Good practices to increase linkage
Providers of HTS have a crucial role in ensuring linkage to care for people diagnosed with an HIV infection, whether that linkage is quick or delayed. Prompt linkage to HIV care and treatment is ideal and should be encouraged. However, many people do not link to care and treatment immediately. Often, people need time to accept the diagnosis and seek support from partners and families before linking to care (67), and others cycle in and out of care (37). Systematic reviews and several studies describe practices, listed below, that may improve linkage to care and treatment of people who have received an HIV-positive diagnosis.
Good practices include
Comprehensive home-based HIV testing, which includes offering home assessment and home-based ART initiation (
52,
68–
70);
Integrated services, where HIV testing, HIV prevention, treatment and care, TB and STI screening and other relevant services are provided together at a single facility or site (
34);
Providing
on-site or immediate CD4 testing with same-day results (
37,
70–
74);
Providing assistance with transport, such as
transportation vouchers, if the ART site is far from the HTS site (
37,
75);
Decentralized ART provision and community-based distribution of ART (
76);
Support and involvement of
trained lay providers who are peers and act as peer navigators, expert patients/clients and community outreach workers to provide support and to identify and reach people lost to follow-up (
76–
78);
Intensified post-test counselling by community health workers (
79);
Using communication technologies, such as
mobile phones and text messaging, which may help with disclosure, adherence and retention (
80–
82), particularly for adolescents and young people (
54);
Providing
brief strengths-based case management, which emphasizes people's self-determination and strengths, is client-led and focuses on future outcomes, helps clients set and accomplish goals, establishes good working relationships among the client, the health worker and other sources of support in the community, and provides services outside of office settings (
52,
83,
84);
Promoting partner testing may increase rates of HIV testing and linkage to care, as may approaches in PMTCT settings that encourage male involvement (
85,
86).
Intimate partner notification by the provider, with permission, is feasible in some settings; it identifies more HIV-positive people and promotes their early referral to care (
87–
90).
