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Institute of Mental Health","doi-asserted-by":"publisher","award":["R25MH083620"],"award-info":[{"award-number":["R25MH083620"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Status\u2010neutral approaches to HIV treatment and prevention, which link all individuals to tailored, comprehensive services following HIV testing, are promising strategies for reducing HIV service delivery inequities and improving clinical outcomes. However, transferable, feasible models of status\u2010neutral service delivery are poorly understood, particularly in the United States, where implementation contexts are geographically and institutionally disparate. To guide expanded implementation, we identified difference\u2010making attributes of status\u2010neutral implementation workflows in a diverse sample of public sector\u2010funded HIV clinical organizations in U.S. jurisdictions prioritized in the Ending the HIV Epidemic (EHE) Initiative.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In March\u2212June 2024, we invited frontline HIV service providers across six EHE jurisdictions (Alabama, Baltimore, Chicago, Dallas, Los Angeles, San Diego) to participate in virtual focus group discussions (FGDs), segmented by ongoing or planned status\u2010neutral implementation. We depicted an HIV status\u2010neutral workflow and elicited discussants\u2019 perspectives on (in)consistencies between the illustration and their implementation practices. Applying comparative workflow modelling, we re\u2010illustrated status\u2010neutral implementation pathways and identified workstream features distinguishing service delivery across clinical organizations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n We facilitated eight FGDs with 56 providers across 20 organizations. Status\u2010neutral implementation processes varied substantially across clinical organizations\u2014distinguished by the roles and responsibilities of clinical (i.e. physicians, nurses) and non\u2010clinical (i.e. navigators, case managers) staff as well as by the sequence and timing of activities within workflows. We identified four workflow attributes that distinguished clinical organizations: (1) the timing of health insurance review (whether insurance assessments and navigation occurred earlier vs. later in the implementation pathway); (2) the magnitude of activity integration (whether services were delivered concurrently vs. sequentially); (3) the presence of implementation partnerships (whether HIV testing was conducted in\u2010house vs. externally); and (4) the extent of workforce task\u2010shifting (whether services were primarily delivered by clinical vs. non\u2010clinical staff).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Workflow heterogeneities reflected jurisdictional and organizational differences in funding, staffing and infrastructure. Generalizable attributes, including the degree of workflow integration and staff role delineation, can inform scalable implementation models. Enhanced cross\u2010training and increased involvement of non\u2010clinical staff (especially in HIV prevention workflows) are critical to enable adaptable, timely and person\u2010centred HIV service delivery across diverse care settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jia2.70158","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:24:17Z","timestamp":1791527057000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Workflow Modelling of HIV Status\u2010Neutral Care Implementation in Six High\u2010Burden Jurisdictions in the United States: A Qualitative Study"],"prefix":"10.1002","volume":"29","author":[{"given":"Tongying","family":"Zhao","sequence":"first","affiliation":[{"name":"Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA"},{"name":"Gillings School of Global Public Health University of North Carolina Chapel Hill North 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Y.Adashi \u201cThe Ryan White HIV\/AIDS Program: Thirty Years of Addressing Health Disparities \u201dJournal\u00a0of\u00a0Health Care\u00a0for the\u00a0Poor\u00a0and\u00a0Underserved35 no.2(2024):726\u2013730 https:\/\/doi.org\/10.1353\/hpu.2024.a928642.","DOI":"10.1353\/hpu.2024.a928642"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70158","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.70158","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70158","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T05:12:16Z","timestamp":1791781936000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.70158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":42,"journal-issue":{"issue":"S5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jia2.70158"],"URL":"https:\/\/doi.org\/10.1002\/jia2.70158","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2025-10-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70158"}}