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Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care

L Gardner, PhD1, L Metsch, PhD2, Anita M. Loughlin, PhD3, Pamela Anderson-Mahoney, PhD4, Carlos Del Rio, MD5, Sonya Green5, Steffanie A. Strathdee, PhD6, Peter Kerndt, MD, MPH7, E Valverde2, Christopher Krawczyk, MPH1, Ramses Sadek, PhD1, Alan Greenberg, MD1, and Scott Holmberg, MD1. (1) Division of HIV/AIDS, Centers for Disease Control, 1600 Clifton Road, MS E-45, Atlanta, GA 30333, 404.639.6163, lig0@cdc.gov, (2) School of Medicine, Department of Epidemiology, University of Miami, 1801 N.W. 9th Avenue, Suite 313, Miami, FL 33136, (3) Maxwell Finlan Laboratories, Boston University, 774 Albany St., Boston, MA 02118, (4) Health Research Association, 3580 Wilshire Blvd, Suite 1660, Los Angeles, CA 90010, (5) Emory University School of Medicine, 69 Butler Street, SE, Atlanta, GA 30303, (6) Division of International Health and Cross Cultural Medicine, University of California, San Diago, 9500 Gilman Drive, Ash Building, La Jolla, CA 92093-0622, (7) Sexually Transmitted Diseases, Los Angeles County Health Department, 600 Commonwealth Ave, suite 1801, Los Angeles, CA 90005

Background. It is estimated that one-third of persons diagnosed with HIV in the U.S. delay entering care for more than one year after diagnosis. The Antiretroviral Treatment Access Study (ARTAS) trial was designed to test a strengths-based case management (CM) intervention to improve linkage to care for recently diagnosed HIV-infected persons. Methods. 316 HIV-infected persons enrolled in 4 cities were randomized 1:1 to either CM or passive referral --standard of care (SOC). The SOC arm received information about HIV and local care resources; the CM intervention arm permitted up to five face-to-face contacts with a case manager over 90 days. The outcome was self-reported attendance at an HIV care provider at least twice over a 12-month period. Adjusted relative risks (RRadj) of in-care were estimated using logistic regression. Results. More case-managed participants than the passively referred participants had visited an HIV clinician at least twice within 12 months (64% vs. 50%; RRadj 1.39; p= 0.006). Clients with ≥2 contacts had more effect of CM (RRadj=1.46) than those with <2 contacts (RRadj=1.22). Older persons, Hispanic persons, persons within six months of an HIV-positive test result, and non-users of crack cocaine use were all significantly more likely to have made two visits to an HIV care provider. We estimate the cost of such case management to be $600-1150 per client. Conclusion. Brief case management relying on client strengths resulted in a 40% increase in entry to HIV care at six and 12 months after the intervention. Brief case management is an affordable and effective resource that can be offered to HIV-infected clients soon after diagnosis.

Learning Objectives: At the conclusion of the session attendees will be able to

Keywords: HIV Interventions, Case Management

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Access to HIV/AIDS Testing, Treatment, and Health Care Services

The 132nd Annual Meeting (November 6-10, 2004) of APHA