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Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care

Gardner, Lytt Ia; Metsch, Lisa Rb; Anderson-Mahoney, Pamelac; Loughlin, Anita Md; Rio, Carlos dele; Strathdee, Steffanied; Sansom, Stephanie La; Siegal, Harvey Af,†; Greenberg, Alan Ea; Holmberg, Scott Dathe Antiretroviral Treatment and Access Study (ARTAS) Study Group

doi: 10.1097/01.aids.0000161772.51900.eb
Epidemiology and Social

Objective: The Antiretroviral Treatment Access Study (ARTAS) assessed a case management intervention to improve linkage to care for persons recently receiving an HIV diagnosis.

Methods: Participants were recently diagnosed HIV-infected persons in Atlanta, Baltimore, Los Angeles and Miami. They were randomized to either standard of care (SOC) passive referral or case management (CM) for linkage to nearby HIV clinics. The SOC arm received information about HIV and local care resources; the CM intervention arm included up to five contacts with a case manager over a 90-day period. The outcome measure was self-reported attendance at an HIV care clinic at least twice over a 12-month period.

Results: A higher proportion of the 136 case-managed participants than the 137 SOC participants visited an HIV clinician at least once within 6 months [78 versus 60%; adjusted relative risk (RRadj), 1.36; P = 0.0005) and at least twice within 12 months (64 versus 49%; RRadj, 1.41; P = 0.006). Individuals older than 40 years, Hispanic participants, individuals enrolled within 6 months of an HIV-seropositive test result and participants without recent crack cocaine use were all significantly more likely to have made two visits to an HIV care provider. We estimate the cost of such case management to be US$ 600–1200 per client.

Conclusion: A brief intervention by a case manager was associated with a significantly higher rate of successful linkage to HIV care. Brief case management is an affordable and effective resource that can be offered to HIV-infected clients soon after their HIV diagnosis.

From the aDivision of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

bUniversity of Miami School of Medicine, Miami, Florida

cHealth Research Association, Los Angeles, California

dDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

eEmory University School of Medicine, Atlanta, Georgia

fDepartment of Community Health, Wright State University, Dayton, Ohio, USA.

Dr Harvey Siegal passed away on December 22, 2004.

*See Appendix.

Received 1 June, 2004

Revised 9 December, 2004

Accepted 20 December, 2004

Correspondence to Dr. Lytt I. Gardner, Centers for Disease Control and Prevention, Mailstop E-45, 1600 Clifton Road, Atlanta, GA 30333, USA E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.