title: Barriers and facilitators of linkage to HIV primary care in New York City.
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.
authors.affiliation: *Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; †New York City Department of Health and Mental Hygiene, New York, NY; and ‡Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Bauman
authors.forename: Sarah
authors.initials: S
authors.lastname: Braunstein
authors.forename: Yvette
authors.initials: Y
authors.lastname: Calderon
authors.forename: Rosy
authors.initials: R
authors.lastname: Chhabra
authors.forename: Blayne
authors.initials: B
authors.lastname: Cutler
authors.forename: Jason
authors.initials: J
authors.lastname: Leider
authors.forename: Angelic
authors.initials: A
authors.lastname: Rivera
authors.forename: Jamie
authors.initials: J
authors.lastname: Sclafane
authors.forename: Benjamin
authors.initials: B
authors.lastname: Tsoi
authors.forename: Dana
authors.initials: D
authors.lastname: Watnick
mesh_terms: D000554:Ambulatory Care Facilities; D016022:Case-Control Studies; D003266:Continuity of Patient Care; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D009519:New York City / Q000453:epidemiology; D011320:Primary Health Care; D036301:Qualitative Research; D057545:Social Stigma