Linkage to Care Programs May Help in Reducing HIV Transmission

By providing HIV testing, counseling, screening for other STDs, transportation assistance, and other services, these programs were able to successfully identify new cases of HIV in high-risk groups and provide them with follow-up care.

During a poster session at the 2013 United States Conference on AIDS, authors shared the results of a comparison of “Linkage to Care” programs in Monroe County, New York. The poster’s first author was Donna Shulman, BSN, MS, MFT, University of Rochester, Center for Health and Behavioral Training.

Though viral suppression significantly reduces HIV transmission, the CDC estimates that only 25% of people living with HIV in the US are virally suppressed, and only 37% currently see a medical provider. Additionally, 18% of the population is unaware of their status. Thus, there is a substantive need to both identify individuals with HIV and to make sure they get successful follow-up care.

The state of New York funded two Linkage to Care Programs (LTC) in Monroe County to address these gaps in two different testing settings. The poster authors analyzed results from the two projects from January 1, 2012 to June 30, 2013.

The first standard LTC program provided services in a public STD clinic, a county jail, and a juvenile correction center. It provided standard services such as HIV testing, behavioral counseling, screening for other STDs, services for partners of infected individuals, and linkage to follow-up medical care, including three to six months of supportive case management.

The second expanded LTC program provided services in hospital emergency rooms and affiliate sites, the first program of this type in the state. In addition to the services above, this program also offered a phone hotline for test results and counseling, transportation assistance, and additional follow-up services. Both programs emphasized heavy collaboration and communication between all Linkage to Care staff.

Over the 18 months duration of the study, the standard LTC program identified 10 percent of the new HIV diagnoses in Monroe County, and the expanded program identified 43% of the new diagnoses (a total of 118 new diagnoses overall). Both programs were relatively successful in linking HIV-positive individuals to follow-up care: 91% in the standard program and 97% in the expanded program. This included linking up newly identified individuals but also connecting people who knew their status but were not currently seeing a provider. According to the authors, to do this they needed bilingual and culturally competent staff willing to maintain ongoing contact with patients, including home visits.

Notably, the two programs identified somewhat different populations with HIV. The standard LTC program identified a high percentage of black MSM and bisexual males. In contrast, the expanded LTC program identified a greater percentage of female, older, and heterosexual individuals, who are not usually identified in traditional HIV testing settings.

One of the program’s collaborators, Ann Schwartz, explained that New York State has decided to continue these expanded testing programs due to their success. Though it can be a challenge implementing these new services in the emergency room setting, the approach can reach people who would otherwise remain undiagnosed. “One of our goals is to make asking about HIV into a routine question. It’s a bit of a paradigm shift—to recognize that we are all at risk,” she said.