Barriers and facilitators of linkage to HIV primary care in New York City

Laurie J. Bauman, Sarah Braunstein, Yvette Calderon, Rosy Chhabra, Blayne Cutler, Jason Leider, Angelic Rivera, Jamie Sclafane, Benjamin Tsoi, Dana Watnick

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

One in 5 people living with HIV are unaware of their status; they account for an estimated 51% of new infections. HIV transmission can be reduced through a "Test and Treat" strategy, which can decrease both viral load and risk behaviors. However, linkage of newly diagnosed HIV-positive persons to care has proved challenging. We report quantitative and qualitative data on linkage to care from HIV testing sites that partnered with the New York City Department of Health and Mental Hygiene to implement "The Bronx Knows" (TBK), an initiative that tested 607,570 residents over 3 years. During TBK, partner agencies reported the aggregate number of HIV tests conducted, the number of confirmed positives (overall and new), and the number of confirmed positives linked to medical care. We conducted qualitative interviews with directors of 24 of 30 TBK HIV testing agencies to identify linkage barriers and selected 9 for case studies. Barriers to linkage fell into 3 domains: (1) health care system factors (long wait for provider appointments, requirement of a positive confirmatory test before scheduling an appointment, system navigation, and disrespect to patients); (2) social factors (HIV stigma); and (3) characteristics of risk populations (eg, mental illness, homelessness, substance use, and immigrant). Best practices for linkage included networking among community organizations, individualized care plans, team approach, comprehensive and coordinated care services, and patient peer navigation. Research and public health implications are discussed.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
Volume64
Issue numberSUPPL. 1
DOIs
StatePublished - Nov 1 2013

Fingerprint

Primary Health Care
HIV
Appointments and Schedules
Patient Navigation
Homeless Persons
Information Storage and Retrieval
Population Characteristics
Risk-Taking
Viral Load
Practice Guidelines
Mental Health
Public Health
Organizations
Interviews
Delivery of Health Care
Health
Infection
Research

Keywords

  • HIV cascade
  • HIV testing
  • HIV/AIDS
  • Linkage to care
  • Stigma

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Barriers and facilitators of linkage to HIV primary care in New York City. / Bauman, Laurie J.; Braunstein, Sarah; Calderon, Yvette; Chhabra, Rosy; Cutler, Blayne; Leider, Jason; Rivera, Angelic; Sclafane, Jamie; Tsoi, Benjamin; Watnick, Dana.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 64, No. SUPPL. 1, 01.11.2013.

Research output: Contribution to journalArticle

Bauman, LJ, Braunstein, S, Calderon, Y, Chhabra, R, Cutler, B, Leider, J, Rivera, A, Sclafane, J, Tsoi, B & Watnick, D 2013, 'Barriers and facilitators of linkage to HIV primary care in New York City', Journal of Acquired Immune Deficiency Syndromes, vol. 64, no. SUPPL. 1. https://doi.org/10.1097/QAI.0b013e3182a99c19
Bauman, Laurie J. ; Braunstein, Sarah ; Calderon, Yvette ; Chhabra, Rosy ; Cutler, Blayne ; Leider, Jason ; Rivera, Angelic ; Sclafane, Jamie ; Tsoi, Benjamin ; Watnick, Dana. / Barriers and facilitators of linkage to HIV primary care in New York City. In: Journal of Acquired Immune Deficiency Syndromes. 2013 ; Vol. 64, No. SUPPL. 1.
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