Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care.
OBJECTIVE
The Antiretroviral Treatment Access Study (ARTAS) assessed a case management intervention to improve linkage to care for persons recently receiving an HIV diagnosis.


METHODS
Participants were recently diagnosed HIV-infected persons in Atlanta, Baltimore, Los Angeles and Miami. They were randomized to either standard of care (SOC) passive referral or case management (CM) for linkage to nearby HIV clinics. The SOC arm received information about HIV and local care resources; the CM intervention arm included up to five contacts with a case manager over a 90-day period. The outcome measure was self-reported attendance at an HIV care clinic at least twice over a 12-month period.


RESULTS
A higher proportion of the 136 case-managed participants than the 137 SOC participants visited an HIV clinician at least once within 6 months [78 versus 60%; adjusted relative risk (RR(adj)), 1.36; P = 0.0005) and at least twice within 12 months (64 versus 49%; RR(adj), 1.41; P = 0.006). Individuals older than 40 years, Hispanic participants, individuals enrolled within 6 months of an HIV-seropositive test result and participants without recent crack cocaine use were all significantly more likely to have made two visits to an HIV care provider. We estimate the cost of such case management to be 600-1200 US dollars per client.


CONCLUSIONS
A brief intervention by a case manager was associated with a significantly higher rate of successful linkage to HIV care. Brief case management is an affordable and effective resource that can be offered to HIV-infected clients soon after their HIV diagnosis.
Gardner
Lytt I
LI
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. lig0@cdc.gov
Metsch
Lisa R
LR
Anderson-Mahoney
Pamela
P
Loughlin
Anita M
AM
del Rio
Carlos
C
Strathdee
Steffanie
S
Sansom
Stephanie L
SL
Siegal
Harvey A
HA
Greenberg
Alan E
AE
Holmberg
Scott D
SD
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D019090:Case Management / Q000191:economics / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D012367:RNA, Viral / Q000097:blood; D012959:Socioeconomic Factors; D014481:United States; D019562:Viral Load
D044966:Anti-Retroviral Agents; D012367:RNA, Viral