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Linkage to Care
Patients’ well-being requires immediate referral to and delivery of medical care after an HIV diagnosis. Linkage requires specific practices to ensure completion of referrals and delivery of services.
What is linkage to care?
Linkage to care is assisting people with HIV to enter into HIV medical care. Newly HIV-diagnosed persons need to connect quickly with a primary HIV doctor and remain in care. Linkage to care involves: educating patients about the health and prevention benefits of being in care, establishing infrastructure to link people to care, and providing linkage services. (For information on CDC guidance and recommendations for linkage to care, refer to: http://www.cdc.gov/hiv/pwp/linkage.html)
Why do it? What are the benefits?
- Increases likelihood of newly HIV-diagnosed people accessing HIV treatment and remaining in HIV care
- Provides patients the opportunity to reduce or eliminate viral load through treatment, experience better health outcomes, and significantly reduce their risk of transmitting HIV
What are some of the barriers to linkage to care?
- Fragmentation of HIV-related services, including lack of linkage coordinators and services facilitators
- Denial or lack of understanding about the importance of care
- Concerns about costs of services
- Conditions that make it harder for patients to enter into care, like substance abuse or mental health issues
- Difficulties arranging transportation, childcare, time away from work, or other logistics related to keeping appointments
- Fear of legal repercussions or stigma
What are some strategies to improve linkage to care?
- The Anti-Retroviral Treatment and Access to Services (ARTAS) strategy –intensive, short-term assistance to facilitate linking newly HIV-diagnosed patients to care
- Linkage providers and patient navigators – peers or health professionals who help patients understand and use medical care systems
- Other programs using a variety of linkage and retention techniques, including appointment adherence support and orientation for new patients
- Coordination of HIV counseling and testing with follow-up medical care
- Making case reports and associated laboratory surveillance data available for use in monitoring linkage, engagement, and retention in care (health departments)
Who is involved to make it work?
Linkage to care requires widespread collaboration among HIV counseling and testing staff, partner services staff, linkage coordinators, case managers, physicians, other medical care providers, and administrators in health departments, medical clinics, and community based organizations. Ideally, newly HIV-diagnosed patients should be connected with staff who:
- Manage the patient referral process and actively link patients to care
- Are familiar with community resources
- Appropriately consider the client’s culture, language, sex, sexual orientation, age, and developmental level
- Develop a referral network suited to patients’ needs