Linkage to Care Specialist
Los Angeles, United States
Client-centred intervention for people newly diagnosed with HIV is effective at linking people to care
A study out of the United States found that the addition of a linkage to care specialist within the HIV testing protocol of the Los Angeles LGBT Center resulted in over 90% of people newly diagnosed being linked to HIV care. In addition, once in care, over 90% of people were retained in care and attained viral suppression.
The Linkage to Care Specialist Project
In 2012, a clinical social worker was hired as a full-time linkage to care specialist at the LGBT Center in Los Angeles. This position was integrated into the HIV testing protocol at the Center to facilitate linkage to care. The linkage to care specialist uses a client-centred approach, and motivational interviewing and strengths-based case management techniques to help the client develop positive health-seeking behaviours. The specialist works at a pace dictated by the client’s needs and provides referrals and schedules medical and other appointments as needed. Reminders are made the day before appointments to encourage attendance.
The work of the linkage to care specialist can be divided into three phases.
Phase 1: Immediately after the delivery of a positive HIV test result, the client meets with the linkage to care specialist. Using motivational interviewing, the linkage to care specialist encourages the client to explore concerns, and discusses strategies to address any needs that arise. The two objectives of this meeting are to develop a support plan and a linkage plan for the client. Even if the client isn’t ready to be linked to medical care at this time, an appointment to address any of the articulated concerns is scheduled by the end of the first meeting.
Phase 2: Based on the client’s needs, contact is maintained to help the client cope, navigate the healthcare system, and develop the skills required for successful engagement in care. Contact can occur in person, over the phone, by text message or by email depending on the individual’s needs.
Phase 3: For clients who are ready to engage in care soon after diagnosis, the linkage to care specialist tapers contact with the client. For clients who express an interest in receiving care at the Center, introductions are made to care team members to support the development of a relationship. If appointments are subsequently missed, the linkage to care specialist follows up with the client to address any barriers. Finally, for people who do not initially engage with the linkage to care specialist, additional attempts are made to engage them. These attempts cease when the client is either successfully linked to care or they ask the linkage to care specialist to stop calling.
The impact of the linkage to care specialist was assessed for people newly diagnosed with HIV between March 2014 and September 2015.1 The primary outcome of interest was attendance at a medical visit with any HIV primary care provider within three months of diagnosis. The secondary outcomes were retention in care (two medical visits at least three months apart within a 12- month period) and viral suppression at retention (any viral load less than 200 copies/mL).
Of the 389 newly diagnosed clients, 118 (30%) were enrolled in the study. The majority of participants were gay men, aged 18 to 29, high school graduates, and had stable housing. Of the 118 people enrolled, 94% had a medical visit within three months of diagnosis. The linkage to care specialist spent an average time of 2.1 hours working with each participants, with an average of 4.9 interactions. For those participants who were successfully linked to care, 92% were retained in care, of which 94% achieved viral suppression.
What does this mean?
This study demonstrates that the incorporation of a linkage to care specialist within a testing protocol can result in high rates of linkage to care, retention and viral suppression. Other models of linkage to care have also demonstrated beneficial results. Organizations looking to improve linkage to care for clients newly diagnosed with HIV may want to consider how these interventions could be incorporated into their programming.
- Bendetson J, Dierst-Davies R, Flynn R, et al. Evaluation of a Client-Centered Linkage Intervention for Patients Newly Diagnosed with HIV at an Urban United States LGBT Center: The Linkage to Care Specialist Project. AIDS Patient Care and STDs. 2017 Jul;31(7):283–89.