Linking the client to care – What happens after a ‘Rapid-Rapid'?

BACKGROUND: Rapid testing algorithms(RTA) allow immediate verification; however screened, verified clients who fail to complete western blot confirmation risk being uncounted by current surveillance definitions. Success linking to providers remains problematic. In NJ,~20% of public health testing utilized an RTA. We assessed whether immediate referral would reduce the numbers of HIV clients failing to transition to care. METHODS: In 2009, 20,359 identifying 178 preliminary positive (PPos) results via RTAs. The second, rapid device verified 159 results (89.3%). Of verified clients, 76.7% were linked to a healthcare provider on the same day as the initial test. To assess linkage success, we followed-up at 19 facilities including FQHCs, health departments, CBO's, and an academic center. We reviewed 62 client referrals attempted during the initial six months following implementation to determine success of healthcare linkage. RESULTS: HIV verified clients received appointments to a healthcare provider 76.76% on the day of the initial RTA. Academic medical centers (1) and FQHCs (4) identified 33 HIV Pos individuals using an RTA, 82% received immediate appt and 97% were in care at six months. One was lost to care. Health Departments (2) and CBOs (2) identified 29 infections, 16 appts. were made on same day (55%). Ten clients were lost to follow-up (34.4%) entirely. At the end of six months only 19 (47%) were in care. CONCLUSIONS: Linking individuals to healthcare is essential to an effective screening program. Efforts to better connect screened infected clients to providers is needed in non-traditional healthcare settings