Implementation of the North Carolina HIV Bridge Counseling Program to Facilitate Linkage and Reengagement in Care for Individuals Infected with HIV/AIDS

Abstract

background Statewide interventions are critical to meeting the goals of the National HIV/AIDS Strategy in this country. In 2012, the North Carolina Division of Public Health developed the North Carolina State Bridge Counselor program to improve linkage to and reengagement in care for newly diagnosed persons and persons living with HIV who were out-of-care. methods We reviewed the planning process for the North Carolina State Bridge Counselor program, which involved a review of existing strengths-based counseling models for persons living with HIV, implementation of these models, and communication strategies with other providers. State bridge counselor responsibilities were delineated from the role of disease intervention specialists while retaining the fieldwork capability of disease intervention specialists to conduct outreach and provide services for persons living with HIV throughout the state. results Program implementation required extensive planning with stakeholders, incorporation of strengths-based counseling models, development of performance standards, and utilization of CAREWare, an HIV care software program to document referrals and data-sharing between state bridge counselors and clinics. By the end of 2014, state bridge counselor services were provided to approximately 60 of the 400 persons living with HIV (15%) who are diagnosed each quarter in North Carolina, with increasing utilization of the program. limitations We assessed the development of this intervention specific to the North Carolina Division of Public Health, which may limit its generalizability. However, the State Bridge Counselor program was implemented in both urban and rural areas throughout the state, which increases its applicability to different public health programs throughout the country. conclusion We demonstrated that a statewide State Bridge Counselor program for linkage and reengagement activities can be implemented by leveraging existing infrastructures, electronic medical records, HIV care networks, and fieldwork activities.

Practical and Ethical Concerns in Implementing Enhanced Surveillance Methods to Improve Continuity of HIV Care: Qualitative Expert Stakeholder Study

“…Many stakeholders suggested that privacy and stigma concerns are more pronounced in areas of the rural south where many study participants are located and among vulnerable groups such as racial, ethnic, and gender and sexual minorities. Our findings lend additional support to previous studies suggesting that stakeholder engagement in program implementation is critical for ensuring that D2C programs and other public health surveillance programs are designed in contextually sensitive ways [ 22 , 23 ], particularly given the high degree of support for the notion that D2C could heighten stigma. The public response to digital surveillance has demonstrated this point during the COVID-19 pandemic, which may reinforce the distrust of public health authorities [ 24 ].…”

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

“…In order to consider patients as LTFU (some articles used the term “out-of-care patients” [ 23 – 28 ] to referred patients disengaged from care but are pending to be confirmed as lost) different time periods were reported in the reviewed literature, including at least six [ 23 , 29 ], nine [ 28 , 30 – 38 ], 12 [ 24 – 27 , 39 – 45 ] and even 14 or 15 months since the last appointment to HIV care, CD4 cell count or viral load test [ 46 , 47 ]. Different strategies to find LTFU patients were reported and, in most articles, they were used simultaneously.…”

“…Different strategies to find LTFU patients were reported and, in most articles, they were used simultaneously. Depending on the complexity of LTFU patients, some were reengaged into HIV care was by means of a simple intervention, while others needed other more specialized services, like the referral to drug addiction units or the support of social, mental or prevention services [ 27 – 30 , 38 , 39 , 45 , 46 ]. Although diverse professionals were involved in the tracing and contact procedures, the most common categories were counsellors/patient navigators, while nurses and social workers were less common (Table 2 ).…”

Expert stakeholders’ perspectives on a Data-to-Care strategy for improving care among HIV-positive individuals incarcerated in jails

“…Extending D2C to jails is one proposed strategy of addressing the needs of PLWH who spend time in jails, in combination with other efforts to facilitate linkage and retention in care (Donovan et al, 2018;Swygard et al, 2018). Expert stakeholders in this qualitative study articulated a range of possible benefits and harms entailed by extending D2C to jails.…”