What Will It Take to End the HIV/AIDS Epidemic? Linking the Most Disenfranchised Into Care Through Outreach

Abstract

The 2015 National HIV/AIDS Strategy renewed its goal of increasing access to care for people living with HIV/AIDS (PLWHA) and called for an increased focus on linkage to care efforts. As many PLWHA face multiple barriers to care and live on the margins of society, adoption of intensive outreach activities is necessary to engage the most disenfranchised PLWHA into care and to ultimately end the HIV epidemic. The Bay Area Network for Positive Health (BANPH), comprising 12+ agencies, established a network outreach model for our linkage-to-care project to engage the hardest-to-reach populations in the San Francisco Bay Area. During the years 2010-2013, BANPH agencies conducted street outreach, analyzed internal tracking systems to identify out-of-care individuals and individuals experiencing tenuous care, and surveyed participants using Apple iPod Touch devices. During the 3-year project, BANPH agencies engaged 602 out-of-care PLWHA and linked 440 to care. On average, outreach workers made 10 contact attempts with a client to link them to care. Sixty-three percent of participants were linked to care on an average of 56 days after initial contact. Factors, including lack of case management, lack of transportation, competing concerns, substance abuse, and HIV stigma, were significantly associated with linkage-to-care outcomes. Intensive outreach efforts could help to reduce barriers to care for hard-to-reach PLWHA, but these efforts require a tremendous amount of time and resources. A network outreach model could help facilitate sharing of limited resources and increase regional outreach capacity for linkage-to-care programs.

What do we know about interventions to reduce intersectional stigma and discrimination in the context of HIV? A systematic review.

“…Five studies used study-specific stigma measures, particularly to examine sex work- and sexual identity-related stigmas (Figueroa et al, 2016; Gómez et al, 2017; Li et al, 2018; Lyons et al, 2020; Vega et al, 2011). Most studies measuring HIV stigma used previously validated scales (Barroso et al, 2014; Batey et al, 2016; Bauermeister et al, 2019; Bogart et al, 2021; Hosek et al, 2015; Li et al, 2018; Rao et al, 2018).…”

“…Of the 23 included interventions, nearly all (n = 21) were multistrategy (i.e., information, skills building, counseling support, contact, structural, biomedical; Table 1; Figure 2c). Two included studies relied on a single intervention strategy each: An expressive writing intervention designed to facilitate coping and resilience among MSM living with HIV who used methamphetamine in the United States (skills building; Carrico et al, 2015), and a network care model targeting structural barriers to HIV care among disenfranchized PLHIV in the United States (structural;Go ´mez et al, 2017). Intervention duration ranged from one-and-a-half days (Batey et al, 2016) to 3 years (Go ´mez et al, 2017).…”

“…Community engagement during intervention development, implementation, evaluation, and dissemination ranged from low (n = 3) to medium (n = 5) to high engagement (n = 15; Supplemental Materials File 4). Studies rated as having high engagement included CBPR research projects (Bogart et al, 2018(Bogart et al, , 2020(Bogart et al, , 2021Guy et al, 2020;Hergenrather et al, 2013), those with frequent and collaborative engagement with community advisory boards (Hergenrather et al, 2013;Reback et al, 2019), and those that otherwise represented high levels of community ownership throughout the intervention process (Bauermeister et al, 2019;Carter et al, 2021;Go ´mez et al, 2017;Gurnani et al, 2011;Jackson et al, 2022;Li et al, 2018;Lippman et al, 2012;Rao et al, 2018).…”

“…Thirteen studies reported stigma outcomes. This included HIVrelated stigma (including internalized, anticipated, experienced, and observed; Barroso et al, 2014;Batey et al, 2016;Bauermeister et al, 2019;Bogart et al, 2020Bogart et al, , 2021Figueroa et al, 2016;Go ´mez et al, 2017;Hosek et al, 2015;Li et al, 2018;Rao et al, 2018) sexual minority stigma (including internalized homophobia, sexual prejudice, and anticipated MSM stigma; Bauermeister et al, 2019;Bogart et al, 2020Bogart et al, , 2021Li et al, 2018;Lyons et al, 2020;Vega et al, 2011), sex work stigma (Lyons et al, 2020), and stigma related to ethnicity or immigration status (Bogart et al, 2020). One study measured media coverage of stigma (Gurnani et al, 2011).…”

The Effect of Routine Management Combined with Case Management Model on Social Support, Self-Efficacy, Self-Management Ability, and Psychological Flexibility of AIDS Patients

“…Case management is a nursing model produced in the implementation of the biopsychosocial medicine model and the medical resource control management system. It meets the needs of clinical, community, and market [ 4 ]. Compared with the conventional management mode, case management is patient-centered, and the medical institution and the patient jointly manage the disease.…”