An evaluation of an HIV linkage to care program: Baltimore's successes and challenges

Background: If the benefits of expanded HIV testing programs are to be realized, individuals must be linked to care. While essential, few HIV care linkage programs have been integrated into standard testing programs. The Baltimore City Health Department (BCHD) has merged these efforts with successes and challenges.

Methodology: Between January-June 2007 the BCHD tested 11,692 individuals utilizing non-rapid HIV tests; 428 tested positive [70.3% men, 91.6% African American; 54.2% under 45 years]. Post-test counseling activity records were completed by disease intervention specialists for HIV positive individuals and entered into the national STD Management Information System. The possible outcomes were: 1) already in care, 2) linked to care, 3) not located, or 4) refused care.

Results: Of the HIV positive individuals 295 (68.9%) were already in care [32.0% through record search; 36.9% through field investigation]. Of the remaining 133 individuals, the program was able to link 19 (14.3%) into care while 88 (66.2%) were not locatable and only 5 (3.8%) refused care.

Conclusions: The results of the study suggest that BCHD is becoming increasingly skillful in linking new HIV positive individuals into care. However, the limited available resources are needlessly wasted in contacting individuals already in care highlighting the need for more accurate and efficient care data management. In addition, the inability to locate a sizable positive population may warrant the use of rapid testing methods. BCHD's success and lessons learned should be a model for other health department-academic partnerships in order to promote HIV prevention and conserve resources.