Case Study · PL Cares · HIV
Developing a solution to improve linkage to and retention in care — through proactive tools and hands-on support.
The UVA Ryan White Clinic deployed PL Cares as standard of care in 2017 — the first clinic in the country to do so. Eight years of continuous deployment, from 2017 to 2025, produced sustained improvements in viral suppression, care retention, and clinical engagement across a diverse rural and urban patient population.
93%
vs. national avg.
Viral suppression rate as of June 2023
880+
since 2017
Clients enrolled at UVA Ryan White
570+
Active Clients
Active clients in the program
61%
vs. 17% industry avg.
1-year PL program retention rate
Background
A rural Ryan White clinic serving 900 patients across 52 counties.
The University of Virginia Health's Ryan White Clinic serves approximately 900 patients with HIV across 52 counties in central and southwest Virginia — a largely rural area that includes only a handful of small towns and cities. The clinic has received Ryan White funding from HRSA since 1998.
Clients face multiple compounding challenges: racial inequity, stigma, poverty, isolation, limited social support, substance use disorder, and significant barriers to transportation and clinic access. Funding from Ryan White Parts B, C, and D supports on-site medical, gynecologic, and mental health care; case management; dental services; community health and retention services; and housing, transportation, and food assistance.
UVA Ryan White Clinic — Charlottesville, Virginia
HIV care clinic serving approximately 900 patients across 52 counties in central and southwest Virginia. Offers primary and gynecologic care, infectious disease services, mental health support, case management, dental care, and housing, transportation, and food assistance.
Challenge
Reaching patients across six hours of rural Virginia — by car.
Prior to 2013, UVA's Ryan White Clinic aimed to support all patients in engaging with care, but actually reaching them was the problem. Patients often didn't answer phone calls — so case managers would drive up to six hours round-trip to connect with clients in person. Clients faced equally long journeys to reach the clinic.
Geographic, structural, and psychological barriers limited communication, connections, and clinic attendance. A new strategy was needed to give both clients and clinic staff the tools to engage consistently — without requiring everyone to be in the same room.
“
“
PL supports patients when and where they need it most, and it has led to improved individual and clinic level outcomes. It is a key tool in my practice.
Rebecca Dillingham, M.D., M.P.H.
Co-Founder, WHT · Infectious Diseases Specialist, UVA
Solution
A clinic-centered digital platform, built with patients and staff.
The UVA team set out to develop a clinic-centered solution focused on improving linkage to care, retention in care, and day-to-day communication — particularly for clients who were new to care, returning to care, or not yet virally suppressed.
After originally testing bi-directional texting programs, the team developed PositiveLinks (PL) — a full-featured smartphone app paired with an online portal. When integrated into clinical practice, the platform combines patient self-monitoring of medication adherence, mood, and stress levels with care coordination tools and access to anonymized social support. The design was shaped directly by input from both clients and clinic staff.
The program includes providing smartphones to clients who don't have a phone, plus a monthly data credit for any client who responded to a predetermined percentage of daily check-ins in the preceding month — the same engagement-based incentive model that has since been adopted by AID Upstate and other partners.
“
Getting data-driven insights from PL has been crucial. Being able to truly make informed decisions has made a real impact.
Karen Ingersoll, Ph.D.
Co-Founder, WHT · HIV Psychologist, UVA · Professor of Psychiatry & Neurobehavioral Sciences
After studies confirmed that PL was effective in improving key outcomes — retention in care and viral suppression — the program was implemented as a component of usual care at the UVA Ryan White Clinic in 2017, where it served as an opt-out program through 2025.
The platform is used by the full care team, including:
Medical providers
Mental health providers
Case managers
Community health workers
Substance use counselors
Nutritionists and pharmacists
CHARLI case managers
Research, development, and testing conducted at UVA and partner universities during the deployment period produced the evidence base that underpins PL Cares and PL HOPE today.
Outcomes
Eight years of sustained clinical improvement.
In the initial 2013 study, CD4 counts, viral load suppression, retention in care, and rates of visit constancy all improved significantly for PL clients. Qualitative analysis also found that PL's community message board provided a meaningful sense of connection and social support — a finding that directly shaped the peer community feature in PL HOPE.
12-month outcomes
87%
Viral suppression rate at 12 months
↑ CD4
CD4 counts improved significantly
51%
Visit constancy improved vs. baseline
Sustained improvements in viral suppression and care retention were maintained at 24 months post-enrollment — demonstrating that PL's impact is durable, not just an initial engagement effect.
24-month outcomes
93%
Well above national Ryan White avg.
Viral suppression rate, UVA cohort
61%
vs. 17% medical app industry avg.
1-year program retention rate
880+
2017–2023
Total clients enrolled
570+
At peak enrollment
Active PL clients at UVA Ryan White
The 1-year retention rate of 61% compares to a medical app industry average of 17% (Alchemer Healthcare App Engagement Benchmarks, 2021).
With funding and support from the Virginia Department of Health, UVA Health has supported PL implementations in other Virginia clinics — extending the reach of the model beyond the original Ryan White Clinic site.
Funding
Ryan White Parts B, C, and D — plus Virginia Department of Health support.
The UVA Ryan White Clinic's PL Cares program has been supported by Ryan White funding from HRSA (Parts B, C, and D), supplemented by grants from the Virginia Department of Health. The VDH has also provided support for PL implementations at other Virginia clinics — demonstrating state-level recognition of the program's clinical value.
The program covers smartphone provision for clients without a device, monthly data credits tied to engagement, and ongoing platform licensing and support from WHT.