title: Assessing HIV testing and linkage to care activities and providing academic support to public health authorities in Houston, TX.
abstract: BACKGROUND
  Health departments often have little knowledge of HIV testing and linkage activities outside of those they directly fund. Many health departments also have limited access to outside academic expertise.
  
  
  METHODS
  We conducted a survey of health organizations in the Houston/Harris County region to determine the number of HIV tests completed in 2011, activities that organizations conducted to promote linkage to care for persons newly diagnosed with HIV, and barriers to linkage to care. We also convened a Scientific Advisory Council to advise the local health department on HIV prevention activities.
  
  
  RESULTS
  In 2012, 55 of 84 organizations (65.5%) completed the survey and 43 of those 55 organizations reported conducting HIV testing, so were included in this analysis. Organizations reported conducting 210,565 HIV tests in 2011 and 50.9% under health department contract. The median number of tests per organization was 1045 (interquartile ratio: 159-3520). More than 90% of the organizations used active linkage to care methods, but only 46.5% had written linkage to care protocols. Barriers to linkage to care most often reported were client refusal followed by staff capacity and funding limitations. The Scientific Advisory Council provided valuable informal expertise to the local health department.
  
  
  CONCLUSIONS
  Half of the HIV testing in the Houston/Harris County region is conducted without local health department funding, and half the organizations conducting HIV testing have linkage to care protocols. The findings of the study and Scientific Advisory Council advice have helped the health department with policy, procedures, evaluation tools, and technical assistance offerings.
authors.affiliation: Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX.|Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.affiliation: Houston Department of Health and Human Services, Houston, TX.
authors.forename: Camden J
authors.initials: CJ
authors.lastname: Hallmark
authors.affiliation: Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX.|Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.affiliation: Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX.|Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Monisha
authors.initials: M
authors.lastname: Arya
authors.affiliation: Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX.|Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: G John
authors.initials: GJ
authors.lastname: Chen
authors.affiliation: Houston Department of Health and Human Services, Houston, TX.
authors.forename: Christina
authors.initials: C
authors.lastname: Shaw
authors.affiliation: Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX.|Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Lena
authors.initials: L
authors.lastname: Williams-Ellis
authors.affiliation: Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX.|Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Tanisha
authors.initials: T
authors.lastname: Darko
authors.affiliation: Houston Department of Health and Human Services, Houston, TX.
authors.forename: Marlene
authors.initials: M
authors.lastname: McNeese-Ward
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy; D019538:Health Care Surveys; D006282:Health Personnel / Q000193:education* / Q000523:psychology; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening; D011634:Public Health / Q000191:economics; D013781:Texas; D000078329:Workforce