Building an Active Re-linkage Program

Since 2008, Service Linkage Workers (SLW) have been in place in Houston/Harris County to assist persons newly diagnosed with HIV link to medical care. Although there were at least 25 SLWs in 2012, there were no dedicated staff assigned to re-link HIV-positive persons who had dropped out of care.

With private funding, the Houston Department of Health and Human Services initiated a re-linkage to care project. All referrals were given to a Service Linkage Supervisor (SLS) who attempted initial contact with the client and, if they accepted services, the client was assigned to a SLW. The SLW worked to mitigate barriers to care and re-link the client to medical and supportive services.

During the program’s pilot, phone contact was attempted for 202 clients. Of these, 82 (40.6%) were unable to be contacted. Another 59 (29.2%) self-reported they were already in care. Due to the high proportion that were not reached by phone, the program adopted locating procedures to include two phone calls to all available phone numbers, certified letters and field visits to all addresses. To reduce the resources expended to contact those already in care, we obtained access to search four surveillance and care databases for evidence of care (i.e. CD4/VL laboratory results and care visits) prior to attempting contact. Using these searches, we were able to find recent evidence of care for 44% of all referrals received.

Future research should include determination of the most effective and efficient methods for locating clients in need of re-linkage.