A statewide linkage to HIV medical care initiative in North Carolina

background: Timely linkage to HIV care is associated with improved clinical outcomes and retention-in-care. Linkage services incorporating strengths-based counseling, HIV education and systems navigation support were provided by public health service employees (State Bridge Counselors, SBCs) to newly-diagnosed people living with HIV/AIDS (PLWHA) who failed to attend first HIV medical appointments. This study describes the demographics of patients receiving linkage services, client needs addressed, and linkage-to-care outcomes.

methods: SBC intervention tracking data from CAREWare were utilized. Linkage clients’ records from July 2013 to June 2014 were analyzed. Descriptive statistics were calculated on patient demographics, services provided, and outcomes. Data collection and analyses are ongoing.

results: Ninety-four newly diagnosed PLWHA were referred for SBC linkage services, out of 1509 (preliminary number) new diagnoses during this period.  Of those referred, 75(79.8%) were male and 63(67.0%) were black/African American. Forty-four patients received SBC linkage services (direct or indirect), addressing 172 identified specific needs. Medically-related needs (providing education or appointment scheduling) were the most common (n=86, 50.0%); barriers-to-care most commonly addressed among this group were transportation (n=43,25.0%), insurance/benefits (n=36,20.9%), and other financial barriers (n=27,15.7%). Outcomes for referrals included: 37(39.3%) engaged in care; 18 (19%) were not located; 8 (8.5%) were located and did not enter care; and 6(6.3%) moved out-of-state [missing data=17(18.1%)].

conclusions: Nearly 40% of patients referred for linkage services were engaged in medical care, suggesting the SBC linkage program may be beneficial for this hard-to-engage population. Additional patient search mechanisms should be explored to enhance the reach and impact of this intervention.