Health Department Model
Health departments that conduct HIV surveillance-based outreach to facilitate linkage and re-engagement in care can assign surveillance staff to review CD4 and viral load laboratory tests reported to surveillance to determine preliminarily if an HIV-diagnosed individual has never been in care or is no longer receiving care. By reviewing laboratory tests and dates, surveillance staff can look for missing laboratory tests or a gap in laboratory tests indicating a missed connection or disconnection from care.
Health departments then might assign the list of persons meeting these criteria to field staff, such as disease intervention specialists (DIS) or linkage coordinators, to investigate the care status of those on the list by reviewing other health department records (e.g., CAREWare, ADAP, STD Surveillance, etc.) and contacting the provider each person most recently visited, if any. If field staff can find no evidence or no recent evidence of care, they might attempt to contact the client by telephone, email, or home visit and assist the individual in linking or re-engaging in care.
In jurisdictions that have linked the HIV Partner Services program to HIV surveillance, DIS already might be attempting to facilitate HIV care to fulfill one of the objectives of the program. Contacting all persons who need but are not connected to HIV care will, for many health departments, represent either an expansion of the scope of the Partner Services program or the addition of a new program to focus on reaching individuals needing linkage or re-engagement in HIV care. Both options typically require additional staff resources.