Abstract
BackgroundImplementation of linkage to HIV care programs in the U.S. is poorly described in the literature despite the central role of these programs in delivering clients from HIV testing facilities to clinical care sites. Models demonstrating success in linking clients to HIV care from testing locations that do not have co-located medical care are especially needed.MethodsData from the Antiretroviral Treatment Access Studies-II project ('ARTAS-II') as well as site visit and project director reports were used to describe structural factors and best practices found in successful linkage to care programs. Successful programs were able to identify recently diagnosed HIV-positive persons and ensure that a high percentage of persons attended an initial HIV primary care provider visit within six months of enrolling in the linkage program.ResultsEight categories of best practices are described, supplemented by examples from 5 of 10 ARTAS-II sites. These five sites highlighted in the best practices enrolled a total of 352 HIV+ clients and averaged 85% linked to care after six months. The other five grantees enrolled 274 clients and averaged 72% linked to care after six months. Sites with co-located HIV primary medical care services had higher linkage to care rates than non-co-located sites (87% vs. 73%). Five grantees continued linkage to care activities in some capacity after project funding ended.ConclusionsWith the push to expand HIV testing in all U.S. communities, implementation and evaluation of linkage to care programs is needed to maximize the benefits of expanded HIV testing efforts
Highlights
Implementation of linkage to HIV care programs in the U.S is poorly described in the literature despite the central role of these programs in delivering clients from HIV testing facilities to clinical care sites
Programs that actively facilitate connecting a recently diagnosed HIV-positive person to HIV medical care are known as linkage to care programs or models
ARTAS-II showed that 79% of all participants enrolled in the program visited an HIV clinician at least once within the first six months [13]. These findings indicated that a brief linkage case management intervention can be implemented effectively by service-oriented organizations in typical HIV programs in rural, mid-sized, and urban settings in the U.S The objective of the current report was to describe best practices and structural characteristics of organizations from the ARTAS-II demonstration project, those factors which facilitated successful implementation of a program to link recently diagnosed HIV-infected persons to HIV care providers
Summary
Implementation of linkage to HIV care programs in the U.S is poorly described in the literature despite the central role of these programs in delivering clients from HIV testing facilities to clinical care sites. Linkage to care models have been mostly homegrown, small single-site efforts at large medical centers closely co-located with HIV testing facilities. Some of these models from large medical centers with emergency room testing and a nearby HIV clinic have shown impressive rates of linkage to care within a few months, often exceeding 85% [7,8,9,10,11]. There is still an urgent need to evaluate linkage models that connect clients to HIV care from testing locations outside of HIV medical care settings
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