title: An Integrated Service Delivery Model to Identify Persons Living with HIV and to Provide Linkage to HIV Treatment and Care in Prioritized Neighborhoods: A Geotargeted, Program Outcome Study.
abstract: BACKGROUND
  Recent studies have demonstrated that high human immunodeficiency virus (HIV) prevalence (2.1%) rates exist in "high-risk areas" of US cities that are comparable to rates in developing nations. Community-based interventions (CBIs) have demonstrated potential for improving HIV testing in these areas, thereby facilitating early entry and engagement in the HIV continuum of care. By encouraging neighborhood-based community participation through an organized community coalition, Project LINK sought to demonstrate the potential of the CBI concept to improve widespread HIV testing and referral in an area characterized by high poverty and HIV prevalence with few existing HIV-related services.
  
  
  OBJECTIVE
  This study examines the influence of Project LINK to improve linkage-to-care and HIV engagement among residents of its target neighborhoods.
  
  
  METHODS
  Using a venue-based sampling strategy, survey participants were selected from among all adult participants aged 18 years or more at Project LINK community events (n=547). We explored multilevel factors influencing continuum-of-care outcomes (linkage to HIV testing and CBI network referral) through combined geospatial-survey analyses utilizing hierarchical linear model methodologies and random-intercept models that adjusted for baseline effect differences among zip codes. The study specifically examined participant CBI utilization and engagement in relation to individual and psychosocial factors, as well as neighborhood characteristics including the availability of HIV testing services, and the extent of local prevention, education, and clinical support services.
  
  
  RESULTS
  Study participants indicated strong mean intention to test for HIV using CBI agencies (mean 8.66 on 10-point scale [SD 2.51]) and to facilitate referrals to the program (mean 8.81 on 10-point scale [SD 1.86]). Individual-level effects were consistent across simple multiple regression and random-effects models, as well as multilevel models. Participants with lower income expressed greater intentions to obtain HIV tests through LINK (P<.01 across models). HIV testing and CBI referral intention were associated with neighborhood-level factors, including reduced availability of support services (testing P<.001), greater proportion of black/African Americans (testing and referral P<.001), and reduced socioeconomic capital (testing P=.017 and referral P<.001). Across models, participants expressing positive attitudes toward the CBI exhibited greater likelihood of engaging in routine HIV testing (P<.01) and referring others to HIV care (P<.01). Transgender individuals indicated greater intent to refer others to the CBI (P<.05). These outcomes were broadly influenced by distal community-level factors including availability of neighborhood HIV support organizations, population composition socioeconomic status, and high HIV prevalence.
  
  
  CONCLUSIONS
  Project LINK demonstrated its potential as a geotargeted CBI by evidencing greater individual intention to engage in HIV testing, care, and personal referrals to its coalition partner organizations. This study highlights important socioecological effects of US-based CBIs to improve HIV testing and initiate acceptable mechanisms for prompt referral to care among a vulnerable population.
authors.affiliation: Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlanta, GAUnited States; Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlanta, GAUnited States.
authors.forename: Paula M
authors.identifier: 0000-0002-3078-9124
authors.initials: PM
authors.lastname: Frew
authors.affiliation: Department of Sociology Colby College Waterville, ME United States.
authors.forename: Matthew
authors.identifier: 0000-0002-5801-2587
authors.initials: M
authors.lastname: Archibald
authors.affiliation: Division of Infectious Diseases Department of Medicine Emory University School of Medicine Atlanta, GA United States.
authors.forename: Jay
authors.identifier: 0000-0002-0038-0686
authors.initials: J
authors.lastname: Schamel
authors.affiliation: Division of Infectious Diseases Department of Medicine Emory University School of Medicine Atlanta, GA United States.
authors.forename: Diane
authors.identifier: 0000-0001-7482-246X
authors.initials: D
authors.lastname: Saint-Victor
authors.affiliation: Division of Infectious Diseases Department of Medicine Emory University School of Medicine Atlanta, GA United States.
authors.forename: Elizabeth
authors.identifier: 0000-0002-9998-5326
authors.initials: E
authors.lastname: Fox
authors.affiliation: AID Atlanta Atlanta, GA United States.
authors.forename: Neena
authors.identifier: 0000-0003-3289-4558
authors.initials: N
authors.lastname: Smith-Bankhead
authors.affiliation: SisterLove, Inc. Atlanta, GA United States.
authors.forename: Dazon Dixon
authors.identifier: 0000-0001-8693-846X
authors.initials: DD
authors.lastname: Diallo
authors.affiliation: Emory University School of Nursing Atlanta, GA United States.
authors.forename: Marcia M
authors.identifier: 0000-0002-5558-8660
authors.initials: MM
authors.lastname: Holstad
authors.affiliation: Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlanta, GAUnited States; Hubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlanta, GAUnited States.
authors.forename: Carlos
authors.identifier: 0000-0002-0153-3517
authors.initials: C
authors.lastname: Del Rio
keywords: High-Impact Prevention; community-based organizations; human immunodeficiency virus; human immunodeficiency virus prevention; human immunodeficiency virus testing; racial/ethnic minorities