PROJECT SUMMARY (CATEGORY B ONLY) Antiretroviral therapy (ART) has dramatically changed the landscape of clinical care for HIV. For people living with HIV (PLWH), ART can extend the lifespan, decrease morbidity, and prevent onward transmission of the virus. Because of the benefits for PLWH and for public health, ART is now recommended for all PLWH. Yet nearly 1 in 5 people who are diagnosed with HIV and who receive medical care do not receive ART. This has contributed to the United States falling far short of its national goal of 80% viral suppression, with racial/ethnic and urban-rural disparities in viral suppression remaining. Identifying the PLWH most in need of these interventions in real-time, where impact can be immediate, is challenging although Data to Care interventions using surveillance data have recently successfully been implemented. However, no Data to Care interventions have been implemented, to our knowledge, using medical claims data which is a rich, real-time source of medical engagement and quality of care. The AIMS project (Antiretroviral Improvement among Medicaid enrolleeS) will uniquely integrate administrative claims and HIV surveillance data in real-time to implement a novel insurance-based Data to Care study that will improve antiretroviral prescribing and adherence among Medicaid enrollees living with HIV. We aim to: 1) Refine and assess a novel algorithm to identify people living with HIV and their providers from real-time administrative claims (Aim 1); 2) Implement and evaluate AIMS— including peer-to-peer provider consultation, enhanced patient support, and usual care for Medicaid enrollees with HIV and no antiretroviral prescriptions for an extended period—using a rigorous experimental design (Aim 2); and 3) Conduct a cost-effectiveness of the AIMS patient and provider interventions (Aim 3). By leveraging real-time, comprehensive administrative claims and HIV surveillance data, AIMS interventions will be delivered at the critical stage before PLWH fall out of HIV care. The AIMS interventions thus have the potential to improve key quality of care and health outcomes for people living with HIV, including ART initiation, re- initiation, adherence, and viral suppression. The AIMS study builds on the successful implementation of a Data2Care initiative in Virginia, which has used HIV surveillance data to successfully re-link PLWH to care, and capitalizes on Virginia's recent expansion of Medicaid, providing a unique sample of PLWH who may be receiving HIV medical care for the first time. Results from this project have the potential to improve several key health indicators for PLWH in Virginia, which are critical for improving public health and promoting health equity. This work will also develop and rigorously test a model for real-time interventions to support the HIV care continuum, which other jurisdictions may adopt.