Literature on the HIV care continuum has shown that there are common barriers–biomedical, environmental, and psychosocial– that prevent persons living with HIV (PLWH) from linking to care after being diagnosed with HIV.  Even when clients are ready to access care, there may be a number of reasons why they may have difficulty getting to an initial care appointment or remaining engaged in HIV care.  Likewise, clients who are diagnosed as HIV-negative, but are identified as “high-risk,” must also be linked to primary medical care, pre-exposure prophylaxis (PrEP) services and other essential support services to stabilize care or to remain HIV-negative.

Purpose of This Tool

The Linkage to Care (LTC) online tool provides clinicians and other HIV service providers with an interactive, user-friendly on-line resource that can be used with newly and previously diagnosed PLWH and persons who are high-risk HIV-negative  (PWHRN) to immediately address client concerns that may hinder linkage, reengagement or access to medical care, HIV treatment for PLWH, and preventive services for PLWH and PWHRN.  This LTC tool encourages providers to elicit information from clients to identify potential barriers to care, and equip providers with the steps to immediately address client concerns.  In addition, this tool provides guidance on how to link PWHRN to PrEP and other supportive services for HIV prevention.  A strengths-based framework underpins this tool, which helps to engender trust between the provider and clients by identifying and highlighting clients’ personal strengths, providing support, and referring clients to relevant services.

How This Tool Works

Users of the tool will be asked to facilitate a client discussion to elicit information on potential barriers to medical care for PLWH and essential supportive service for PLWH and PWHRN.  Based on clients’ answers and concerns, tool users will select from a “checklist” of common barriers, view recommended action steps and statements that can be made, fill-in forms with next steps and referral information for clients, and, save and/or print fillable forms.

Who Can Use This Tool

This tool is intended for clinicians and other HIV service providers responsible for linking clients to care, including linkage coordinators, navigators, field outreach staff, HIV testing counselors and care coordinators.

Preparing for Client Meeting

Preparation for client meeting should include the following activities:

  • Develop a clear understanding of your agency’s linkage process so that a client can be immediately linked to medical care and other support services.
  • Gather a list of local referrals and resources for clients. This may include resources related to medical care, insurance and the Affordable Care Act, mental health services, substance use treatment, housing and employment. Select resources are included in the Guidelines document for each checklist.
  • Have handy references, factsheets, and handouts available.  Be sure to preview factsheets to ensure they are up-to-date and accurate.

Building Trust and Focusing on Client Strengths

Trust and rapport are fundamental to establishing positive client relationship.  The following are tips for building trust and rapport with clients:

  • Be fully present during your client appointments; establish that the client is the priority.
  • Establish credibility by describing your interest and experience in working with PLWH and PWHRN. Explain your role in linking the client to medical care and other prevention and support services.
  • Create a non-judgmental environment; ensure confidentiality and non-disclosure.
  • Take time to listen. Give your client an opportunity to talk freely about their recent HIV diagnosis or risk behaviors. Clarify any questions the client has about HIV and make sure that the client understands that it is natural to have many feelings and unanswered questions after receiving an HIV-positive diagnosis or learning of their own risk for HIV.
  • For PLWH, emphasize that it is possible to have a healthy life living with HIV. For PWHRN, emphasize the sexual safety and prevention strategies available to remain HIV-negative.
  • Pay special attention to the client’s barriers to care and treatment and support services (e.g. readiness to accept care, medication adherence, housing, transportation, employment, child care, mental health issues, substance abuse).
  • Identify the client’s personal strengths, abilities, and skills. Use these strengths to emphasize how the client can cope, get treatment and services, and overcome any barriers.
  • Be sure to let the client know when you do not have the information are unsure about something. Explain that you will have the information available for the next follow-up meeting.
  • When appropriate, use fact sheets or handouts from trusted sources to reinforce the information that has been discussed with the client.