Improving Retention in HIV Care Through New York's Expanded Partner Services Data-to-Care Pilot

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Abstract

Context:

Data to Care (DTC) represents a public health strategy using HIV surveillance data to link persons living with diagnosed HIV infection (PLWDHI) to HIV-related medical care.

Objective:

To investigate the feasibility of the DTC approach applied to a Partner Services program serving a geographically diffuse area of New York State.

Design:

Disease intervention specialists received training to function as Expanded Partner Services (ExPS) advocates. HIV surveillance data identified PLWDHI presumed to be out of care (OOC). ExPS advocates attempted to locate and reengage OOC individuals in HIV-related care. The pilot ran from September 1, 2013, to August 31, 2014.

Setting:

Four upstate New York counties, home to one-third of all PLWDHI in upstate New York.

Participants:

A total of 1155 PLWDHI presumed to be OOC.

Main Outcome Measures:

Linked to HIV medical care—cases verified as attending 1 or more HIV medical appointments subsequent to case assignment; reengaging in HIV care—any HIV laboratory test in the 6 months following case closure; and retention in HIV care—2 or more HIV laboratory tests in the 6 months following case closure.

Results:

The majority of assigned cases (85.3%) were located; 23.7% (n = 233) of located cases confirmed as OOC; and 71.2% of OOC cases (n = 166) were successfully relinked into care. Relinkage success did not differ by gender, transmission risk, or major race/ethnicity categories; however, there was a direct relationship between age and successful relinkage (P < .001). Ninety-five percent of relinked cases reengaged in medical care, and 63.3% were retained in care. Individuals relinked by ExPS advocates were more likely to reengage in care (95%) than individuals interviewed but not relinked to care by advocates (53.7%) and individuals ineligible for the ExPS intervention (34.2%).

Conclusion:

DTC can be effective when conducted outside large metropolitan areas and/or closed health care systems. It can also be effectively incorporated into existing Partner Services programs; however, the relative priority of DTC work must be established in this context.

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