Barriers and Facilitators of Linkage to HIV Primary Care in New York City

Conference PaperinJAIDS Journal of Acquired Immune Deficiency Syndromes 64 · November 2013with11 Reads
DOI: 10.1097/QAI.0b013e3182a99c19
Conference: 141st APHA Annual Meeting and Exposition 2013
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.
  • [Show abstract] [Hide abstract] 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.
    Article · Aug 2013
  • Article · Jul 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives Linkage to care after HIV diagnosis remains underinvestigated in Europe, yet delays in linkage to care are an important obstacle to controlling the HIV epidemic. The Test and Keep in Care (TAK) project aims to determine the prevalence of HIV-positive persons who are lost or late to care and factors associated with this.Methods Data from community-based voluntary counselling and testing that occurred in 2010–2011 were linked with data from HIV clinics using unique test numbers. Persons not registered in HIV clinics were considered lost to care (LTC). For statistical analysis, nonparametric tests were used for comparison, and a multivariable logistic regression model was developed that included all variables with P < 0.1 from the univariable models.ResultsA total of 110 persons were diagnosed as HIV-positive: 91% lived in central Poland, 5% were female and 71% were men who have sex with men (MSM). Forty-seven (42%) persons were LTC, seven of whom did not collect their enzyme-linked immunosorbent assay (ELISA) test result. Of those who registered, 75% registered within 1 month from HIV diagnosis, and 54% were late presenters. LTC individuals were more likely to have heterosexual or bisexual orientation, to have > 20 sexual partners, to not be in a relationship with an HIV-positive partner, to not use condoms, and to be taking their first HIV test. In a logistic regression model, after adjusting for these factors, using condoms in a stable relationship decreased the odds of LTC by 72% (odds ratio 0.28; confidence interval 0.11−0.67).Conclusions Integration into care after HIV diagnosis requires improvement. Our results suggest that broadening awareness and counselling about sexual risks may have a positive impact.
    Full-text · Article · Sep 2014
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