Improving access to HIV care through the Positive Charge Intervention: Lessons learned from five US cities

Background:  AIDS United’s Positive Charge (PC) was a multi-organizational HIV linkage to care program implemented in five U.S. locations from 2010-2013. PC worked with individuals who were never in care or who had fallen out of care, a sub-population of people living with HIV (PLWH) who are harder to engage in care than the newly diagnosed.  Despite the public health significance of linkage to care, few studies have documented lessons learned from implementing linkage to care programs.

Methods: To better understand the process of linkage and re-engagement in care, two researchers conducted 35 interviews with care coordinators and program supervisors at 20 PC implementing agencies. Interviews focused on barriers to implementation, facilitating factors, and collaboration between agencies. Interviews were digitally recorded, transcribed, and analyzed using conventional content analysis.

Results: Six recommendations emerged from the data: recognize and plan for a complex constellation of client needs; nurture and cultivate inter-organization networks; proactively establish procedures to share health information about participants; create strong relationships with medical providers; involve peers to support linkage to care; and address ongoing organizational management barriers, such as frequent staff turnover and training.

Conclusions:  In light of the goals of the National HIV AIDS Strategy, these cross-cutting findings have important implications for implementing national policy. This study is of utility to community-based linkage and re-engagement in care interventions.