Linking recently diagnosed HIV-infected persons to medical care using a brief case management intervention in non-research settings

Background: Nearly 40% of persons testing positive for HIV delay entering primary care for a year or more. The Antiretroviral Treatment Access Study (ARTAS-II) utilized a brief (5 contacts/90 days) strengths-based case management model to facilitate entry into care of recently diagnosed HIV-infected persons. The primary objective was to achieve 75% linkage to care within six months of enrollment.

Methods: ARTAS-II was conducted in health departments and community-based organizations (CBOs) in the U.S. from 2005-2007. 646 participants recently diagnosed with HIV and not in care were enrolled. 423 have completed baseline and 6-month interviews. A total estimated percentage of care-linkage at six months was calculated using self-interview, medical record data, and reports from the participant's case manager.

Results: Participants were predominantly male (72.2%), black non-Hispanic (70.0%), annual household income £$10,000 (61.9%), median age=35. 86.3% (365/423) of participants completing the 6-month interview reported visiting an HIV care provider since baseline interview. Among those not interviewed at follow-up but who had medical record data available, 85.2% (46/54) had at least one documented HIV-related care visit. For the remaining 169 participants, case manager documentation confirmed that 52.7% (89/169) linked to care. The total estimated percentage of care-linkage within the first six months is 77.4% (500/646). Multivariate analysis revealed that feeling well/not having symptoms was significantly associated with not linking to care (OR_adj=12.9; p<.0001).

Conclusions: Brief case management conducted at health departments and CBOs by existing staff is an effective tool to increase the number of recently diagnosed persons quickly entering HIV primary care.