Chair Babafemi O. Taiwo, MBBS, prepared useful Practice Aids pertaining to HIV for this CME/MOC/NCPD/CPE/CECH activity titled “Road Map to Re-Engagement: A Visual Guide to Overcoming Individual and Systemic Barriers to HIV Care and Treatment .” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/CPE/CECH information, and to apply for credit, please visit us at http://bit.ly/3UKumGN. CME/MOC/NCPD/CPE/CECH credit will be available until August 2, 2024.

1. Motivational Interviewing to Improve Engagement
in Care and Adherence to Treatment1-3
Full abbreviations, accreditation, and disclosure information
available at PeerView.com/JDT40
1. https://aidsetc.org/sites/default/files/resources_files/MAAETC-%20Motivational_Interviewing2018.pdf. 2. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY:
Guilford Press; 2013. 3. Douaihy A, Gold MA, Kelly TM. Motivational Interviewing: A Guide for Medical Trainees. New York, NY: Oxford University Press; 2015.
• Motivational Interviewing is a goal-oriented style of communication involving use
of the language of change and collaboration between patient and healthcare
provider
• It is a practice empirically validated across diverse populations and for a wide
variety of target behaviors in the context of chronic medical conditions, diet and
exercise, drug and alcohol use, and treatment engagement and adherence
• It strengthens personal motivation for, and commitment to, specific goals
by exploring the person’s own reasons for change in an accepting and
compassionate atmosphere
Manage roadblocks to listening
Listen with the intent to understand
what the person is thinking, feeling,
and experiencing
Use more reflective listening to
engage the person
Normalize the person’s ambivalence
about change
Believe that change is within this
person’s own reach
Respect and support the person’s
autonomy and right to make decisions
Provide specific affirmations
Evoke the person’s reasons and
ideas for change
Summarize the person’s thoughts,
feelings, and experiences
Focus more on eliciting change talk
Ask permission to give feedback and
suggestions
Have in-depth discussions about the
person’s statements
Let roadblocks get in the way
of listening
Listen with the intent to reply
Use more questions to engage
the person
Ignore ambivalence and push
for change
Believe the person is not capable
of change
Convey that I am the expert and the
person must follow my advice
Use cheerleading
Impose reasons and ideas for change
Summarize my thoughts and
perspectives
Focus more on reinforcing sustain talk
Provide unsolicited feedback and
suggestions
Keep the conversation superficial
Do Don't

2. Rapid ART Restart1,2
Full abbreviations, accreditation, and disclosure information
available at PeerView.com/JDT40
• Immediate antiretroviral therapy (ART) refers to starting HIV treatment
as soon as possible after the diagnosis of HIV infection, preferably
on the first clinic visit (and even on the same day the HIV diagnosis is
made). This strategy also is known as "rapid ART," "same-day ART," and
"treatment upon diagnosis”
• Rapid ART is recommended by the Guidelines for the Use of Antiretroviral
Agents in Adults and Adolescents with HIV from the U.S. Department of
Health and Human Services to “increase the uptake of ART and linkage
to care, decrease time to viral suppression for individual patients, and
improve the rate of virologic suppression among persons with HIV”
• Nearly all PWH who are re-engaging
in care
• PWH for whom the ART history is
known, and HIV resistance is known
or can be predicted
• An appropriate ART regimen can
be devised without information from
current resistance test results
• HIV RNA (viral load)
• CD4 cell count
• HIV resistance test
• Creatine, liver transaminases
• Other tests if not previously done
• Persons with certain untreated
opportunistic infections (OIs), such
as CNS OIs, for whom a short
period of treatment for the OI is
recommended before ART initiation
• An appropriate ART regimen cannot
be devised without information from
current resistance test results
Rapid ART Restart for Persons Returning to Care
• While a key goal of HIV care is for people with HIV (PWH) to achieve
continuous viral suppression on ART, many PWH may stop ART or fall out of
care for periods of time
• It is important to re-engage these patients in care at the earliest opportunity,
and to support them in restarting ART
Immediate ART Restart
Is Appropriate For
Immediate ART Restart
Is Not Appropriate For
Laboratory Testing
What Is
Rapid ART?

3. Rapid ART Restart1,2
Full abbreviations, accreditation, and disclosure information
available at PeerView.com/JDT40
1. https://aidsetc.org/sites/default/files/resources_files/ncrc-rapid-art-6-10-21_0.pdf. 2. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv.
ART Regimens for Rapid Restart
Regimens should be selected individually, based on the
patient’s specific HIV, ART, and resistance history; as well as
their comorbidities, tolerance of previous ARVs, adherence
challenges, and other factors
It is not possible to make recommendations for individual patients, but common ART
restart scenarios include
– The patient was taking a 1st or 2nd ART regimen and there is no suspected
resistance: can start one of the regimens for initial immediate ART or (unless
contraindications) can restart the patient’s previous regimen
– The patient has a known or suspected history of virologic failure with acquired
ART resistance: select the ART regimen based on the suspected resistance
mutations
– If there is concern for NRTI and/or NNRTI resistance, consider a boosted
protease inhibitor + 2 NRTIs ± an integrase inhibitor
– If there is concern for NRTI and/or INSTI resistance, consider a boosted
protease inhibitor + 2 NRTIs ± a second-generation NNRTI
– If more extensive resistance may be present, consider a multi-class regimen
with a boosted darunavir + an integrase inhibitor ± an NNRTI ± NRTIs ±
fostemsavir or other ARVs as indicated
Consult with an HIV expert!

4. Tool and Steps for Identifying Evidence-Based Interventions
for Retention and Re-Engagement of PLWH in Care1,2
Full abbreviations, accreditation, and disclosure information available at PeerView.com/JDT40
1. https://wwwn.cdc.gov/HIVCompendium/SearchInterventions. 2. https://www.cdc.gov/hiv/research/interventionresearch/compendium/lrc/index.html.
The CDC provides a searchable Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention1
as well as a separate list of interventions for linkage to, retention in, and re-engagement in HIV care2
4. Assemble
a team with
assigned roles
3. Select a plan that
will work for your situation
and clinical program
1. Enter your targeted
population
2. Enter your desired
effects or outcomes
5. Implement
the intervention
6. Collect data 7. Evaluate 8. Adjust
9. Repeat
as needed