Programming Connection

HIV retention and LTC 


American study shows HIV linkage-to-care and retention programs are cost-saving

A recent American study1 of 12 HIV linkage-to-care and retention programs found that the programs are a cost-saving way to improve the health and well-being outcomes of people living with HIV and to reduce new HIV transmissions.

What types of programs were included in the study?

The 12 linkage-to-care and retention programs served a variety of people living with HIV, including women, trans people, people of colour, prisoners, youth, and men who have sex with men. The goal of each program was to link and retain people diagnosed with HIV who:

  • had never linked to care
  • had been lost to care
  • were at risk of disengaging from care

The programs used a variety of strategies to link and retain people in care, including telemedicine in rural areas, outreach and mobile teams in urban areas, and working with prisoners before their release into the community.

Most of the programs had at least one dedicated staff member who was responsible for working with clients to support them to link and remain in care. These staff members were called care coaches, case managers, linkage-to-care specialists, or navigators. Despite the different titles, they all played similar roles: working with clients to identify their individual barriers to linking to and remaining in care; and supporting them to overcome these barriers by coordinating the services they need. Most of the programs offered multidisciplinary care services to clients, including healthcare, support services, housing supports and substance-use treatment.

How was cost saving calculated?

Over a six-month or 12-month period, each program calculated the payer costs (public and private insurance), the societal costs (payer costs plus the cost to the client), and the cost-saving and cost-effectiveness thresholds associated with each program.


The study researchers concluded that linkage to care and retention programs, such as the ones included in this analysis, were likely an efficient use of resources to address the HIV epidemic.

What does this mean for Canadian service delivery?

We know from estimates in Ontario2 and British Columbia3 that we are not optimally linking and retaining people in HIV care once diagnosed. This research shows that complex, tailored services that support people living with HIV to link to and remain in care may seem expensive but likely cost less than lifetime treatment for a person living with HIV.

Currently, a number of Canadian programs have been developed specifically to link people diagnosed with HIV to care, including Making the Links in Toronto, and the STOP Outreach Team in Vancouver.


  1. Jain KM, Maulsby C, Brantley M, et al. Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs. AIDS Care. 2016 Mar 28;1–6.
  2. Gilbert M, Gardner S, Murray J, et al. Quantifying the HIV care cascade in Ontario: Challenges and future directions. Poster presented at: 24th Annual Canadian Conference on HIV/AIDS Research; 2015 May 30; Toronto, Ontario. Available from:
  3. Nosyk B, Montaner JSG, Colley G, et al. The cascade of HIV care in British Columbia, Canada, 1996–2011: a population-based retrospective cohort study. The Lancet Infectious Diseases. 2014 Jan;14(1):40–9.