Online Program

Barriers and facilitators of linkage to HIV primary care in New York City

Monday, November 4, 2013 : 8:30 a.m. - 8:45 a.m.

Laurie J. Bauman, PhD, Preventive Intervention Research Center, Albert Einstein College of Medicine/Yeshiva University, Bronx, NY
Rosy Chhabra, PsyD, Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
Angelic Rivera-Edwards, MPH, MBA, Pediatrics, Albert Einstein College of Medicine, Bronx, NY
Jamie Sclafane, MS, MCHES, Pediatrics, Albert Einstein College of Medicine, Bronx, NY
Dana Watnick, MPH, MSSW, Preventive Intervention Research Center for Child Health, Albert Einstein College of Medicine, Bronx, NY
Background: One in five people living with HIV in the U.S. are unaware of their status; they account for 51% of new infections. HIV transmission can be reduced through “test and treat,” which can decrease both viral load and risk behaviors. However, linkage to care has proved challenging. We performed a qualitative study on linkage of HIV testing sites that partnered with the New York City Department of Health and Mental Hygiene (NYCDOHMH) to implement “The Bronx Knows,” a NYCDOHMH borough-wide initiative that tested 607,570 residents over 3 years.

Design/Methods: We interviewed directors and administrators of 24 HIV testing sites to identify linkage problems and successes, and selected 9 for case studies of best linkage practices.

Results: There were three problem domains: (1) system factors (long wait for provider appointments; requirement of a positive confirmatory test before scheduling an appointment; lack of staff respect for patients); (2) social factors (HIV stigma, public, perceived and enacted); (3) stigmatizing patient statuses (e.g., mental illness, homelessness, substance use, immigrant). Best practices for linkage included networking among community organizations; individualized care plans; team approach; and patient peer navigation. No providers cited decreased community viral load as a rationale for prioritizing linkage.

Conclusions: Successful linkage requires a comprehensive individualized approach that reduces the compounded stigma that risk populations face, minimizes delays in seeing a care provider, and provides patient navigation services to address system complexity. Providers defined their role as caring for patients, overlooking the broader public health impact of preventing HIV transmission.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify the major barriers to linkage to HIV care. Describe 3 best practices to remove barriers to successful linkage to HIV care.

Keyword(s): HIV/AIDS, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator of multiple federally funded grants focusing on HIV/AIDs, risk behaviors and health systems. I am the PI of the research study that generated the data that will be reported. I wrote the proposal for the project, designed the project methods, and supervised its implementation. With my abstract colleagues, I analyzed the data and prepared the abstract. I have published multiple articles on children 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.