Tracking Linkage to HIV Care for Former Prisoners: A Public Health Priority

Issues: Improving testing and uptake to care amongst highly impacted populations is a critical element of Seek, Test, and Treat strategies for reducing HIV incidence in the community. HIV disproportionately impacts prisoners. Incarceration may provide an opportunity to initiate therapy, however, treatment is frequently disrupted after release. No scalable metrics exists to evaluate the adequacy of linkage to care on release. Description: Ryan White Care programs submit Client Level Data (CLD) to HRSA for reporting. We developed a model for assessing the adequacy of linkage to care based on linking corrections release data to reported CLD. Corrections and CLD datasets from RI, TX, NC, and Puerto Rico will be linked using the HRSA encrypted Unique Client Identifier (eUCI). Measures of time to first service and indicators of clinical status at first service will be generated. Measures will be compared across sites to identify high-performing and low-performing sites. Qualitative and quantitative analyses will identify correlates of linkage success. Validation of the eUCI as a means to link large datasets is being performed in RI and in TX. Results are anticipated in April of 2011. Lessons Learned: Ryan White CLD offers an unprecedented opportunity to assess the adequacy of linkage to care. The use of the eUCI permits the use of CLD while maintaining the confidentiality of protected health information. Recommendations: Once validated, these analyses could be applied nationwide using aggregated CLD from HRSA. Validated metrics for linkage adequacy should be considered as part of standard quality metrics for HIV care programs.