Proven interventions to improve initial linkage-- between positive test and first attendance at clinic?
RE-EDITED FOR CLARIFICATION ON 29OCT:
This post takes a step back in the process of providing HIV care from Tuesday's NYT article on LTFU:
I am working with colleagues in the Swaziland MOH to improve linkage to care following a positive HIV test. We are particularly interested in increasing enrollment in care following testing conducted in a campaign in which large numbers of (likely healthy) people will be tested in a short period of time.
We are in the process of conducting a literature search on the topic, but are not finding much in the published literature regarding effective interventions. I think there is overlap between interventions that would encourage adherence/retention among already enrolled patients and the interventions I am interested in that encourage initial enrollment. However, I think that this initial linkage-- particularly for individuals who might have high CD4 counts and be fairly healthy-- requires special attention.
Interventions that we have heard of include: providing appointments and following up with a phone call if the person does not attend clinic on the scheduled day; providing transport vouchers; physically escorting the person to clinic; incentivizing the person to attend clinic with the offer of cash or commodities (multivitamins, water filter, bednet); among others.
I was hoping the community could provide assistance with developing a list of suggested best practices. I would welcome publications, but also descriptions of attempted programs (whether successful or not), write-ups on barriers that prevent patients from linking, etc.
I also am curious as to how people would define linkage to care. Is registration in a Care and Treatment site enough? Returning for a CD4 count result? A second visit?
Thanks in advance for your input,