Lessons Learned from Applying a Modified Learning Collaborative Model to Promote Change in Regional and Statewide HIV Care Systems

Abstract

The Health Resources and Services Administration Special Projects of National Significance launched the Systems Linkage and Access to Care for Populations at High Risk of HIV Infection Initiative in 2011. Six state departments of health were funded to utilize a modified Learning Collaborative model to develop and/or adapt HIV testing, linkage to care and retention in care system-level interventions. More than 60 Learning Sessions were held over the course of the Learning Collaborative. A total of 22 unique interventions were tested with 18 interventions selected and scaled up. All interventions were created to impact services at a systems level, with standardized protocols developed to ensure fidelity. Our findings provide key lessons and present considerations for replication for use of a modified Learning Collaborative to achieve state-level systems change.

Strengths and Challenges of Implementing a Learning Collaborative in the Ryan White HIV/AIDS Program

“…The collaborative, rapid-learning approach of an LC, and its focus on affecting system-level change and uptake of evidence-based interventions, provides a useful tool for jurisdictions to address these barriers and improve disparities along the HIV care continuum. Furthermore, LCs were used to address similar problems in other programs (see DeLorenzo et al, 2019; Haine-Schlagel et al, 2013; and Selk et al, 2015 for examples).…”

“…An LC is a network of participants, which could be individuals, organizations, or organizational systems, that come together to share information, work toward a goal, and/or conduct work on a particular topic (Institute for Healthcare Improvement, 2003; Wenger-Trayner & Wenger-Trayner, 2015). Examples of topics LCs have helped address include increasing uptake of routine HIV testing (Rodriguez et al, 2016), promoting evidence-based engagement strategies in early intervention programs for young children (Haine-Schlagel et al, 2013), and addressing health disparities (Chin et al, 2004; Chin et al, 2007; DeLorenzo et al, 2019; Fernandes et al, 2012; Landon et al, 2004; Landon et al, 2007; Oyeku et al, 2012; Taplin et al, 2008). LC projects in health care are typically related to achieving health care quality measures.…”

Rapid start antiretroviral therapies for improved engagement in HIV care: implementation science evaluation protocol

“…To support implementation, we have utilized the Institute for Healthcare Improvement’s Collaborative Model [ 50 ] (colloquially known as “learning collaboratives”) as a primary technical assistance mechanism [ 51 ]. We have used a similar approach on multiple prior HIV service projects [ 52 , 53 ]. Each of the implementation sites work with an assigned coach with expertise in quality improvement (QI) methods in HIV care delivery; participate in initiative-wide, two-day Learning Sessions three times a year; and attend webinars and cohort meetings that include peer learning and/or experts in rapid ART start.…”

Special Projects of National Significance Systems Linkages Initiative (2011 to 2016): Improving Access to Care for Hard-to-Reach Populations Living with HIV

“…Based on its prior experience with Cross-Part initiatives, HAB required the use of an adaptation of the Model for this initiative to explore how its scope might be expanded beyond its traditional focus on quality improvement to the development and implementation of regional and statewide community-level interventions. DeLorenzo et al [19] explain how this adoption shaped the overall initiative, describing the mechanics of implementing the Model's Learning Collaborative meetings where stakeholders from all over their respective states worked together to craft the innovative interventions, and in so doing created cooperation and buy-in. As such, this approach shows great promise for creating collaborative partnerships at regional and statewide levels to improve the care and treatment of PLWH.…”