Psychosocial factors associated with successfully transitioning into publically brokered case management for HIV among those without primary medical care in an urban setting

Objective: Case management has been shown to help individuals obtain social services. However, people living with HIV often have difficulty obtaining case management. In this study we investigated the psychosocial factors associated with beginning case management when brokered by a city's department of public health.

Design: Our study consisted of 2316 clients who contacted the Philadelphia Department of Public Health (PDPH) for case management between 2001 and 2005. We excluded clients who already had HIV medical care from the study. We abstracted client psychosocial characteristics and self-reported needs, and whether the client kept his/her first case management appointment from the PDPH database.

Methods: We used multiple logistic regression to assess the association of psychosocial factors and social service needs with beginning case management.

Results: We found that clients in social support groups and those requesting assistance meeting basic needs were significantly more likely to attend their first case management appointment (adjusted OR 1.91 95% CI 1.22-2.97 and adjusted OR 1.24 95% CI 1.01-1.54, respectively). Clients requesting medical care or substance abuse treatment were less likely to attend their first case management appointment (adjusted OR 0.75 95% CI 0.59-0.95 and adjusted OR 0.70 95% CI 0.53-0.91, respectively).

Conclusion: Belonging to a social support group and requesting assistance for basic needs are associated with successful transitioning into HIV case management from a brokering agency. Clients with drug addictions are least likely to keep their first case management appointment and may require more intensive approaches to help them transition into case management.