Barriers and Facilitators of Linkage to HIV Primary Care in New York City
ABSTRACT Background: One in five people living with HIV in the U.S. are unaware of their status; they account for 51% of new infections. HIV transmission can be reduced through test and treat, which can decrease both viral load and risk behaviors. However, linkage to care has proved challenging. We performed a qualitative study on linkage of HIV testing sites that partnered with the New York City Department of Health and Mental Hygiene (NYCDOHMH) to implement The Bronx Knows, a NYCDOHMH borough-wide initiative that tested 607,570 residents over 3 years.
Design/Methods: We interviewed directors and administrators of 24 HIV testing sites to identify linkage problems and successes, and selected 9 for case studies of best linkage practices.
Results: There were three problem domains: (1) system factors (long wait for provider appointments; requirement of a positive confirmatory test before scheduling an appointment; lack of staff respect for patients); (2) social factors (HIV stigma, public, perceived and enacted); (3) stigmatizing patient statuses (e.g., mental illness, homelessness, substance use, immigrant). Best practices for linkage included networking among community organizations; individualized care plans; team approach; and patient peer navigation. No providers cited decreased community viral load as a rationale for prioritizing linkage.
Conclusions: Successful linkage requires a comprehensive individualized approach that reduces the compounded stigma that risk populations face, minimizes delays in seeing a care provider, and provides patient navigation services to address system complexity. Providers defined their role as caring for patients, overlooking the broader public health impact of preventing HIV transmission.
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ABSTRACT: The contributions reported in this supplemental issue highlight the relevance of NIH-funded CEWG research to health department–supported HIV prevention and care activities in the 9 US cities with the highest numbers of AIDS cases. The project findings have the potential to enhance ongoing HIV treatment and care services and to advance the wider scientific agenda. The HIV testing to care continuum, while providing a framework to help track progress on national goals, also can reflect the heterogeneities of local epidemics. The collaborative research that is highlighted in this issue not only reflects a locally driven research agenda but also demonstrates research methods, data collection tools, and collaborative processes that could be encouraged across jurisdictions. Projects such as these, capitalizing on the integrated efforts of NIH, CDC, DOH, and academic institutions, have the potential to contribute to improvements in the HIV care continuum in these communities, bringing us closer to realizing the HIV prevention and treatment goals of the NHAS.JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2013; 64 Suppl 1. DOI:10.1097/QAI.0b013e3182a99bc1 · 4.56 Impact Factor
- Clinical Infectious Diseases 07/2014; 59(8). DOI:10.1093/cid/ciu554 · 8.89 Impact Factor
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ABSTRACT: We evaluated 1,359 adults newly diagnosed with HIV in Philadelphia in 2010-2011 to determine if diagnosis site (medical clinic, inpatient setting, counseling and testing center (CTC), correctional facility) impacted time to linkage to care (difference between date of diagnosis and first CD4/viral load). 1,093 patients (80%) linked to care: 86% diagnosed in medical clinics, 75% in inpatient settings, 62% in CTCs, and 44% in correctional facilities. Adjusting for other factors, diagnosis in inpatient settings, CTCs, and correctional facilities resulted in a 33% (adjusted hazard ratio=0.77, 95% confidence interval=0.64-0.92), 46% (0.56, 0.42-0.72), and 75% (0.25, 0.18-0.35) decrease in the probability of linkage compared to medical clinics, respectively.JAIDS Journal of Acquired Immune Deficiency Syndromes 12/2014; 68(3). DOI:10.1097/QAI.0000000000000459 · 4.56 Impact Factor