Implementation Pilot of a Low-Barrier HIV Care Model Adapted for an Urban Outpatient Infectious Disease Clinic: A Mixed-Methods Evaluation of Feasibility and Acceptability
Bijou R. Hunt, Jacquelyn Jacobs, Patricia Labellarte, Yasmeen Santana, Nancy R. Glick, Nanette D. Benbow, Dennis H. LiObjective
Retention in HIV care remains suboptimal in the United States. Low-barrier care (LBC)—combining walk-in access, integrated case management, and incentives—is effective as a stand-alone clinic, but integration within existing HIV primary care programs is understudied. Methods. From October 2023–December 2024, we piloted a modified LBC model at an urban Chicago infectious disease clinic serving predominantly Black and Hispanic patients, using mixed methods to assess acceptability and implementation challenges. Of 20 eligible patients, 13 enrolled and 8 completed interviews. Walk-in access was offered twice monthly; case managers delivered intensive support services (ISS); incentives ($75–$150) were tied to patient-selected milestones.
Results
All interviewed participants with missed-appointment histories (5/5) attended at least one walk-in visit, two exclusively. Walk-ins improved timeliness and flexibility; ISS provided trusted support; incentives met basic needs but rarely drove engagement.
Conclusions
Challenges included inconsistent schedule awareness and incentive confusion. A clinic-adapted LBC model was acceptable and feasible to deliver with existing resources.