https://www.hiv.uw.edu/go/screening-diagnosis/linkage-care/core-concept/all
For people with HIV, treatment adherence means:
- Starting HIV treatment
- Taking HIV medicines every day and exactly as prescribed (also called medication adherence)
- Keeping all medical appointments
Adherence to treatment is a key part of staying healthy with HIV.[3]
[3] NIH’s Office of AIDS Research. (2021, August 12). HIV treatment adherence. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-adh…
Explore these HIVinfo and Centers for Disease Control and Prevention (CDC) resources to learn more about treatment adherence:
HIVinfo:
- Just Diagnosed: Next Steps After Testing Positive for HIV
- How to Find HIV Treatment Services
- Following an HIV Treatment Regimen: Steps to Take Before and After Starting HIV Medicines
CDC:
A positive HIV diagnosis can be very isolating, as people oftentimes cut themselves off from the world when diagnosed with HIV. But the truth is that isolating yourself makes it worse for their mental health. Going to a support group for people with HIV is a more reliable way of getting support. Support groups can be beneficial for people feeling vulnerable or anxious because of ill health, lack of confidence, immigration, poverty or being unable to work.
A key way that social support groups help people is to challenge the idea that ‘HIV = death’. In doing so, support groups help build confidence and strength. It can be hugely inspiring if people can see other people who are ‘in the same boat’ doing well. A stand-out benefit of peer support networks in HIV care can be found in the increased recognition that peer support as a complement to general healthcare services, contributes to meeting the healthcare needs of people living with HIV.
Peer support with routine medical care is superior to routine clinic follow-up in improving outcomes for people living with HIV. It can be highly considered an effective approach for linking and retaining people living with HIV to HIV care, which can help improve their day-to-day quality of life.[4]
[4] Imani. (2022, June 3). The importance of a peer support network in HIV care. Minority AIDS Support Services, Inc. https://minorityaidssupport.org/the-importance-of-a-peer-support-network-in-hiv-care/#:~:text=You%20are%20in%20the%20right,worse%20for%20their%20mental%20health
COMMUNITY RESOURCES AND SUPPORT
COMMUNITY RESOURCES AND SUPPORT- Peer support may help with coping with the challenges of living with HIV.
- Online support groups provide a convenient way to connect with others at a distance.
- It’s important to discuss any medical information from online support resources with a doctor or medical professional.
Peer support may help those with HIV cope with the challenges of living with this condition.
A 2015 review of studies found that participating in an HIV support group has many potential benefits. It may help:
- improve quality of life
- relieve physical symptoms
- reduce anxiety and depression
- decrease sleeping difficulties
- make it easier to stick to prescribed treatment
If it’s difficult or inconvenient to attend an HIV support group in person, an online support group or other support resources may help.
Many online support resources are available to help people with HIV connect with others with this condition. The following is a list of online support groups where individuals living with HIV/AIDS can connect, share experiences, and receive emotional support:
POZ Community Forums
POZ Community Forums is a discussion board that allows people with HIV and loved ones to share information and support on topics such as:
- diagnosis
- treatment
- daily living
- community resources
Access the forums at any time of day to share questions and stories or to respond to posts from others.
The forums are moderated, and users may be banned for making inappropriate posts or sharing inaccurate medical advice.
Keep in mind that others can see posts, so choose a username wisely to remain anonymous if needed.
HIV/AIDS Therapy Tribe
Therapy Tribe is an online community that offers support to people coping with mental health and wellness concerns, including HIV.
The HIV/AIDS Tribe offers a space to connect with others who are going through similar experiences. Take part in discussion forums, send and receive friend requests, and find a variety of wellness tools.
The Well Project
The Well Project is a nonprofit organization for girls and women living with HIV.
The organization hosts multiple moderated forums where girls and women around the world can connect to share information and support.
Visitors can read about the experiences of others on the organization’s blogs, including A Girl Like Me in English or the Spanish version, Una Chica Como Yo.
Positive Peers
Positive Peers is an online app for teenagers and young adults ages 13 to 34.
It helps youth with HIV find information and tools for managing the condition. It also helps them connect with other youth who have HIV.
Users need a smartphone and email address to register for the app.
NAMI Connection
People with HIV have an increased risk of mental health conditions, such as depression and anxiety.
Doctors may recommend medication, talk therapy, or a combination to treat mental health conditions.
It may also be helpful to join a support group for people experiencing mental health challenges. The National Alliance on Mental Illness offers in-person and virtual support groups in many states. Check for nearby support groups with the NAMI Connection search tool.
Social media groups
Many groups on Facebook and other social media platforms share information and connect people living with HIV.
One example is Healthline’s HIV Awareness Facebook group.
Social media groups are asynchronous, which means comments are posted at any time. Some groups also offer live videos or virtual events about specific topics and connections with others.
Some social media groups are run by medical professionals or patient advocacy organizations, while others are run by individuals. Choosing to join a group or multiple groups depends on preference.[5]
[5] Cherney, K. (2021, March 19). Mental health spotlight: online HIV support groups. Healthline Media. https://www.healthline.com/health/hiv/online-hiv-support-groups
financial assistance for hiv care
HIV care and treatment involves taking HIV medicine called antiretroviral therapy (ART) and having regular check-ups with your health care provider who will monitor your health status on an ongoing basis.
These things are important because with the proper care and treatment, you can reduce your viral load, protect your health, enjoy a long and healthy life, and prevent transmitting the virus to others.
But you might have concerns about how to pay for this. There are resources that can help you pay for the care you need. The following are some of those financial assistance resources:[6]
[6] HIV.gov. (2023, July 13). Paying for HIV care and treatment. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/paying-for-hiv-care-and-treatment/
ADAP
AIDS Drug Assistance Program (ADAP) Directory
ADAP is a federal program administered by the HRSA HIV/AIDS Bureau that covers medication costs for people with HIV. This website provides information on ADAP coverage for each U.S. state and territory, including eligibility, application instructions, and formulary links. ADAPs also assist with insurance premium co-pays for people with HIV.
Manufacturer-based Programs
All listed medications are approved for treatment of HIV infection. Medications used in post-exposure prevention and pre-exposure prevention are also listed below.
Pharmaceutical Company Patient Assistance Programs and Cost-Sharing Assistance Programs
Fact sheets and reference tables compiled by NASTAD covering HIV treatment, prevention, and hepatitis B and C treatment. Includes eligibility and contact information.
PhRMA: Medicine Assistance Tool
Single database of most patient assistance programs with links out to the programs listed below. The site also features educational information for patients on a range of payment sources (Health Insurance Marketplace, Medicare, Medicaid).
HIV Pre-exposure Prophylaxis (PrEP)
See the AETC Prescribing PrEP Quick Guide for details.
Federal program to make all PrEP medication available at no cost.
HIV Post-exposure Prophylaxis (PEP/nPEP/oPEP)
See the AETC nPEP Toolkit for prescribing details.
Non-Profit Organizations
These projects assist with medication costs (including co-pays) for HIV prevention and care and other conditions.
Non-profit. Check for funding availability.
- Patient Access Network (PAN Foundation)
Non-profit. Check for funding availability.
Non-profit. Check for funding availability.
Non-profit providing medications for the uninsured. They also have a program to support people who are on their state's ADAP waiting list.[7]
[7] AETC National Coordinating Resource Center. (2023, July 12). HIV medication assistance programs. https://aidsetc.org/resource/medication-assistance-programs#:~:text=AIDS%20Drug%20Assistance%20Program%20(ADAP,application%20instructions%2C%20and%20formulary%20links
Get Help Paying for HIV Care
If you do not have health insurance or money to pay for health services, you might qualify for medical care and other essential support services.
If you have HIV and cannot work, you may qualify for benefits from the Social Security Administration.
Use online cost calculators to help you understand options for lowering the cost of health insurance.
If you have Medicare, learn about what the drug plans cover and the costs you’ll pay.
See if you can enroll in or change plans and get answers to common questions.
The ACA created several changes that expand access to coverage for people with HIV.
Find prescription drug assistance information and learn about current expanded access trials. [8]
[8] Centers for Disease Control and Prevention. (2022, July 15). Resources for people with HIV. https://www.cdc.gov/hiv/basics/livingwithhiv/resources.html
Legal Assistance
HIV-related legal services are essential to protect and promote the rights of people living with HIV, and are essential to ensure good public health outcomes. HIV-related legal services help build and sustain an environment for effective HIV testing, treatment, and prevention. With legal assistance, people with HIV can secure and protect their legal rights. Legal services can help provide concrete solutions to HIV-related legal and social problems. CHLP is dedicated to strengthening HIV-related legal services.
The National Resource Center on HIV, Infectious Disease, Sexual Health and Identity
This HIV Policy Resource Bank category includes compilations of resources and information about organizations and agencies that provide legal advice and representation for people with HIV, in most cases free of charge to those who meet financial eligibility requirements. It also includes materials that address the importance of legal services and their relevance to health outcomes for people in need.
Select your state for information on HIV criminalization laws and policies that have been used to prosecute people living with HIV based on research for CHLP's Sourcebook on State and Federal HIV Criminal Law and Practice.[9]
[9] Making Positive Justice Possible. (n.d.). Making positive justice possible. https://www.hivlawandpolicy.org/
How Can I Help End HIV?
Want to get involved in HIV-related efforts? Here are some ideas:
Reach out to a local HIV service organization. Many HIV service organizations have opportunities for people living with HIV and others to share their time and talents. Depending on the organization, volunteer opportunities may include:
- Assisting with onsite or mobile testing events by being a greeter, registrar, health educator, or HIV tester
- Providing administrative support, such as filing, data entry, or answering phones
- Helping with special events
- Participating in fundraising or advocacy activities
- Providing language skills
- Offering professional services, such as legal assistance or medical care, if licensed
To find a local HIV service organization near you, use HIV.gov’s HIV Testing Sites & Care Services Locator.
Engage with others. Social media tools like Facebook, Twitter, Instagram, and LinkedIn offer many opportunities to connect with others who are interested and involved in HIV issues. Many organizations, including HIV.gov, share content on YouTube and other video-sharing platforms about HIV testing, prevention, treatment, and policies. You can share information about HIV via these channels to help others learn more.
Get involved in HIV awareness days. Check out HIV.gov's HIV awareness days page to see how you can support national observances to raise awareness and encourage people to get tested for HIV, seek, or return to care.
Learn. Stay abreast of changes in HIV prevention, care, treatment, and research, and learn about new tools or resources. Check out HIV.gov's learning opportunities page to find webinars, conferences, Twitter chats, and other events.
Share what you know. You can make a difference by learning more about HIV and sharing that knowledge with others. Talk to others about testing, how to prevent HIV, the effectiveness of treatment, and the importance of getting and staying in medical care. Use HIV.gov's Basics pages to find answers to questions you or others may have. You can easily share those pages on social media or via email using the buttons at the top right side of each page.
Stay up to date. Subscribe to receive HIV.gov Email Updates.[10]
[10] HIV.gov. (2023, July 10). Getting involved. https://www.hiv.gov/hiv-basics/overview/making-a-difference/getting-involved/
Stigma Reduction
What Is HIV Stigma?
HIV stigma refers to irrational or negative attitudes, behaviors, and judgments toward people living with or at risk of HIV. It can negatively affect the health and well-being of people living with HIV by discouraging some individuals from learning their HIV status, accessing treatment, or staying in care. HIV stigma can also affect those at risk of HIV by discouraging them from seeking HIV prevention tools and testing, and from talking openly with their sex partners about safer sex options.
Populations disproportionately affected by HIV are also often affected by stigma due to, among other things, their gender, sexual orientation, gender identity, race/ethnicity, drug use, or sex work.
HIV stigma drives acts of discrimination in all sectors of society, including health care, education, the workplace, the justice system, families, and communities.
Breaking down HIV stigma is a critical part of ending the HIV epidemic.
What Is Internalized Stigma for People with HIV?
Internalized stigma is when a person with HIV experiences negative feelings or thoughts about themselves due to their HIV status. Almost 8 in 10 adults with HIV receiving HIV medical care in the United States report feeling internalized HIV-related stigma, according to a CDC study. Internalized stigma can lead to depression, isolation, and feelings of shame, and can affect individuals’ ability to stay adherent to their HIV medication. Read more about this and about how people with HIV can reduce internalized stigma.
How Can I Stand Up to HIV-Related Stigma?
You can play an important role in reducing stigma and discrimination by offering support and speaking out to correct myths and stereotypes about HIV that you hear from others.
Learn which words have negative meanings for people at risk for or living with HIV and which are empowering. Be intentional when you choose your words and mindful of how they can affect those around you. Use CDC’s HIV Stigma Language Guide to learn how to talk about HIV in a way that is not stigmatizing.
Here are some other ideas for standing up to stigma:
- Get the facts. Read CDC’s fact sheet on HIV stigma.
- Get inspired. View the personal stories of people who are living healthy with HIV. Visit Positive Spin.
- Learn more. Check out CDC’s Stop HIV Stigma campaign, which highlights the role that each person plays in stopping HIV stigma and gives voice to people living with HIV, as well as their friends and family.
- Get involved. Give your time to HIV-related efforts.[11]
[11] HIV.gov. (2023, July 18). Standing up to stigma. https://www.hiv.gov/hiv-basics/overview/making-a-difference/standing-up-to-stigma/
FREQUENTLY ASKED QUESTIONS (FAQ)
FREQUENTLY ASKED QUESTIONS (FAQ)Activities provided under the Medical Case Management service category have as their objective improving health care outcomes. In contrast, those provided under the Non-Medical Case Management service category have as their objective providing guidance and assistance in improving access to needed services.
Resources
ResourcesRWSD recently added a new module that allows for agencies to share eligibility status. Please review the manuals below and check the Resource Center for additional information.
This Service and Resource Guide includes listings for HIV/AIDS services funded through the Massachusetts Department of Public Health (MDPH). It has been created to assist providers in making appropriate referrals for individuals in need of HIV prevention, testing, treatment, medical case management, and other health and social services. It also includes resources for related topics including sexual assault, viral hepatitis, sexually transmitted infections, and substance abuse. Please contact the individual programs and agencies listed for more information about their available services, languages spoken, hours of operation, and eligibility requirements.
Reference List
ReferencesHealth Resources and Services Administration. (2018, October 22). Ryan White HIV/AIDS Program services: eligible individuals & allowable uses of funds. https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/service-category-pcn-16-02-final.pdf
Budak, J. (2017, April 17). Linkage to HIV care. The National HIV Curriculum. https://www.hiv.uw.edu/go/screening-diagnosis/linkage-care/core-concept/all
NIH’s Office of AIDS Research. (2021, August 12). HIV treatment adherence. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-adherence
Imani. (2022, June 3). The importance of a peer support network in HIV care. Minority AIDS Support Services, Inc. https://minorityaidssupport.org/the-importance-of-a-peer-support-network-in-hiv-care/#:~:text=You%20are%20in%20the%20right,worse%20for%20their%20mental%20health
Cherney, K. (2021, March 19). Mental health spotlight: online HIV support groups. Healthline Media. https://www.healthline.com/health/hiv/online-hiv-support-groups
HIV.gov. (2023, July 13). Paying for HIV care and treatment. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/paying-for-hiv-care-and-treatment/
AETC National Coordinating Resource Center. (2023, July 12). HIV medication assistance programs. https://aidsetc.org/resource/medication-assistance-programs#:~:text=AIDS%20Drug%20Assistance%20Program%20(ADAP,application%20instructions%2C%20and%20formulary%20links
Centers for Disease Control and Prevention. (2022, July 15). Resources for people with HIV. https://www.cdc.gov/hiv/basics/livingwithhiv/resources.html
Making Positive Justice Possible. (n.d.). Making positive justice possible. https://www.hivlawandpolicy.org/
HIV.gov. (2023, July 10). Getting involved. https://www.hiv.gov/hiv-basics/overview/making-a-difference/getting-involved/
HIV.gov. (2023, July 18). Standing up to stigma. https://www.hiv.gov/hiv-basics/overview/making-a-difference/standing-up-to-stigma/