Care and access network: Beyond linking persons living with HIV/AIDS to primary medical care in los angeles county

The Los Angeles Division of HIV and STD Programs (LA DHSP) reports that between 2006 and 2009, 34% of persons newly diagnosed with HIV in Los Angeles County did not access primary medical care within 12 months of their diagnosis. In response, AIDS Project Los Angeles (APLA) joined a national initiative aimed at improving access to care by addressing barriers faced by low-income PLWHA, in particular, ethnic/racial and sexual minorities. APLA targets PLWHA who are out of care, in sub-optimal care, or in tenuous care through essential services including mental health, dental, food and nutrition, case management, housing support and public benefits counseling. The intervention incorporates a Patient Navigator (PN) model with program components also identified in client advocacy, health education, case management, and social work. Bilingual navigators create Individual Service Plans mapping available resources, linking clients to and maintaining adherence to HIV medical care, initiating referrals to supportive services, and explaining the complexities of treatment. The implementation of this intervention has generated a number of “lessons learned,” including the effectiveness of using technology for data collection, executing structural changes within programs to include linkage to care, importance of follow-up and retention beyond the initial medical appointment, addressing non-HIV medical care, adding a disclosure measure to understand true stigma, and understanding barriers to attaining virologic control for clients in medical care and on cART. This initiative allows for the development of partnerships with the LA DHSP in expanding this model throughout four County clinics exhibiting low-retention in care.