Meeting patients where they are: The Tacoma MAX clinic's collaborative low-barrier approach to HIV care.

In Tacoma, Washington, people with HIV (PWH) face significant barriers to care. This study compares viral suppression and patient-centered outcome effectiveness of co-located Ryan White (RW) and MAX (low-barrier, walk-in, engaging previously disengaged PWH with unsuppressed viral loads (VL) clinics.Mixed-methods, prospective cohort study of MAX/RW participants surveyed/interviewed at baseline, 6 and 12 months, assessing VL suppression (86 qualitative interviews coded thematically across six health/medical care domains). Eligibility criteria: VL >200 copies/mL (last 12 months), out of care ≥12 months, or facing engagement barriers. EMR VL data were collected between January 2020 and February 2025.Participants enrolled: 30 MAX and 70 RW. Viral suppression by timeline: -6 months (69.6% MAX, 78.4% RW; p = 0.4). -2.5 years (60.0% MAX, 92.1% RW; p = 0.003). MAX had higher baseline rates of housing instability (p = 0.11) and mental illness (p = 0.02) but cited immediate access, non-judgmental care, and wraparound services as being "lifesaving", with fewer unmet mental health needs and greater care access and education.Low-barrier models play a vital role in re-engaging PWH facing barriers. While RW achieved higher long-term viral suppression, MAX achieved improved trust, health literacy, and retention-foundations for long-term health. Integrated, patient-centered approaches can complement traditional care and address service gaps.