207602 A Care Bridge Coordination Program: Linking HIV-infected patients with care in North Carolina

Wednesday, November 11, 2009: 1:30 PM

Emily S. Brouwer, MPH PharmD , Departments of Medicine and Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Leslie Strayhorn, MSW , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Arlene C. Sena, MD, MPH , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Heidi Swygard, MD MPH , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Peter A. Leone, MD , Departments of Medicine and Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Evelyn M. Foust, CPM MPH , NC Department of Health and Human Services, North Carolina Division of Public Health, Raleigh, NC
Sonia Napravnik, PhD , Departments of Medicine and Epidemiology, University of North Carolina, Chapel Hill, NC
Joseph J. Eron, MD , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
  
Issues: The North Carolina (NC) HIV Prevention Branch estimates that 38% of state residents who are aware of their HIV-infection status are currently not “in care” (accessing HIV primary care).

Description: We developed a Care Bridge Coordination (CBC) program at two NC health departments to link newly diagnosed HIV–positive persons and those lost to follow-up, to medical care. A bridge coordinator (BC) accepts referrals from health care providers, disease intervention specialists (DIS), and community HIV testing sites.

Lessons Learned: The CBC program in Durham County, NC began in April, 2008. The program received 90 referrals; 40 were successfully and 1 unsuccessfully linked into care. The remaining 49 clients are followed by the BC. Newly diagnosed clients (29%) were referred by DIS (42%), a public STD clinic (29%), the county jail (21%), other testing sites (8%). The remaining referrals (71%) were lost-to-care clients from a public HIV clinic. Newly diagnosed clients had questions related to stigma and the meaning of an HIV diagnosis, while lost-to-care clients reported losing focus on treatment due to changes in personal circumstances. Clients report a number of challenges with initiating and maintaining care, including: lost jobs, incarceration, homelessness, sexual bargaining, and intravenous drug use. A significant portion of the BC's time was spent locating clients with unstable living situations.

Recommendations: The CBC model is an effective strategy to link HIV-positive clients in the community into initial or continued medical care. Similar strategies are needed to assist HIV prevention programs for persons not in care.

Learning Objectives:
Describe a new care bridge coordination program to link newly diagnosed HIV patients and those lost to care to medical care in North Carolina.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am trained in epidemiology and pharmacy with a focus in HIV treatment. Currently I am working towards my doctoral degree in epidemiology which will focus on long-term outcomes of individuals infected with HIV.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Healthcare and Social Services for Individuals Living with HIV
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