271021 A Conceptual Model of Factors that Influence HIV Linkage to Care in Florida

Wednesday, October 31, 2012

Christa Cook, MSN, Doctoral Candidate , College of Nursing, University of Florida, Gainesville, FL
Barbara Lutz, PhD, RN, CRRN, APHN-BC, FNAP, FAAN , College of Nursing, University of Florida, Gainesville, FL
Robert L. Cook, MD, MPH , Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL
Allyson Hall, PhD , College of Public Health & Health Professions, University of Florida, Gainesville, FL
Robert Davis, Program Director , HIV/AIDS Program, Alachua County Health Department, Gainesville, FL
Background National estimates indicate approximately 31% of those diagnosed with HIV do not seek care initially after diagnosis. Early linkage to HIV care is associated with better health outcomes and decreased transmission. Florida, despite its high incidence of HIV, has no comprehensive plan for linkage or for tracking outcomes. Evidence-based interventions to improve linkage exist; however, smaller health departments and rural areas face many additional barriers for linkage. Case management, transitional care, and medical home models provided the basis for developing an integrated and practical linkage to care model. Description Using existing evidence, clinical experience, and input from community experts, we examined HIV linkage to care from an ecological approach and incorporated concepts integral to public health nursing case management, transitional care, and medical homes. We developed an integrated model that includes practical applications at the individual, community, and state levels. It incorporates concepts of advocacy, coordination, continuity, communication, and patient-centered care, and will serve as a foundation to guide research and practice for HIV linkage to care. Lessons Learned Specific ethical, financial, and legal barriers may impede the implementation of this integrated model. Furthermore, integration of electronic health records at state and national levels could greatly enhance the ability to identify persons not linked to care. Recommendations The model suggests that decreasing fragmentation of HIV services is needed to ensure linkage and adherence to care. Continued research incorporating concepts from public health case management, transitional care, and medical homes is needed to inform policy and improve linkage outcomes.

Learning Areas:
Chronic disease management and prevention
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1) Identify concepts integral to public health nursing case management, transitional care, and medical homes that can help decrease fragmentation in the delivery of HIV care. 2) Describe the barriers that impede the implementation of a comprehensive model of HIV linkage to care.

Keywords: Access to Health Care, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I began my research in HIV/AIDS during my undergraduate nursing program. Since enrolled in a PhD program, I have spent the past 3+ years researching linkage to care, served on the local Ryan White Care Consortium board, completed an internship at the local public health department in their linkage to care program, served as a consultant for the Rural South Public Health Training Center for HIV/AIDS, and nominated to the state HIV/AIDS comprehensive planning network.
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.